The global incidence of syphilis has been rising, and atypical clinical presentations are increasingly recognized. Human immunodeficiency virus (HIV)-induced immune changes can alter syphilis progression and complicate diagnosis. Otosyphilis is a rare but potentially reversible cause of sensorineural hearing loss (SNHL). This study investigates otologic involvement in patients co-infected with syphilis and HIV. Medical records of patients diagnosed with both syphilis and HIV infection at Etlik City Hospital between January 2023 and June 2025 were retrospectively reviewed. Adults aged ≥ 18 years with audiometry-confirmed SNHL were included. Other causes of hearing loss were excluded. Demographic, clinical, laboratory, radiologic, and treatment data were collected and analyzed. Among 591 patients diagnosed with syphilis, 152 were HIV-positive, and five met inclusion criteria. Four had newly diagnosed HIV infection. None reported hearing loss spontaneously; symptoms were identified through systematic questioning or physical examination. Serologic profiles varied: three showed combined TPHA and VDRL positivity, one had isolated TPHA positivity, and one had isolated VDRL positivity. Lumbar puncture (LP) in four patients revealed abnormalities in two, including one with cerebrospinal fluid VDRL positivity. One patient who declined LP had magnetic resonance imaging findings compatible with neurosyphilis. All patients received intravenous penicillin G and progressively tapered prednisone treatment for 14 days, and clinically significant hearing improvement was observed in all cases; four of them were documented with audiometric measurements. Otosyphilis should be considered in individuals with HIV infection presenting with auditory symptoms, and syphilis testing should be performed in unexplained SNHL. Early recognition and appropriate treatment are critical to preventing irreversible hearing loss.
Solay et al. (Fri,) studied this question.