To evaluate the efficacy of oral doxycycline as an alternative treatment to intravenous (IV) penicillin for ocular syphilis.
Methods
32 patients received either oral doxycycline or a full course IV penicillin through shared decision making. Retrospective chart review was performed to assess clinical resolution, serologic resolution, treatment regimen completion, and loss to follow-up. Outcome measures included clinical resolution of ocular inflammation, improvement in visual acuity, and serologic resolution (four-fold RPR titer reduction).
Results
A total of 32 patients with ocular syphilis were included in the cohort; 16 patients were treated with oral doxycycline and 16 were treated with IV penicillin. The median age was 46 years (IQR: 36-56) and 78% of the cohort was male. Visual acuity at presentation was better in the doxycycline group (0.44 logMAR (IQR: 0.18-1.09) vs 1.0 (IQR: 0.39-1.70); p=0.0378). Visual acuity improved in both groups, with the doxycycline group showing better final visual acuity (0.18 logMAR vs. 0.40 logMAR; p=0.0272). Clinical resolution at one month and final follow-up was achieved in 75% of patients, with no significant difference between groups. There was a fourfold decrease in RPR titers in 100% of patients treated with doxycycline and penicillin who had RPR titers measured.
Conclusion
Oral doxycycline is a safe and effective alternative to IV penicillin for treating ocular syphilis in selected patients. This outpatient regimen avoids the risks and costs associated with hospitalization and PICC lines. Careful patient selection and monitoring are essential to mitigate the risk of non-adherence and treatment failure. Further prospective studies are needed to confirm these findings and establish long-term outcomes.
Conflict of interest
No
1
Last name
BAO
Initials of first name(s)
Y
Department
USC Roski Eye Institute
City
Los Angeles
Country
United States
2
Last name
Hwang
Initials of first name(s)
J
Department
USC Roski Eye Institute
City
Los Angeles
Country
United States
3
Last name
Long
Initials of first name(s)
C
Department
USC Roski Eye Institute
City
Los Angeles
Country
United States
4
Last name
Davar
Initials of first name(s)
K
Department
Los Angeles General Medical Center
City
Los Angeles
Country
United States
5
Last name
Kapadia
Initials of first name(s)
N
Department
Los Angeles General Medical Center
City
Los Angeles
Country
United States
6
Last name
Spellberg
Initials of first name(s)
B
Department
Los Angeles General Medical Center
City
Los Angeles
Country
United States
7
Last name
Wong
Initials of first name(s)
B
Department
Los Angeles General Medical Center
City
Los Angeles
Country
United States
8
Last name
Rao
Initials of first name(s)
N
Department
Los Angeles General Medical Center
City
Los Angeles
Country
United States
9
Last name
Toy
Initials of first name(s)
B
Department
USC Roski Eye Institute
City
Los Angeles
Country
United States
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