Résumé
Purpose: to describe the demographic and clinical characteristics of patients with ocular syphilis in Montpellier, Nîmes, Marseille, and Nice, over the past 20 years.Methods: we retrospectively studied 145 eyes from 90 patients who consulted at the University Hospitals of Montpellier, Nîmes, Marseille, and Nice between January 1, 2004, and January 1, 2024. All these patients had a positive syphilitic serology associated with an ophthalmologic diagnosis of ocular syphilis. Subgroup analyses were performed based on HIV status, sexual behavior, type of ocular involvement, and final visual acuity. Results: the mean age was 46.8 years, with 90% being male. HIV positivity was detected in 26 (32.1%) patients, 7 (26%) of whom were newly diagnosed. In this study 38 (60.3%) men were men who have sex with men (MSM). Posterior uveitis was the most common presentation (57.9%), followed by panuveitis (24.8%). Ocular involvement was bilateral in 55 (60%) patients. On average, logMAR visual acuity improved by -0.47. Optic disc edema (66.9%) and acute posterior placoid chorioretinitis (53.1%) were the predominant clinical findings. The stage of syphilis most frequently associated with ocular involvement was secondary syphilis (85.7%).Cutaneous-mucosal manifestations were concomitant in 30.8% of patients at the diagnosis of ocular syphilis. Lumbar puncture was performed for 46.4% of patients, with 58% of cerebrospinal fluid abnormalities. Scleritis was significantly associated with HIV. Patients with posterior uveitis presented later for consultation with a mean of 31.4 days, compared to those with other ocular conditions, while patients with panuveitis tended to seek medical attention earlier, with a mean of 16.2 days. Among MSM, patients were significantly younger with 49% being HIV positive. Patients presenting posterior uveitis had a better final best-corrected visual acuity (0.07 logMAR, p=0.02) and the most significant visual improvement (-0.57 logMAR).Conclusion: syphilis has been increasingly prevalent for many years. Considering the various potential manifestations of ocular syphilis, it appears essential to conduct screening tests whenever signs of ocular inflammation are observed, especially among the MSM population, given the relatively low cost of the test. Ocular syphilis remains a frequent clinical manifestation that can lead to initial HIV diagnosis.