Almost any ocular tissue may be affected. Optic Nerve Disease. The optic nerve is affected in a substantial percentage of patients with secondary syphilis. Anterior optic neuritis usually occurs in the late secondary stage of syphilis.
Visual loss is rapid and usually associated wth the development of a visual field defect.
The fields vary widely. Retrobulbar optic neuritis may occur in patients with syphilitic retinitis, syphilitic meningitis or syphilitic periosteitis that affect the orbit. Unless CSF contamination by seropositive blood occurs during lumbar puncture, a reactive CSF VDRL is nearly allways diagnostic of pasr or present neurosyphilis. CSF treponemal tests are frequently reactive in patients with serologic evidence of syphilis but no other CSF or neurologic findings suggestive of neurosyphilis. Since data from studies in the pre-antibiotic erasuggest that such patients are at little risk for developing clinical neurosyphilis, even if untreated, many experts would not diagnose neurosyphilis based solely on reactive CSF treponemal serologic tests.