Syphilitic Uveitis

Key Points at a Glance

Syphilitic uveitis is an infectious uveitis caused by Treponema pallidum and presents with a variety of ocular findings as “the great imitator”⁵⁾.
It occurs in approximately 5% of secondary syphilis cases and is estimated to account for about 10% of all infectious uveitis cases³⁾.
In recent years, the number of syphilis reports has been rapidly increasing in Japan, and syphilis should always be considered in cases of uveitis of unknown cause.
Panuveitis is the most common type (75%), and chorioretinitis is observed in 93% of cases³⁾⁴⁾.
ASPPC (acute syphilitic posterior placoid chorioretinitis) is a characteristic special type.
Diagnosis combines non-treponemal tests (RPR) and treponemal tests (TPHA/EIA). RPR ≥16-fold and TPHA ≥1,280-fold indicate high activity¹⁰⁾.
Treatment follows neurosyphilis guidelines with high-dose intravenous penicillin G (18–24 million units/day for 10–14 days) as standard ¹⁾.
Steroid monotherapy without antibiotics is contraindicated; it may progress to full-thickness retinal necrosis ⁴⁾.
HIV testing should be performed in all cases of syphilis diagnosis. HIV co-infection increases risk of bilateral and severe disease ¹⁾.
Treatment success rate is high at approximately 90%; early diagnosis and treatment are key to visual prognosis ³⁾.

1. What is Syphilitic Uveitis?

Syphilitic uveitis is a condition in which Treponema pallidum enters the eye hematogenously and causes intraocular inflammation. Syphilis is a sexually transmitted infection caused by the spirochete Treponema pallidum, and symptomatic syphilis is classified into stages 1 through 4. Recently, stages 3 and 4 syphilis are rarely encountered; most cases are latent syphilis without skin or mucosal lesions. In acquired syphilis, uveitis occurs in approximately 5% of secondary syphilis cases. Due to advances in perinatal care, fresh cases of congenital syphilis with ocular involvement are almost never seen in Japan.

Globally, 5.7–6 million new syphilis infections are reported annually among individuals aged 15–49 ¹⁾⁵⁾. Ocular syphilis accounts for approximately 0.6–2% of all syphilis cases ¹⁾²⁾ and about 10% of all infectious uveitis cases ³⁾. A study in North Carolina found ocular syphilis in 63 of 4,232 cases (1.5%), of which 38% were diagnosed during primary or secondary syphilis ¹⁾.

In Japan, the number of syphilis infections has been increasing again, from fewer than 1,000 reported cases in 2011 to over 6,000 in 2017. Recently, the increase has been centered on patients including MSM (men who have sex with men) and those with HIV co-infection. Because of its diverse clinical presentations, syphilis is called “the great imitator” ¹⁾⁵⁾. Treatment follows neurosyphilis guidelines.

Q At what stage of syphilis does ocular syphilis occur?

Ocular syphilis can occur at any stage, including primary, secondary, tertiary, and latent stages. It most commonly occurs during secondary acquired syphilis, with uveitis being the main manifestation. Since ocular symptoms may be the first clue to syphilis diagnosis, syphilis should always be considered in cases of uveitis of unknown cause.

Q What does it mean that syphilis is "the great imitator"?

Ocular manifestations of syphilis include anterior segment inflammation, uveitis, optic neuritis, and chorioretinitis, among others, and can mimic many other eye diseases. This makes diagnosis often delayed, and this diverse clinical picture is why it is called “the great imitator” ⁵⁾.

2. Pathogen and Route of Infection

Pathogen

Treponema pallidum (Treponema pallidum subsp. pallidum): an obligate parasite of the order Spirochaetales¹⁾.
It has slow growth and the ability to invade immune-privileged tissues such as the eye, CNS, and placenta¹⁾.

Transmission routes

Sexual contact: the main route with a transmission rate of about 60%¹⁾.
Transplacental infection: causes congenital syphilis¹⁾.
Mucosal or percutaneous contact: after hematogenous dissemination throughout the body, it reaches ocular tissues.

