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Ocular Syphilis May Suggest HIV Co-Infection

The number of patients with ocular syphilis (OS) is increasing, and OS may be more common in syphilis patients who have concurrent HIV than in those who don't, recent research from North Carolina suggests.
"Reports of primary, secondary, and early latent syphilis have increased in North Carolina in recent years. Between 2014 and 2015, early syphilis increased from 1137 cases to almost 1900 cases, representing a 64% increase in reported cases... We found ocular syphilis in all stages of syphilis," lead author Anna Barry Cope, PhD, MPH, said in her late-breaker presentation September 22, 2016 at the Centers for Disease Control and Prevention (CDC) 2016 STD Prevention Conference in Atlanta, Georgia.
"Nearly half of all syphilis cases in North Carolina are co-infected with HIV. They were infected with HIV either prior to their syphilis diagnosis or within 30 days after," added Dr. Cope, an epidemiologist at CDC in Atlanta.
"Clinicians need to look for ocular syphilis in their at-risk patients. Patients need to know whether they have ocular syphilis, and that if they have it, they need to get treated quickly to prevent complications, including possible blindness," Thomas Peterman, MD, MSc, chief of the Field Epidemiology Unit for the Epidemiology and Surveillance Branch of the Division of STD Prevention at CDC in Atlanta, who moderated the late-breaker session, told Contagion®.
Dr. Cope and her colleagues compared OS prevalence by HIV status and timing of HIV diagnosis among all syphilis patients in North Carolina. They reviewed all syphilis cases reported in the North Carolina Electronic Disease Surveillance System (NC EDSS) in 2014 and 2015.
The researchers identified potential ocular syphilis cases in NC EDSS and matched ocular and non-ocular syphilis cases with the Enhanced HIV/AIDS Reporting System (eHARS) to obtain HIV diagnosis date.
They grouped all syphilis cases with HIV co-infection into previously diagnosed (HIV diagnosed more than 30 days before syphilis diagnosis) and concurrently diagnosed (HIV diagnosed within 30 days before or after syphilis diagnosis) cases. Cases with HIV diagnosed more than 30 days after syphilis diagnosis were considered HIV-uninfected. Prevalence ratios were used to match OS prevalence with HIV status.
Of 4232 confirmed syphilis cases, 63 (1.5%) had ocular syphilis; of these 63 cases, 35 (56%) were co-infected with HIV; and of the 35, the diagnosis was concurrent in 11 cases (31%).
Of the 4169 confirmed syphilis cases without OS, 1659 (40%) were co-infected with HIV; of the 1,659, the diagnosis was concurrent in 253 (15%).

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