# Ocular Syphilis in an HIV-Positive Transgender Female: A Case Report

## TL;DR

A transgender woman with HIV developed ocular syphilis, highlighting the need for early STI screening and addressing healthcare barriers for transgender patients.

## Contribution

This case emphasizes the importance of syphilis screening in HIV-positive transgender individuals with visual symptoms.

## Key findings

- The patient was diagnosed with syphilitic uveitis after delayed testing confirmed syphilis in the CSF.
- Treatment with penicillin improved visual symptoms and resolved optic nerve edema.
- Healthcare barriers delayed diagnosis, risking permanent vision loss in this transgender HIV-positive patient.

## Abstract

This is a case of a 56-year-old transgender female with a history of HIV who presented to the emergency department with visual disturbances and bilateral papilledema. Initially, intracranial abnormalities were ruled out through imaging studies. However, a lumbar puncture later confirmed the presence of syphilis in the cerebral spinal fluid (CSF), and the patient was diagnosed with bilateral syphilitic uveitis by a retina specialist. Treatment with intravenous and intramuscular penicillin led to significant improvement in her visual symptoms and resolution of optic nerve edema. This case underscores the importance of early screening for syphilis and other sexually transmitted infections (STIs) in transgender patients living with HIV presenting with visual symptoms. The delayed syphilis screening and treatment in this patient highlight the impact of healthcare barriers on transgender individuals. Prompt diagnosis and treatment are critical to prevent serious complications, such as permanent vision loss. Healthcare providers must maintain a high index of suspicion for syphilis in HIV-positive patients with visual symptoms, irrespective of their cluster of differentiation 4 (CD4) count or viral load. Addressing barriers to healthcare for transgender individuals is essential to ensure timely diagnosis and treatment to improve patient outcomes.