Risk factors

MSM (men who have sex with men): a major risk factor driving the recent increase in infections¹⁾. All cases with positive syphilis antibodies in vitreous fluid were HIV-positive, with a median CD4 count of 228/μL⁴⁾.
HIV co-infection: increases the risk of ocular syphilis approximately twofold¹⁾. It tends to be bilateral and more often involves the posterior segment. Prevalence increases with CD4 count <200 cells/mL and viral load >200 copies/mL. Immunodeficiency worsens ocular syphilis and increases the risk of serological false negatives.
Multiple sexual partners, lack of condom use⁸⁾.
IRIS (immune reconstitution inflammatory syndrome): can occur after initiation of ART in HIV-positive patients¹¹⁾.

Congenital syphilis

It occurs via transplacental infection. Early congenital syphilis (birth to 3 months of age) presents with chorioretinitis. Late congenital syphilis is characterized by the classic Hutchinson triad (M-shaped notching of permanent teeth, sensorineural hearing loss, interstitial keratitis). In old congenital syphilis, the fundus shows a salt-and-pepper appearance (scattered chorioretinal atrophy) with proliferation of retinal pigment epithelial cells, sometimes resembling retinitis pigmentosa.

Q If diagnosed with syphilis, is HIV testing necessary?

HIV co-infection is an important risk factor for ocular syphilis, and HIV testing is recommended for all patients at the time of syphilis diagnosis¹⁾. In HIV-positive individuals, uveitis is more severe and often bilateral, altering the clinical presentation. Additionally, in AIDS, serological tests may be false negative, which requires attention.

3. Staging and Ocular Complications

Four Stages of Syphilis and Timing of Ocular Involvement

Primary Stage

Incubation period: 10–90 days.

Chancre: Painless induration at the inoculation site. Disappears in about 4 weeks. May occur on the conjunctiva or around the eye.

Secondary Stage

Onset: 4–10 weeks after the appearance of chancre.

Systemic dissemination: Hematogenous spread affects the nervous system, eyes, gastrointestinal tract, and liver. Ocular involvement occurs in about 10%. Maculopapular rash on palms and soles is seen in over 70%.

Ocular findings: Mainly uveitis, retinitis, and optic neuritis.

Latent Stage

Classification: Early (within 1 year) and late (after 1 year).

Course: About one-third of untreated cases progress to the tertiary stage. Ocular syphilis may become apparent even without symptoms.

Tertiary Stage

Cardiovascular: Aortitis, aortic aneurysm.

Neurosyphilis: Meningeal syphilis, meningovascular syphilis, tabes dorsalis, general paresis.

Ocular findings: Argyll Robertson pupil, optic atrophy, gumma.

Gumma: Benign localized granulomatous reaction. Occurs throughout the body including the choroid and iris.

Ocular symptoms by stage

Ocular findings vary greatly depending on the stage of syphilis.

Classification	Onset time	Main ocular symptoms
Congenital syphilis (early)	Birth to 3 months of age	Chorioretinitis
Congenital syphilis (late)	School age and later	Interstitial keratitis, iritis, dacryocystitis
Acquired primary syphilis	3 weeks to 3 months	Chancre of eyelid and conjunctiva
Acquired secondary stage	4 to 10 weeks	Blepharitis, conjunctivitis, keratitis, iridocyclitis, iris nodules, scleritis, retinochoroiditis, vitritis, optic neuritis, retinal vasculitis, exudative retinal detachment
Acquired late stage	Several years to decades	Eyelid gumma, interstitial keratitis, scleritis, uveitis, optic papillitis, Argyll Robertson pupil, lens dislocation, secondary retinitis pigmentosa

Frequency by disease type

Disease type	Frequency
Panuveitis	75%³⁾
Chorioretinitis	93%⁴⁾
Granulomatous iridocyclitis	46%¹⁾
Hypopyon	6%²⁾

4. Clinical Presentation

Fundus, FAF, OCT, and fluorescein angiography images of syphilitic uveitis showing placoid chorioretinal lesions at the posterior pole

Ye Z, et al. Syphilis and the Eye: Clinical Features, Diagnostic Challenges, and Evolving Therapeutic Paradigms. Pathogens. 2025. Figure 1. PMCID: PMC12472546. License: CC BY.

