How is ophthalmic syphilis in HIV infection diagnosed?

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Diagnosis of ocular syphilis in patients with HIV follows the same algorithm used for HIV-negative patients and should include a specific treponemal-antibody assay (fluorescent treponemal antibody absorption [FTA-ABS] or microhemagglutination Treponema pallidum [MHA-TP]) and a nonspecific treponemal-antibody assay (Venereal Disease Research Laboratory [VDRL] or rapid plasma reagin [RPR] test).

The VDRL test becomes positive 1-3 weeks after the appearance of the chancre. The VDRL and RPR tests may show a false-negative result in early primary, latent, or late syphilis. [25]  FTA-ABS and MHA-TP are highly sensitive and specific in all stages of syphilis.

Lumbar puncture may be performed if the patient has a positive FTA-ABS test combined with neurologic or neuro-ophthalmologic signs, papillitis, active chorioretinitis, or uveitis.

VDRL or RPR results correlate with disease activity, so these tests are useful in monitoring response to treatment. FTA-ABS and MHA-TP results do not reverse to normal, so they are not helpful in assessing the patient’s response to treatment.

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