Abstract：
BACKGROUND: Screening for syphilis increasingly relies on positive treponemal rather than nontreponemal tests (rapid plasma reagin [RPR]). We compared ocular syphilis in patients with nonreactive versus positive RPR.
METHODS: We conducted a retrospective observational cohort study of ocular syphilis treated at two New England hospitals 1996-2021 based on ophthalmologist-diagnosed eye findings and positive treponemal serology, regardless of RPR. We excluded patients with alternative diagnoses. We categorized RPR into nonreactive RPR, low-titer RPR (<1:8), and high-titer RPR (≥1:8) and compared early and long-term response to therapy.
RESULTS: Our sample included 115 patients with ocular syphilis (median follow-up 2.5 years): 25 (22%) nonreactive RPR, 21 (18%) low-titer RPR, 69 (60%) high-titer RPR. Compared with nonreactive and low-titer RPR, people with high-titer RPR were younger (mean 47 years, p<0.001), more likely male (93%, p<0.001) and more likely to be living with HIV (49%, p<0.001). People with nonreactive and low-titer RPR were less likely than high-titer RPR to have posterior/panuveitis (32% and 29% versus 75%, p<0.001) or abnormal CSF (26% and 35% versus 75%, p<0.001), and more likely to present with chronic eye findings (20% and 29% versus 1%, p<0.001). In long-term follow up, eye findings improved and did not recur in most patients (62% nonreactive, 68% low-titer, 96% high-titer RPR); improved but recurred in 29%, 11%, and 4%, respectively; and were stable in 10%, 21%, and 0%, respectively.
CONCLUSIONS: Patients with ocular syphilis and nonreactive RPR are similar to patients with low-titer RPR, and antibiotic therapy is beneficial in most.
METHODS: We conducted a retrospective observational cohort study of ocular syphilis treated at two New England hospitals 1996-2021 based on ophthalmologist-diagnosed eye findings and positive treponemal serology, regardless of RPR. We excluded patients with alternative diagnoses. We categorized RPR into nonreactive RPR, low-titer RPR (<1:8), and high-titer RPR (≥1:8) and compared early and long-term response to therapy.
RESULTS: Our sample included 115 patients with ocular syphilis (median follow-up 2.5 years): 25 (22%) nonreactive RPR, 21 (18%) low-titer RPR, 69 (60%) high-titer RPR. Compared with nonreactive and low-titer RPR, people with high-titer RPR were younger (mean 47 years, p<0.001), more likely male (93%, p<0.001) and more likely to be living with HIV (49%, p<0.001). People with nonreactive and low-titer RPR were less likely than high-titer RPR to have posterior/panuveitis (32% and 29% versus 75%, p<0.001) or abnormal CSF (26% and 35% versus 75%, p<0.001), and more likely to present with chronic eye findings (20% and 29% versus 1%, p<0.001). In long-term follow up, eye findings improved and did not recur in most patients (62% nonreactive, 68% low-titer, 96% high-titer RPR); improved but recurred in 29%, 11%, and 4%, respectively; and were stable in 10%, 21%, and 0%, respectively.
CONCLUSIONS: Patients with ocular syphilis and nonreactive RPR are similar to patients with low-titer RPR, and antibiotic therapy is beneficial in most.
摘要：
背景：梅毒筛查越来越依赖于阳性的螺旋体而不是非螺旋体试验（快速血浆反应蛋白[RPR]）。我们比较了非反应性与阳性RPR患者的眼部梅毒。
方法：我们根据眼科医生诊断的眼部发现和阳性的螺旋体血清学，对1996-2021年在新英格兰两家医院治疗的眼部梅毒进行了回顾性观察性队列研究。不管RPR。我们排除了有替代诊断的患者。我们将RPR分类为非反应性RPR，低滴度RPR(<1:8)，和高滴度RPR（≥1：8），并比较了对治疗的早期和长期反应。
结果：我们的样本包括115例眼梅毒患者（中位随访2.5年）：25（22％）无反应性RPR，21(18%)低滴度RPR,69(60%)高滴度RPR。与非反应性低滴度RPR相比，高滴度RPR的人更年轻(平均47岁，p<0.001)，更有可能是男性（93%，p<0.001)，并且更有可能感染艾滋病毒(49%，p<0.001)。与高滴度RPR相比，无反应性且低滴度RPR的人患后部/全葡萄膜炎的可能性较小（32％和29％对75％，p<0.001)或脑脊液异常(26%和35%对75%，p<0.001)，更有可能出现慢性眼部检查结果(20%和29%对1%，p<0.001)。在长期随访中，大多数患者的眼部检查结果改善且未复发（62%无反应性，68%低滴度，96％高滴度RPR）；改善但复发29％，11%,4%,分别稳定在10%，21%,0%,分别。
结论：眼部梅毒和非反应性RPR患者与低滴度RPR患者相似，和抗生素治疗是有益的大多数。
方法：我们根据眼科医生诊断的眼部发现和阳性的螺旋体血清学，对1996-2021年在新英格兰两家医院治疗的眼部梅毒进行了回顾性观察性队列研究。不管RPR。我们排除了有替代诊断的患者。我们将RPR分类为非反应性RPR，低滴度RPR(<1:8)，和高滴度RPR（≥1：8），并比较了对治疗的早期和长期反应。
结果：我们的样本包括115例眼梅毒患者（中位随访2.5年）：25（22％）无反应性RPR，21(18%)低滴度RPR,69(60%)高滴度RPR。与非反应性低滴度RPR相比，高滴度RPR的人更年轻(平均47岁，p<0.001)，更有可能是男性（93%，p<0.001)，并且更有可能感染艾滋病毒(49%，p<0.001)。与高滴度RPR相比，无反应性且低滴度RPR的人患后部/全葡萄膜炎的可能性较小（32％和29％对75％，p<0.001)或脑脊液异常(26%和35%对75%，p<0.001)，更有可能出现慢性眼部检查结果(20%和29%对1%，p<0.001)。在长期随访中，大多数患者的眼部检查结果改善且未复发（62%无反应性，68%低滴度，96％高滴度RPR）；改善但复发29％，11%,4%,分别稳定在10%，21%,0%,分别。
结论：眼部梅毒和非反应性RPR患者与低滴度RPR患者相似，和抗生素治疗是有益的大多数。
