Using the Reverse Testing Algorithm to Detect a Case of Ocular Syphilis
Abstract
According to the Center for Disease Control and Prevention (CDC), incidence rates of syphilis have been steadily increasing in the United States over the last 5 years, despite well-established treatment and prevention precautions. Importantly, ocular syphilis can be the only presenting symptom in up to 40% of patients diagnosed with syphilis. This case report aims to identify symptoms, investigative factors, and ethical considerations involved in ocular syphilis to better recognize and manage future cases. An IRB-approved descriptive study and thorough chart review was conducted to examine the clinical presentation, diagnosis, and medical management course of a male in his mid-50s with ocular syphilis. The patient presented to the optometry clinic in spring 2024 with unilateral anterior uveitis refractive to treatment with topical steroids, systemic steroids, and trial of valacyclovir. He was referred to the ophthalmology clinic 3 weeks after initial presentation, and lab work-up was positive for treponemal antibodies. Using the CDC reverse sequence algorithm for syphilis screening, a confirmatory RPR test was ordered and found reactive. Infectious Disease (ID) recommended a 2-week course of IV Penicillin G every four hours and Prednisone Acetate drops for affected eye. At the time of diagnosis, this patient stated that he has not been sexually active with his wife for two years. Infectious disease reported the diagnosis to Washington County Health Department as mandated by the CDC. While patient autonomy should always be upheld, ethical considerations include valuing the health of other individuals and the general population to avoid the risks associated with syphilis infection. Follow-up testing revealed residual positive RPR at month 7 after treatment, and the patient will continue to be treated with recommendations from ID and ophthalmology.
Start Time
16-4-2025 9:00 AM
End Time
16-4-2025 11:30 AM
Presentation Type
Poster
Presentation Category
Health
Student Type
Clinical Doctoral Student (e.g., medical student, pharmacy student)
Faculty Mentor
Brent Aebi
Faculty Department
Surgery
Using the Reverse Testing Algorithm to Detect a Case of Ocular Syphilis
According to the Center for Disease Control and Prevention (CDC), incidence rates of syphilis have been steadily increasing in the United States over the last 5 years, despite well-established treatment and prevention precautions. Importantly, ocular syphilis can be the only presenting symptom in up to 40% of patients diagnosed with syphilis. This case report aims to identify symptoms, investigative factors, and ethical considerations involved in ocular syphilis to better recognize and manage future cases. An IRB-approved descriptive study and thorough chart review was conducted to examine the clinical presentation, diagnosis, and medical management course of a male in his mid-50s with ocular syphilis. The patient presented to the optometry clinic in spring 2024 with unilateral anterior uveitis refractive to treatment with topical steroids, systemic steroids, and trial of valacyclovir. He was referred to the ophthalmology clinic 3 weeks after initial presentation, and lab work-up was positive for treponemal antibodies. Using the CDC reverse sequence algorithm for syphilis screening, a confirmatory RPR test was ordered and found reactive. Infectious Disease (ID) recommended a 2-week course of IV Penicillin G every four hours and Prednisone Acetate drops for affected eye. At the time of diagnosis, this patient stated that he has not been sexually active with his wife for two years. Infectious disease reported the diagnosis to Washington County Health Department as mandated by the CDC. While patient autonomy should always be upheld, ethical considerations include valuing the health of other individuals and the general population to avoid the risks associated with syphilis infection. Follow-up testing revealed residual positive RPR at month 7 after treatment, and the patient will continue to be treated with recommendations from ID and ophthalmology.