Both eyes show yellowish-white placoid lesions predominantly at the posterior pole, suggesting syphilitic posterior uveitis. FAF, OCT, and fluorescein angiography also confirm the extent of lesions, outer retinal damage, staining of lesions, and optic disc hyperfluorescence.

Subjective Symptoms

Decreased vision: Progresses acutely to chronically. Severity ranges from mild blurring to severe visual impairment. Caused by retinal/choroidal lesions and vitreous opacities.
Floaters and photopsia: Appear with vitreous opacities or retinitis.
Eye pain and redness: Seen in anterior segment inflammation (uveitis, scleritis).
Photophobia: Increases with progression of inflammation. Intensifies when complicated by iridocyclitis.
Unilateral or bilateral (more often bilateral in HIV-positive patients)²⁾.
Ocular symptoms may be the first sign of syphilis²⁾⁵⁾.

Clinical Findings

Findings in ocular syphilis vary depending on the affected site. Panuveitis is the most common type (75%)³⁾, and chorioretinitis is observed in 93% of posterior segment involvement⁴⁾.

Anterior Segment Findings

Conjunctiva: Chancre in the first stage, mild conjunctivitis in the second stage, and gumma in the third stage.

Sclera: Episcleritis (more common in the second stage), scleritis (more common in the third stage). Nodular or diffuse.

Syphilitic interstitial keratitis: Immune-mediated non-ulcerative, non-suppurative interstitial keratitis. Neovascularization → ghost vessels. One of Hutchinson’s triad in congenital syphilis.

Granulomatous iridocyclitis: Most common ocular type of syphilitic uveitis (46%) ¹⁾. May leave anterior synechiae and iris atrophy. Characteristically resistant to topical steroids.

Hypopyon and keratic precipitates (KP): Bilateral hypopyon occurs in about 6% ²⁾. May form mutton-fat KP.

Uvea and Posterior Segment

Intermediate, posterior, and panuveitis: Can present as anterior, posterior, or panuveitis. Granulomatous or non-granulomatous.

ASPPC (Acute Syphilitic Posterior Placoid Chorioretinitis): A characteristic special type in secondary syphilis. Disc-shaped, yellow lesions at the RPE level in the macula to peripapillary area. OCT shows disruption and hyperreflective elevation of the outer retina and RPE ³⁾. FAF shows hyperfluorescent and hypofluorescent patches. Responds well to antibiotic treatment.

Retinal vasculitis and retinitis: Arteritis is considered characteristic, but phlebitis is also common and may lead to sheathing ⁹⁾. Non-perfusion areas can lead to proliferative changes. “Ground-glass retinal infiltration” and “small creamy retinal surface deposits” are characteristic findings ¹⁾⁵⁾.

Severe vitreous opacities: Often resolve rapidly within a few days after administration of penicillin antibiotics.

Optic Nerve and Neuro-ophthalmology

Optic neuritis: Unilateral or bilateral. Anterior or retrobulbar optic neuritis, papilledema, neuroretinitis, optic atrophy. Optic nerve involvement is seen in 12–78% of ocular syphilis ³⁾. Delayed treatment leads to optic atrophy and affects visual prognosis.

Argyll Robertson pupil: Miosis, loss of light reflex but preserved near response. More common in the third stage but can appear earlier ⁵⁾.

Ocular motility abnormalities: In the third stage, caused by superior orbital fissure syndrome, brainstem infarction, or compression by aneurysm. Diplopia occurs when neurosyphilis is present.

Q What is ASPPC?

ASPPC (Acute Syphilitic Posterior Placoid Chorioretinitis) is a posterior segment finding highly specific to syphilis, characterized by the formation of large, placoid yellow-white lesions in the posterior pole ⁵⁾. Fluorescein angiography shows characteristic early hypofluorescence and late hyperfluorescence. OCT reveals disruption and hyperreflective elevation of the outer retina and RPE, and it responds well to antibiotic treatment.

