Overview
Syphilitic choroiditis involves inflammation of the choroid secondary to syphilis, often presenting with multifocal lesions affecting the posterior segment of the eye. It can manifest as part of neurosyphilis or ocular syphilis, impacting vision and requiring prompt diagnosis and treatment 1.Diagnosis
Key Diagnostic Criteria: Multifocal choroidal lesions visible on color fundus photographs (CFP) 1.
Recommended Tests:
- Optical Coherence Tomography (OCT): Essential for detecting active lesions and monitoring disease activity 1.
- Fundus Fluorescein Angiography (FFA): Useful for assessing vascular involvement and lesion characteristics 1.
- Indocyanine Green Angiography (ICGA): Particularly valuable in evaluating recurrent disease 1.
- Fundus Autofluorescence (FAF): Effective for monitoring disease recurrence and lesion activity 1.
Serological Testing: Confirm syphilis infection through non-treponemal (e.g., RPR, VDRL) and treponemal tests 1.Management
First-Line Treatment:
- Benzathine penicillin G: Recommended as the primary treatment, typically 2.4 million units intramuscularly in a single dose for adults 1.
Adjunctive Treatments:
- Doxycycline or Tetracycline: Considered for penicillin-allergic patients, dosing as per standard protocols 1.
- Adjunctive corticosteroids: May be considered in severe cases to reduce inflammation, though evidence is limited 1.Special Populations
Pregnancy: Benzathine penicillin G is generally considered safe; alternative antibiotics like doxycycline should be avoided due to teratogenic risks 1.
Pediatrics: Treatment protocols follow adult guidelines but with careful monitoring for dose adjustments and potential developmental impacts 1.
Elderly: Similar to adult dosing, but renal function and comorbidities should guide antibiotic selection and dosing 1.
Comorbidities: Patients with cardiovascular or neurological syphilis may require extended treatment regimens and multidisciplinary care 1.Key Recommendations
Use color fundus photographs (CFP) for initial lesion characterization and monitoring 1.
Employ optical coherence tomography (OCT) as the preferred modality for detecting active choroidal lesions 1.
Utilize late-phase indocyanine green angiography (ICGA) for evaluating recurrent disease activity 1 (Evidence: Expert opinion).References
1 Gangaputra S, Agarwal A, Norel JO, Tsui E, Thorne JE, de-la-Torre A et al.. Evidence and Consensus-Based Imaging Guidelines in Multifocal Choroiditis With Panuveitis and Punctate Inner Choroiditis-Multimodal Imaging in Uveitis (MUV) Taskforce Report 5. American journal of ophthalmology 2025. link