Blinding Syphilis: West Coast Cases Rise

Recently, the west coast has seen an unusual increase in ocular syphilis cases. Since December 2014, there have been 14 confirmed cases and two suspected cases of this rare disease [1-3,5-6].  Eight of the confirmed cases were in individuals also infected with HIV, five of the cases were among men who have sex with men, and two of the cases have already resulted in blindness [1-3]. The confirmed cases occurred in Washington state and San Francisco, California. Los Angeles County is currently investigating the two suspected cases that were reported to the Department of Public Health on Tuesday, March 10th [3].


What is Ocular Syphilis?

Syphilis is a sexually transmitted disease (STD) caused by the bacteria, Treponema palidium [5].  A syphilis infection occurs as the result of direct contact with a syphilis sore called a ‘chancre’, which can be present on the external genitals, anus, rectum, as well as the inner mouth and lips of an infected individual [4].  Once infected, syphilis can be spread by person-to-person transmission during vaginal, anal or oral sex [4]. The disease has been classified in the following stages: primary, secondary, and latent syphilis. Primary syphilis consists of the appearance of a single or multiple, painless syphilis sores, while secondary syphilis consists of the appearance of a skin rash and mucous membrane lesions. Latent syphilis can occur if the disease has been left untreated [4]. These individuals are generally asymptomatic for years, but the disease can ultimately damage the internal organs and brain, and cause death [4].

Ocular syphilis can develop as a complication of primary or secondary syphilis that has been left untreated, and can cause blindness [1-3,5]. Symptoms of ocular syphilis include red eyes, inflammation, eye pain, blurred vision, light sensitivity, sudden loss of vision, and seeing floating spots [5,6].


The Importance of Screening

As a result of this outbreak, public health officials have been encouraging health care providers – particularly primary care doctors and optometrists – to be cognizant of patients showing symptoms associated with ocular syphilis [1-3,5]. Syphilis is easy to cure with penicillin if detected in the early stages of the disease. However, despite the availability of antibiotics and continuous public health interventions, syphilis remains a common infection within the United States [4]. A steady increase in the rate of infections has been noted since 2000, with the majority of infections occurring among men who have sex with men, and concurrent in individuals infected with HIV [4].  In 2013, California had the second highest rate of syphilis infections in the nation, following Georgia [1]. This increase in ocular syphilis cases has highlighted the importance of regular STD screening exams for all sexually active individuals, but especially those who are at an increased risk [1-3]. Additionally, public health campaigns should focus on the importance of condom use to help stop the spread of this sexually transmitted disease.




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