5. Diagnosis and Examination Methods

In uveitis of unknown cause, always consider syphilis and maintain a high index of suspicion. When investigating the cause of uveitis, serological testing for syphilis should always be performed.

Serological Tests

In clinical practice, non-treponemal tests and specific treponemal tests are used in combination.

Type of Test	Representative Tests	Features and Uses
Non-treponemal tests (STS)	RPR (rapid plasma reagin), VDRL	High sensitivity, positive early. Biological false positives possible. Parallels infection activity → used for screening and treatment efficacy assessment
Treponemal tests (TP antigen method)	TPHA, FTA-ABS, TP-PA, EIA	Positive confirms syphilis. Remains positive long after treatment → unsuitable for treatment assessment

Assessment of activity: RPR ≥16-fold, TPHA ≥1,280-fold → high activity¹⁰⁾. In one review case, RPR was as high as 1:256³⁾.
Assessment of treatment effect: RPR ≤8-fold or decreased to ≤1/4 of initial value → effective anti-syphilitic treatment¹⁰⁾.
Prozone phenomenon: Non-treponemal tests may be false negative at high titers (dilution testing required).
Reverse sequence algorithm: First treponemal test (EIA/CLIA) → if positive, then non-treponemal test. Advantageous for detecting early cases¹⁾. For discordant results (treponemal positive, non-treponemal negative), retest with TP-PA.

Intravitreal Antibody Testing

Detection of syphilis antibodies in vitreous fluid by EIA shows high accuracy with sensitivity 90.9% and specificity 100%⁴⁾. It is useful for diagnosis even in HIV-coinfected cases where serum tests may be false negative.

Test	Sensitivity	Specificity
Serum EIA	High sensitivity (screening)	High specificity
Vitreous EIA	90.9%⁴⁾	100%⁴⁾

Cerebrospinal Fluid (CSF) Examination

In ocular syphilis, CSF examination is recommended to evaluate for neurosyphilis ⁴⁾. If isolated ocular symptoms, confirmed ocular abnormalities, and positive treponemal tests are present, CSF examination before treatment is not considered mandatory ³⁾. Lumbar puncture is performed when optic neuritis, ocular muscle palsy, or cranial nerve symptoms are suspected.

CSF-VDRL: High specificity but low sensitivity. A positive result confirms the diagnosis of neurosyphilis.
CSF FTA-ABS: High sensitivity but low specificity.

Ophthalmic Imaging

Fluorescein Angiography (FA): Shows vessel wall staining, vascular leakage (present in 100% of cases ⁴⁾), optic disc hyperfluorescence, and leopard spot pattern in ASPPC ¹⁾. Also useful for monitoring treatment response.
Optical Coherence Tomography (OCT): Reveals outer retinal changes (EZ/IZ band disruption, RPE elevation), cystoid macular edema, and epiretinal membrane ³⁾. EZ disruption is seen in 89% of cases ⁴⁾.
Fundus Autofluorescence (FAF): In ASPPC, shows hyperautofluorescent and hypoautofluorescent patches ³⁾.
Ultra-widefield Fundus Photography: Useful for assessing peripheral lesions.

Q In which cases is intraocular antibody testing useful?

It is useful in HIV-coinfected patients, where serum syphilis tests are prone to false negatives, and in cases where syphilitic uveitis is strongly suspected despite negative serology ⁴⁾. Vitreous EIA has 100% specificity, and a positive result provides diagnostic evidence for syphilitic uveitis.

6. Differential Diagnosis

Differential diagnoses include sarcoidosis, tuberculous uveitis, acute retinal necrosis (ARN)/PORN, APMPPE, serpiginous choroiditis, cytomegalovirus retinitis, toxoplasma retinitis, Behçet’s disease, and intraocular lymphoma ⁴⁾⁷⁾. Since direct detection of T. pallidum in the eye is not possible, integrated assessment of serological tests and clinical findings is crucial ¹⁰⁾. Special attention is needed in HIV-positive patients, as serological tests may be false negative in AIDS.

