Syphilis uveitis in New Zealand: Is it possible to discriminate from Yaws?

Hannah Gill1, Helen D. Meyer2, Jo Sims1, Rachael Niederer1

Meeting:  2019 RANZCO


Date:      -

Session Title: Uveitis

Session Time:      -

Aim: To describe the spectrum of syphilis uveitis in New Zealand.

Methods: Retrospective review of subjects seen in uveitis and neuro‐ophthalmology clinics at Auckland District Health Board between January 2006 and June 2019.

Results: 2493 subjects were reviewed, of whom 46 were diagnosed with syphilis uveitis (1.8%). Mean age was 56.5 ± 14.8 years and 35 (76.1%) were male. Ethnicity was Pacific Peoples in 17 (37.0%), Caucasian in 16 (34.8%), Asian 6 (13.0%) and Maori in 2 (4.4%), and other 5 (10.9%). Pacific Peoples were older at presentation (P = 0.0005) with 76.5% over 60 years compared to 24.1% of other ethnicities (P = 0.001). Comparing Pacific People aged >60 to the rest of the cohort, older Pacific subjects had lower RPR titres (median 4 vs 32 P = 0.028), less likely to have optic nerve swelling (0% vs 28% eyes P = 0.014), and less likely to have posterior uveitis (5.9% vs 32.0% eyes P = 0.033). No difference was observed in anterior and intermediate uveitis between the groups and no difference in resolution or inflammation or recurrence.

Conclusions: Syphilis uveitis is common in New Zealand, occurring in 1 in 55 subjects seen in consultant uveitis clinics. Significant differences exist in the presentation of older Pacific Peoples with positive treponemal serology. These differences may be due to chronicity of disease or due to false positives secondary to Yaws.