Clinical Manifestations and Treatment Prognosis of Patients with co-infection of Ocular Syphilis and HIV

Purpose This study aimed to evaluate the clinical manifestations and treatment prognosis of patients co-infected with ocular syphilis and HIV, focusing on ocular involvement subtypes and visual outcomes. Methods A cohort of 31 patients (42 eyes) diagnosed with both ocular syphilis and HIV at Beijing You’an Hospital from January 2022 to March 2025 was analyzed. Diagnosis was confirmed through serological tests (TPPA, RPR) and ocular examinations. Patients received intravenous penicillin G followed by intramuscular benzathine penicillin. Best-corrected visual acuity (BCVA), ocular manifestations, and treatment responses were assessed. Results Posterior segment involvement was universal, with predominant subtypes being acute syphilitic posterior placoid chorioretinitis (13 eyes), confluent syphilitic retinochoroiditis (12 eyes), retinal vasculitis (4 eyes), and optic neuritis (13 eyes). BCVA improved significantly post-treatment. Optic neuritis showed better baseline and final BCVA, correlating with lower macular involvement. Conclusions Co-infection of ocular syphilis and HIV predominantly affects the posterior segment, with optic neuritis exhibiting a distinct clinical profile. A comprehensive ocular and serological evaluations in high-risk populations is recommended.