7. Standard Treatment

Antibiotic Therapy

Oral antisyphilitic therapy (for mild cases or outpatient management):

Sawacillin tablets (250 mg) 4 tablets 4 times daily for 4 weeks¹⁰⁾.

Neurosyphilis and ocular syphilis (inpatient intravenous therapy):

Syphilitic uveitis is often associated with neurosyphilis, and high-dose penicillin intravenous therapy is standard. First-line treatment is intravenous aqueous penicillin G.

Regimen	Dose and route
Aqueous crystalline penicillin G (first-line)	18–24 million units/day (3–4 million units IV every 4 hours or continuous infusion) for 10–14 days¹⁾²⁾³⁾⁵⁾
Procaine penicillin G (alternative)	2.4 million units IM once daily plus probenecid 500 mg orally 4 times daily for 10–14 days¹⁾²⁾
Ceftriaxone (alternative)	1–2 g IM or IV once daily for 14 days¹⁾⁴⁾⁶⁾

The treatment success rate is reported to be approximately 90%³⁾.

Nwaobi et al. (2023) reported a 46-year-old man with ocular syphilis (RPR 1:64, TPHA 1:512) who received neurosyphilis treatment with IV PCG 4 million units q4h, and vision recovered after 6 months²⁾.

Local ocular treatment and anti-inflammatory therapy

Steroid eye drops + mydriatic eye drops (for anterior segment inflammation).
In cases of severe inflammation, add systemic steroids. However, steroids must be used after starting antibiotics.
In addition to antisyphilitic therapy with penicillin antibiotics, systemic steroid anti-inflammatory therapy is performed in cases of severe inflammation.

Surgical treatment and management of retinal complications

Retinal photocoagulation for non-perfusion areas.
Vitrectomy for proliferative vitreoretinopathy.
If complications such as vitreous hemorrhage or tractional retinal detachment occur, vitrectomy (PPV) is considered ²⁾.

Assessment of treatment efficacy

The course of RPR (lipoidal antigen test) is used as a reference. A decrease in antibody titer to ≤8-fold or ≤1/4 of the initial value is considered evidence of antisyphilitic effect ¹⁰⁾. Recurrence is possible after treatment, so regular RPR monitoring should be continued.

Management of penicillin allergy

Penicillin desensitization is recommended as the first choice ¹⁾⁷⁾.

Ceftriaxone: 1–2 g IM or IV once daily for 14 days ¹⁾⁶⁾.
Doxycycline: 200 mg/day (100 mg twice daily) for 28 days ¹⁾⁷⁾.

Cubelo et al. (2022) reported that a 24-year-old HIV-positive man with PCG allergy received doxycycline 100 mg BID for 14 days, and RPR decreased from 1:1,024 to 1:32 ⁷⁾. PCG desensitization was subsequently performed.

Jarisch-Herxheimer reaction

It develops as a reaction to inflammatory lipoproteins derived from Treponema pallidum that are killed within 24 hours of starting treatment. Ophthalmologically, it may be seen as a recurrence of iritis (flare-up of inflammation).

Symptoms: Fever, headache, myalgia, chills. Occurs in 30–70% of early syphilis and 2% of neurosyphilis ¹⁾. Some reports note it in about 75% of cases ³⁾.
Ocular symptoms: Decreased vision, macular edema, optic disc swelling, and cotton-wool spots have been reported.
Management: Continue treatment. Use antipyretics and analgesics for symptomatic relief.

Q How is it treated if there is a penicillin allergy?

Penicillin desensitization is recommended first. If this is difficult, alternatives include ceftriaxone (1–2 g once daily for 14 days) or doxycycline (200 mg/day for 28 days) ¹⁾⁷⁾. However, evidence for these alternatives in ocular syphilis is limited compared to penicillin.

