This is a condition that negatively affects the eyes when a person leaves syphilis untreated. It is called ocular syphilis, and with early diagnosis and proper treatment, it can help prevent serious complications of this disorder. However, diagnosing ocular syphilis is often difficult because there are multiple infections (such as uveitis) that cause similar symptoms.
Syphilis is a sexually transmitted infection (STI) that occurs due to a bacterium. This disorder is very serious because it may spread to the developing fetus during pregnancy. However, if this STI is left untreated, it may lead to multiple health problems, including neurosyphilis (affecting the central nervous system and the brain), Ocular syphilis (also called eye syphilis) affecting your eyes, and otosyphilis (affecting your ears). Moreover, this condition can cause permanent loss of vision without treatment.
In general, there are about 12 million new cases of syphilis per year in the entire world. Approximately 55,400 of them are in the U.S. According to some data, about 1% to 5% of people with syphilis also develop neurosyphilis in the U.S.
Symptoms
Sometimes, this STI is called by doctors “the great imitator” because it looks similar to multiple health conditions. The symptoms of ocular syphilis can occur at any stage of syphilis. Without treatment, this STI often progresses through stages. These include:
- Primary – This stage often begins within 12 weeks after exposure to the bacteria, and it usually causes genital sores that are not painful.
- Secondary – It occurs 1-6 months after the sores disappear, and you will notice a rash on the body. At this stage, the infection can pass to other people.
- Latent – Without treatment, people usually still have syphilis at this stage, but they do not have any symptoms.
- Tertiary – This is the latest stage of this STI, where the most serious health problems occur.
Check below some general symptoms of syphilis:
- Red eyes
- Eye floaters or pain
- Photophobia (increased sensitivity to light)
- Abnormal eye movements
- Argyll Robertson pupil – This medical term refers to small pupils that get smaller when you are focusing on a near object
- Vision changes (such as blurred vision or loss of vision)
- Chancre on eyelid (rarely)
- Lesions (including bumps or spots) on or in the eyes
Immediately contact your healthcare professional if any of the symptoms listed above occur.
Causes and Risk Factors
This disorder occurs due to a bacterium called Treponema pallidum. Moreover, this bacterium can spread from one person to another through close skin-to-skin contact with an infected person. In most cases, syphilis spreads to other people through unprotected oral, anal, or vaginal sex.
It is important to understand that pregnant women can pass the infection to their unborn baby. That’s why healthcare professionals test for syphilis while you are pregnant. Furthermore, healthcare professionals have identified some factors that could increase your risk of developing ocular syphilis. Examples include:
- Unprotected sex (especially if you have multiple partners)
- MSM (sex among two males)
- A positive test for other STIs (such as HIV infection, gonorrhea, or others)
- You have had sex with an infected person
What Are The Potential Complications of Ocular Syphilis?
People with this eye disorder may also experience some complications, especially if the condition is left untreated. Check below some examples:
- Cataracts
- Corneal opacity (the cornea is no longer see-through)
- Neovascularization of the eye
- Glaucoma
- Macular pucker
- Scarring of eye tissue
- Macular edema (swelling of the macula)
- Retinal vasculitis
- Uveitis
- Interstitial keratitis
- Optic neuropathy (damage to the optic nerve)
- Blindness (permanent loss of vision)
- Hutchinson’s triad – This is a combination of interstitial keratitis, notched incisors, and sensorineural hearing loss. However, this condition usually indicates congenital syphilis.
This document does not contain a full list of ocular syphilis complications. In any case, you can talk with your doctor about ways to reduce the risk of or even prevent them.
How to Prevent Ocular Syphilis?
The best way to prevent ocular syphilis is to avoid sexual activity with an infected person and avoid touching syphilis sores. Check below some tips that may help reduce the risk:
- Abstain from sex (especially with multiple partners)
- Have sex with one partner who has tested negative for STIs
- Use protection during sexual intercourse (such as condoms or dental dams)
Diagnosis
Usually, doctors begin the diagnosis of this eye disorder with questions about the symptoms and medical history. You may also be referred to an ophthalmologist for a complete eye examination and other tests. During this examination, they will check for visual acuity, eye pressure, pupils, blood serum, and cerebrospinal fluid (CSF). Check below for other tests often used to confirm or rule out this STI:
- Tonometry
- Fluorescein angiography
- Slit lamp examination
- Blood tests
Treatment
Healthcare professionals can cure ocular syphilis with antibiotics. The primary antibiotic used to treat this condition is Penicillin. However, they can also recommend other medicines depending on the disease stage. These include topical or other oral medications to relieve the symptoms. Generally, doctors will recommend the following options. Examples include:
- IV (intravenous) Penicillin G antibiotics for 10 to 14 days
- Intramuscular injections that contain Benzathine Penicillin G, along with oral medications with Probenecid for 21 days
- Azithromycin or Ceftriaxone for people who are allergic to Penicillin
However, if you develop syphilitic keratitis, physicians often prescribe steroids instead of antibiotics. In addition, oral and topical steroids are also used to reduce inflammation. They often recommend NSAIDs (nonsteroidal anti-inflammatory drugs), lubricants for the eyes, and medicines to dilate the pupils (mydriatics).
You should know that syphilis treatments may cause some adverse reactions. Check below some of them:
- JHR (Jarisch-Herxheimer reaction) – This reaction often occurs with IV medications. The most common symptoms include sweats, headaches, and rashes that may worsen the inflammation in the eyes.
- Permanent loss of vision – Some people may develop loss of vision that cannot be recovered if they are using high-dose steroids or use them for long periods.
- Steroid complications – In general, all people who use steroids are at increased risk of experiencing the following side effects. These include mood swings, weight gain, sleep disturbances (insomnia), hypertension (high blood pressure), hyperglycemia (high blood sugar), and others.
Frequently Asked Questions
How soon after treatment will I feel better?
In most cases, the treatment for ocular syphilis lasts approximately 14 days. Most people notice improvements within the first days after starting the treatment. In addition, it is very important to finish the course of prescribed medicines even if you do not have symptoms. Otherwise, the bacteria can become resistant to a specific type of antibiotic, which makes them more difficult to treat.
When should I go to the emergency room?
People who experience sudden loss of vision, severe pain in the affected eye, or breathing problems should go to the emergency room (ER) or call 911 right away.
What is the outlook for ocular syphilis?
Syphilis (including ocular syphilis) is a curable disorder, and most people have good outcomes. A big role in the outlook plays existing health conditions (such as poor vision, HIV infection, and others). Ask your healthcare provider if you have additional questions.
