The incidence of ocular
syphilis is increasing in the developing world even in the era of effective human immunodeficiency virus (HIV) treatment, as there is a potential increase of high-risk sexual behavior. Ocular involvement in the form of
uveitis is seen in all stages of
syphilis. Diagnosis begins with ophthalmologic examination, but requires serologic testing for confirmation. Ocular
syphilis presents with unusual presentations or mimics other diseases and is identified by serological screening. It is curable with a relatively short course of
antibiotic treatment, making its recognition a priority. All ophthalmic manifestations of
syphilis should be treated with a Centers for Disease Control and Prevention-approved
neurosyphilis regimen. In this report, we present a case of necrotizing
retinitis with no response to
antiviral treatment. On subsequent serological testing it was proved as
syphilis in a HIV-positive patient who responded well to intravenous
antibiotics with rapid visual recovery. Hence, awareness of this disease will promote early diagnosis and treatment.