Q Should treatment be stopped if a Jarisch-Herxheimer reaction occurs?

Treatment should be continued without interruption. Systemic symptoms such as fever and headache are managed symptomatically with antipyretics and analgesics. Ocular symptoms (including vision loss, optic disc swelling, etc.) are usually temporary and improve with continued treatment ¹⁾.

Q In what situations can steroids be used?

Steroids are considered as adjunctive therapy only when inflammation persists after adequate antibiotic administration. Administering steroids without immunosuppression prior to treatment is contraindicated because it can lead to exacerbation of syphilis ⁵⁾.

8. Course, Prognosis, and Recurrence

Pathophysiological Background

T. pallidum disseminates hematogenously from the primary infection site and reaches systemic organs including ocular tissues. It crosses the blood-retinal barrier and causes inflammation in the choroid, retina, and vitreous. Ocular syphilis can occur at any stage from primary to late syphilis, but posterior segment involvement is more common after the secondary stage.

Immune Response and Tissue Damage Mechanisms

Treponema pallidum induces production of IL-1β, IL-6, IL-12, and TNF-α via TLR2/TLR4/TLR5-dependent signaling, causing tissue damage similar to delayed-type hypersensitivity reactions ¹⁾. CD4+ cells and macrophages dominate primary lesions, while CD8+ cells dominate secondary lesions. IFN-γ production activates and recruits macrophages.

In syphilitic interstitial keratitis, the main pathology is not direct infection by T. pallidum itself, but an immune response to treponemal antigens (lymphocyte infiltration and vascular invasion into the corneal stroma). Therefore, it responds to steroids but may not resolve with penicillin alone.

Immune Evasion and Chronic Infection

Treponema pallidum has slow proliferation and the ability to invade immune-privileged tissues such as the eye, CNS, and placenta ¹⁾. Apoptosis of CD4+ cells via the Fas-associated death pathway leads to incomplete immune clearance and establishment of chronic infection.

HIV Coinfection and IRIS

In HIV-positive patients, progression of ocular syphilis after the secondary stage is accelerated. Bilateral involvement is more frequent in HIV-positive patients (62%) compared to HIV-negative patients (38%) (study of 96 cases) ¹⁾. In AIDS, serological tests may be false-negative, requiring caution in diagnosis.

In HIV-positive patients with ocular syphilis, IRIS (immune reconstitution inflammatory syndrome) may occur after initiation of antiretroviral therapy (ART), causing transient worsening of inflammation ¹¹⁾.

Onset after ART initiation: median 28 days
Unmasking IRIS: Syphilis that was undiagnosed before ART initiation becomes apparent.
Paradoxical IRIS: Syphilis under treatment temporarily worsens.

In a review by Pipito et al. (2023), IRIS cases had low CD4 cell counts before ART (median 196/μL), which recovered to 318/μL after ART ¹¹⁾. In cases with low CD4, there is also a risk of false-negative syphilis serology ¹¹⁾.

Prognosis and Course

Response to penicillin antibiotics is generally good, and vitreous opacity often resolves rapidly within a few days of administration. The treatment success rate is reported to be approximately 90% ³⁾. In cases complicated by optic neuritis, delayed treatment can lead to optic atrophy, affecting visual prognosis. In HIV-coinfected cases, the risk of relapse after treatment is high, and long-term monitoring of RPR trends is necessary.

Q How should ocular inflammation worsening after ART initiation in HIV-positive patients be managed?

If inflammation worsens around 28 days after ART initiation, suspect IRIS. Differentiate between unmasking and paradoxical types, and if syphilis treatment is insufficient, prioritize penicillin G therapy ¹¹⁾. Addition of steroids should be considered after establishing anti-syphilitic treatment.

Latest Research and Future Perspectives (Investigational Reports)

Anti-VEGF therapy for inflammatory choroidal neovascularization (iCNV): iCNV associated with ocular syphilis is an extremely rare condition. In a report by Świerczyńska et al. (2021), intravitreal injection of aflibercept stabilized disease activity in about one-third of cases with a single injection, and stabilized vision in about two-thirds with two injections ⁶⁾. iCNV does not resolve with antibiotic therapy alone, and additional intravitreal anti-VEGF injection was effective.

