Incidence and Prevalence of Syphilitic Uveitis and Associated Ocular Complications in the TriNetX Database

Abstract

Purpose: To determine the yearly and cumulative incidences and prevalences of syphilitic uveitis, concurrent sexually transmitted infections, and ocular complications using the United States TriNetX database. Design: Trend study. Participants: Subjects with syphilitic uveitis in the TriNetX database. Methods: Subjects with syphilitic uveitis from 2013 to 2024 were identified with International Classification for Disease (ICD) codes for uveitis with the constraint of a positive treponemal and nontreponemal test for syphilis within 1 month after the diagnosis of uveitis. Incidence and prevalence data were calculated from 2013 to 2024. Additional data collected included demographics, concurrent infection with other sexually transmitted infections (STI- HIV, gonorrhea, chlamydia), and ocular complications (macular edema and low vision). Main Outcome Measures: The primary outcomes were the incidence and prevalence of syphilitic uveitis (annual and cumulative). Secondary outcomes were the incidence and prevalence of concurrent sexually transmitted infections and ocular complications (annual and cumulative). Results: From the 81 759 791 total population in TriNetx, 161 317 cases of syphilis and 237 cases of syphilitic uveitis were identified. Of the 237 patients with syphilitic uveitis, 53.58% (N = 127, 95% CI 47.2%-59.9%) were White and 75.10% (N = 178, 95% CI 69.6%-80.6%) were male, with a mean age of 52 years (Range: 20-90, SD = 15). The most common STI co-infection was HIV (32.49%, 95% CI 26.53%-38.45%, N = 77). The most prevalent ocular complication was low vision and blindness (27.85%, 95% CI 22.16%-33.54%, N = 66); of which, the highest rates of low vision and blindness were in the cohorts with pan or posterior uveitis (78.79%, N = 52). The cumulative incidence and prevalence rates of syphilitic uveitis over the 2013 to 2024 period were 0.36 and 0.27 cases per 100 000, respectively. Conclusions: The rising incidence and prevalence of syphilitic uveitis from 2013 to 2024 mirrors the overall syphilis epidemic in the United States. This study highlights the need for serologic testing with treponemal and nontreponemal tests for syphilis in patients with uveitis and timely intervention to prevent irreversible visual complications.