Neurosyphilis Presenting with Optic Neuritis


  •   R. Arvinth

  •   Z. Mimiwati

  •   S. C. Reddy


The incidence of syphilis has greatly reduced in the severity of affected individuals due to the early treatment with antibiotics. However, due to the increase in the prevalence of human immunodeficiency virus (HIV) infection, it has also caused a concurrent rise in the number of neurosyphilis patients. Most common ocular manifestations include uveitis, interstitial keratitis, and vasculitis. A healthy 28-years old man presented with a progressive blurring of vision in the right eye for one month. It was his second episode. The first episode occurred 4 months back which resolved spontaneously without treatment. Vision in the right eye was 6/18. The pupil was dilated and the relative afferent pupillary defect was positive. Fundus examination showed a hyperemic swollen right optic disc with blurred margins and no macular fan or star. Vision, anterior segment, and fundus were normal in the left eye. After the investigations, he was diagnosed as a case of neurosyphilis with optic neuritis. He was treated with intravenous penicillin for two weeks followed by oral penicillin for three weeks. Vision in the right eye improved to 6/6; the optic disc swelling resolved with clear margins. He maintained good vision during the follow-up of six months. Early referral to an ophthalmologist upon suspicion of syphilis, detailed evaluation, and immediate treatment is mandatory to prevent permanent vision loss in these patients.

Keywords: Optic neuritis, neurosyphilis, penicillin


R. P. Knudsen and N. N. Singh, “Neurosyphilis Overview of Syphilis of the CNS,”, Updated Jul 17, 2018. (Accessed on Aug. 31, 2021)

J. R. Berger and D.Dean, “Neurosyphilis,” Handb Clin Neurol 121, 1461-72, 2014.

E. Akinci, F. Oncu and B. Topcular, “Neurosyphilis in psychiatric settings: Three Case Reports,” Turk Psikiyatri Derg 28(1): 61-66, 2017.

S. Kiss, F. M. Damico and L. H. Young, “Ocular manifestations and treatment of syphilis,” Semin Ophthalmol 20(3): 161-167, 2005

T. Toptan, B. Ozdilex, G. Kenangil, M. Ulker and F. Mayda Domac, “Neurosyphilis: a case report,” North Clin Istanb 2(1): 66–68, 2015.

A. Hanifatiyah, A. Mohd Fairuz, A. T. Nor Azita and R. O. Raja Nor Farahiyah, “Altered Vision in MSM Patient, Diagnosis of Ocular Syphilis in Primary Care: A Case Report,” Mal J Med Health Sci 15(1): 85-88, 2019.

M. Mustapha, Z. Abdollah, A. Ahem, H. Mohd Isa, M. L. C. Bastion and N. M. Din, “Ocular syphilis: resurgence of an old disease in modern Malaysian society,” Int J Ophthalmol 11(9):1573-1576, 2018.

A. K. Ghanimi Zamli, N. S. Irma Ngah, T. Chew-Ean, J. Muhammad, W. H. Wan Hittam, A. Hussein and E. Zunaina, “Clinical Profile and Visual Outcomes of Ocular Syphilis: A Five-year Review in Hospital Universiti Sains, Malaysia,” Cureus 11(2): e4015, 2019.

N. Farai and T.Craig, “Syphilis: presentations in general medicine,” Clin Med (London) 16(2): 184–188, 2016.

G. T. Smith, D. Goldmeier and C.Migdal, “Neurosyphilis with optic neuritis: An update,” Postgrad Med J 82(963): 36–39, 2006.

F. Shan, Y. Long, Y. Fan, M. Chen, Y. Zheng and C. Gao, “Neuromyelitis optica spectrum disorder and neurosyphilis coexist in a chinese woman,” Journal of Molecular Biomarkers & Diagnosis 5(6), 198, 2014.

S. Dhungana, B. Shararack, I. Pepper and J. Bowen, “Syphilitic Optic Neuropathy: A Diagnosis Not to Be Missed,” The Internet Journal of Neurology 9(2): 25-30, 2007.

X. Gu, Y. Gao, Y. Yan, M. Marks, L. Zhu, H. Lu and P. Zhou, “The importance of proper and prompt treatment of ocular syphilis: a lesson from permanent vision loss in 52 eyes,” Journal of the European Academy of Dermatology and Venereology 34(7): 1569-1578, 2020.

L. Porto, J. Capelo and A. Carragoso, “Unilateral swollen optic disc: do not forget neurosyphilis,” BMJ Case Rep 3:31-35, 2013.

G. Gaurav, J. O. Jason, Y. C. Marcus and L. L. Lyndell, “Keeping an eye on syphilis,” 46(6): 401- 404, 2017.

M. Pastuszczak, A. Wojas-Pelc and A. Jaworek, “Association of CSF glucose concentration with neurosyphilis diagnosis,” Open Medicine 8(1): 48-51, 2013.

L. Yong, K. Wujian, Y. LiGang and W. Zhenyu, “Clinical prediction and diagnosis of neurosyphilis in HIV-negative patients: a case-control study,” BMC Infectious Diseases 19(1): 1-7, 2019.

V. C. Fiona and F.Martin, “Management of syphilis in HIV-positive individuals,” Sex Health 12(2):135-40, 2015.

S. L. Woolston, S. Dhanireddy and J. Marrazzo, “Ocular syphilis: a clinical review,” Curr Infect Dis Rep 18:36, 2016.

Health Management and Disease Control, Ministry of Health: Malaysian Guidelines in the Treatment of Sexually Transmitted Infection, 4th ed, Malaysia; 2015.

World Health Organization. Guidelines for the management of sexually transmitted Infections 2003. 42782. (Accessed on Sept.10, 2021).


How to Cite
Arvinth, R., Mimiwati, Z., & Reddy, S. C. (2021). Neurosyphilis Presenting with Optic Neuritis. European Journal of Clinical Medicine, 2(5), 1-3.