Venous-predominant syphilitic retinal vasculitis: Although syphilitic retinal vasculitis is usually arteritic or mixed, cases with predominant phlebitis have been reported in HIV-coinfected patients. Mammo et al. (2022) reported a case of a 53-year-old HIV-positive male with panuveitis predominantly involving phlebitis, treated with IV PCG 4 million units for 14 days × 2 courses ⁹⁾. After treatment, it progressed to paravenous pigmentary retinopathy.

Improved diagnostic accuracy with multimodal imaging: The combination of EDI-OCT, ultra-widefield autofluorescence (FAF), and ICG is expected to improve the diagnostic accuracy of ocular syphilis¹⁾³⁾. ICG detects choroidal dark dots, hot spots, and blurred choroidal vessels. Accumulation of these multimodal imaging findings may contribute to differentiation from sarcoidosis and tuberculosis.

Advances in diagnostic techniques using intraocular fluids: Detection of syphilis antibodies by EIA in vitreous fluid (sensitivity 90.9%, specificity 100%) has high diagnostic value in serologically false-negative cases and refractory posterior uveitis⁴⁾. Especially in HIV-coinfected or immunocompromised patients, where serological diagnosis is less reliable, intraocular fluid testing is becoming an important adjunctive diagnostic method.

Optimization of IRIS management: Research is progressing on the mechanism of IRIS associated with ART initiation and optimal management strategies¹¹⁾. Optimizing the timing of antisyphilitic treatment and ART for prevention and treatment of IRIS remains a future challenge.

9. References

Chauhan K, Bhatt DL, Bhardwaj P, et al. Demystifying Ocular Syphilis – A Major Review. Ocul Immunol Inflamm. 2023. DOI:10.1080/09273948.2023.2217246.
Nwaobi S, Nwaobi A, Karunakaran K, et al. Through the Eyes: A Case of Ocular Syphilis. Cureus. 2023;15(11):e48XXX. PMC10694475.
Kayabai M, Doğan R, Kaçar İ, et al. Presentation of Ocular Syphilis with Bilateral Optic Neuropathy: A Rare Case Report. Neuro-Ophthalmology. 2023. PMC10732629.
Fekri S, Golabdar M, Rahimi M, et al. The First Reported Case of Ocular Syphilis in an Iranian Patient Presenting with Intermediate Uveitis. J Ophthalmic Vis Res. 2023. PMC10794801.
Das P, Chakraborty PP, Mondal SK, et al. Ocular syphilis in antibiotic era: A review with case series. Indian J Sex Transm Dis AIDS. 2025. PMC12716672.
Świerczyńska MP, Nowak M, Michalak J, et al. Choroidal neovascularization secondary to ocular syphilis treated with intravitreal aflibercept. Rom J Ophthalmol. 2021;65(4). PMC8764425.
Cubelo M, Almeida MJ, Sobrinho-Simões J, et al. A Case of Ocular Syphilis in an HIV-Positive Patient With Penicillin Allergy. Cureus. 2022;14(9). PMC9574520.
Kiani R, Patel L, Gupta N, et al. Blurry Diagnosis of Ocular Syphilis: A Case Report. Cureus. 2022;14(10). PMC9635406.
Mammo DA, Ober MD, Dansingani KK. Ocular Syphilis With Phlebitis and Paravenous Pigmentary Retinopathy. J VitreoRetinal Dis. 2022. PMC9954775.
日本眼炎症学会ぶどう膜炎診療ガイドライン作成委員会. ぶどう膜炎診療ガイドライン. 日眼会誌. 2019;123(6):635-696（梅毒性ぶどう膜炎の項）.
Pipito N, Calcagno A, Caramello P, et al. Immune reconstitution inflammatory syndrome in patients with syphilitic uveitis: a review. J Ophthalmic Inflamm Infect. 2023;13:30.

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