Lobo Ann-Marie, Gao Yan, Rusie Laura, Houlberg Magda, Mehta Supriya D
1 Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA.
2 Division of Epidemiology & Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA.
Int J STD AIDS. 2018 Mar;29(4):357-361. doi: 10.1177/0956462417726700. Epub 2017 Aug 18.
In 2015, the Centers for Disease Control and Prevention (CDC) and the American Academy of Ophthalmology (AAO) released clinical advisories on rising cases of ocular syphilis. We examined the association between eye disease and syphilis infection among primary care and sexually transmitted infection (STI) clinic patients attending an urban lesbian, gay, bisexual, transgender (LGBT) health center. We conducted a retrospective medical record review of all patients who underwent syphilis testing at Howard Brown Health between 1 January 2010 and 31 December 2015. Confirmed eye diagnosis was based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes for conjunctivitis, uveitis, keratitis, retinitis, and red eye. Demographic information, syphilis treatment, HIV status, and high-risk behaviors were abstracted. Syphilis diagnosis was defined by available laboratory data (enzyme immunoassay [EIA], rapid plasma reagin [RPR] titer, fluorescent treponemal antibody absorption [FTA-Abs], Treponema pallidum Ab). Multivariable logistic regression with robust variance was used to identify independent associations. During the study period, 71,299 syphilis tests were performed on 30,422 patients. There were 2288 (3.2%) positive syphilis tests. Seventy-seven patients had a confirmed eye diagnosis (0.25%). Patients with eye disease had higher probability of at least one positive syphilis test (33%) compared to those without eye disease (8%) ( p < 0.01). Of patients with eye disease, 77% were men who had sex with men (MSM) and 65% were HIV-positive. Patients with eye disease had 5.97 (95% CI: 3.70, 9.63) higher odds of having syphilis compared to patients without eye disease. When adjusted for age, race, gender/sexual orientation, insurance status, and HIV status, this association between positive syphilis test and eye disease decreased but was still significant (OR 2.00, 95% CI 1.17, 3.41). Patients who present with an eye diagnosis to STI/primary care clinic have a higher probability of positive syphilis tests even after adjusting for other risk factors for syphilis. High-risk patients with eye symptoms should have routine STI testing and in keeping with CDC and AAO recommendations, full ophthalmologic examination.
2015年，美国疾病控制与预防中心（CDC）和美国眼科学会（AAO）发布了关于眼部梅毒病例增多的临床咨询意见。我们调查了在一家城市女同性恋、男同性恋、双性恋、跨性别者（LGBT）健康中心就诊的初级保健和性传播感染（STI）诊所患者中眼病与梅毒感染之间的关联。我们对2010年1月1日至2015年12月31日期间在霍华德·布朗健康中心接受梅毒检测的所有患者进行了回顾性病历审查。确诊的眼部诊断基于国际疾病分类第九版（ICD - 9）中结膜炎、葡萄膜炎、角膜炎、视网膜炎和红眼的诊断代码。提取了人口统计学信息、梅毒治疗情况、HIV状态和高危行为信息。梅毒诊断由可用的实验室数据（酶免疫测定[EIA]、快速血浆反应素[RPR]滴度、荧光密螺旋体抗体吸收试验[FTA - Abs]、梅毒螺旋体抗体）确定。采用具有稳健方差的多变量逻辑回归来确定独立关联。在研究期间，对30422名患者进行了71299次梅毒检测。有2288次（3.2%）梅毒检测呈阳性。77名患者确诊患有眼病（0.25%）。与没有眼病的患者相比，患有眼病的患者梅毒检测至少有一次呈阳性的概率更高（33%对8%）（p < 0.01）。在患有眼病的患者中，77%是男男性行为者（MSM），65%为HIV阳性。与没有眼病的患者相比，患有眼病的患者患梅毒的几率高5.97倍（95%置信区间：3.70，9.
