Ocular syphilis is a severe manifestation of syphilis, a bacterial infection that specifically impacts the eyes. This condition can lead to significant vision impairment, including permanent blindness, if not diagnosed and treated promptly.
What is Ocular Syphilis
Ocular syphilis is a complication arising from a systemic syphilis infection. It occurs when the bacterium Treponema pallidum, which causes syphilis, spreads to and affects the eye structures. This ocular involvement can emerge at any stage of syphilis, whether primary, secondary, latent, or tertiary.
The infection can inflame and damage various parts of the eye, leading to a wide range of symptoms that may mimic other eye conditions. The uvea, the middle layer of the eye, is frequently affected, leading to a condition called uveitis.
How Syphilis is Transmitted
Syphilis is primarily transmitted through direct contact with a syphilis sore, known as a chancre, during sexual activity. This includes vaginal, anal, and oral sex. The bacteria enter the body through the mucous membranes or small breaks in the skin.
The infection is highly contagious during the primary and secondary stages when these sores or rashes are present. Even without penetration or ejaculation, direct skin-to-skin contact with an active lesion can lead to transmission.
Syphilis can also be passed from a pregnant person to their baby during pregnancy, resulting in congenital syphilis. This occurs when the Treponema pallidum bacteria cross the placenta, potentially leading to serious health issues for the newborn. Consistent screening for syphilis during prenatal care is therefore important.
Historically, syphilis could be transmitted through blood transfusions, but this route is now extremely rare due to routine screening of donated blood. Transmission through sharing needles is also possible, though it is less common for syphilis compared to other bloodborne infections.
How Syphilis Affects the Eyes
Once the Treponema pallidum bacterium enters the body, it can travel through the bloodstream and disseminate to various organs, including the eyes. This systemic spread allows the bacteria to invade eye tissues, leading to inflammation and damage characteristic of ocular syphilis.
Ocular syphilis can manifest in diverse ways depending on the specific eye structures affected. Common manifestations include uveitis, which is inflammation of the uvea, and can be present in the anterior or posterior parts of the eye. Other possible manifestations include retinitis, an inflammation of the retina, or optic neuritis, which involves inflammation of the optic nerve.
The visual symptoms, such as blurred vision, floaters, eye pain, or sensitivity to light, arise from the inflammatory responses triggered by the presence of the bacteria within the eye. Ocular syphilis is considered a form of neurosyphilis because the eye is an extension of the central nervous system.
Risk Factors for Ocular Syphilis
Engaging in unprotected sexual activity significantly increases the risk of acquiring syphilis, and consequently, ocular syphilis. This includes any form of sexual contact without barrier methods like condoms. Having multiple sexual partners also elevates the likelihood of exposure to the Treponema pallidum bacterium.
Individuals who have other sexually transmitted infections (STIs) are at a higher risk for syphilis, including ocular involvement. Co-infection with HIV can alter the course of syphilis and increase the chance of ocular manifestations.
A lack of regular STI screening can delay the diagnosis and treatment of syphilis, allowing the infection to progress to more severe stages, including ocular syphilis. A history of syphilis infection does not provide immunity, and re-infection is possible, placing individuals at renewed risk. Increasing age has also been associated with a significantly increased risk of ocular syphilis.