Sexually transmitted diseases (STDs) are infections primarily spread through sexual contact. While often associated with the reproductive system, some can affect the eyes. Ocular involvement can lead to problems ranging from mild irritation to severe vision loss.
STDs That Affect the Eyes
Chlamydia, a common bacterial STD, can cause eye infections. It can manifest as inclusion conjunctivitis, leading to redness, irritation, discharge, and swollen eyelids. Other symptoms include a gritty sensation, tearing, and light sensitivity. Untreated, it can lead to trachoma, a leading cause of preventable blindness from repeated infections and eyelid scarring.
Gonorrhea, another bacterial STD, can infect the eyes through contact with infected secretions. In adults, this results in gonococcal conjunctivitis, characterized by intense redness, significant eye discharge, and eyelid swelling. Untreated, it can advance to corneal ulcers, causing scarring and permanent vision loss. Newborn infection acquired during birth, known as ophthalmia neonatorum, carries a risk of severe eye damage and blindness.
Syphilis, caused by Treponema pallidum, can affect any part of the eye and is known as “the great imitator” due to varied presentations. Ocular syphilis commonly causes uveitis (inflammation of the uvea) at any stage. Other manifestations include interstitial keratitis (cornea inflammation), optic neuritis, and retinal vasculitis. Symptoms include redness, eye pain, light sensitivity, blurred vision, and floaters, which can lead to irreversible vision loss if untreated.
Herpes Simplex Virus (HSV), associated with cold sores and genital herpes, can cause eye infections. Ocular herpes (herpes keratitis) typically affects one eye, causing symptoms like eye pain, redness, tearing, blurred vision, and light sensitivity. While outer corneal infections often resolve without scarring, deeper infections can lead to scarring, vision loss, or blindness if recurrent or untreated.
HIV and its weakened immune system can lead to various ocular complications. HIV retinopathy, the most common eye problem in individuals with AIDS, involves changes to retinal blood vessels, appearing as cotton-wool spots and hemorrhages. While often not directly threatening vision, these can indicate systemic disease progression. Opportunistic infections are a concern for those with advanced HIV, including Cytomegalovirus (CMV) retinitis, a severe infection causing inflammation, bleeding, rapid vision loss, potentially leading to retinal detachment and blindness. Other conditions include ocular toxoplasmosis and Kaposi’s sarcoma, appearing as purple-red lesions on the eyelids or conjunctiva.
Diagnosing and Treating Ocular STDs
Diagnosing ocular STDs begins with a detailed patient history, including sexual health information. A thorough eye examination, often using a slit lamp microscope, identifies signs of inflammation or damage. Since ocular STDs can mimic other eye conditions, specific laboratory tests are crucial for confirmation.
For bacterial infections like chlamydia and gonorrhea, diagnosis involves swabs from eye discharge for laboratory testing (PCR or culture). Blood tests (RPR or VDRL) screen for syphilis; positive results are followed by treponemal tests. A lumbar puncture may be considered for ocular syphilis with neurological symptoms. For viral infections like herpes simplex, diagnosis is often clinical, though viral cultures or PCR tests can confirm. HIV diagnosis relies on blood tests detecting antibodies or antigens.
Ocular STD treatment is tailored to the infection and its severity. Bacterial infections like chlamydia and gonorrhea are treated with antibiotics (oral, eye drops, or intravenous for severe cases). Syphilis, including ocular syphilis, is treated with penicillin, often intravenously depending on stage and severity. Alternative antibiotics may be used for penicillin allergies.
Herpes simplex eye infections are managed with antiviral medications (eye drops, gels, or oral tablets) to reduce viral replication and prevent damage. Topical and oral antivirals may be combined. For HIV-related eye complications, treatment focuses on managing HIV with antiretroviral therapy (ART) to strengthen the immune system. Specific opportunistic infections, like CMV retinitis, are treated with antiviral drugs. Treatment aims to eliminate the infection, reduce inflammation, and prevent permanent vision loss.
Preventing Ocular STD Complications
Preventing ocular STD complications starts with safe sexual behaviors. Consistent condom use significantly reduces the risk of acquiring and transmitting STDs. This includes avoiding hand-to-eye contact after touching genital areas, as some infections can spread this way.
Regular STD screening is beneficial, especially for sexually active individuals or those with new partners. Early detection allows prompt treatment, preventing the infection from spreading to the eyes. Pregnant individuals should also be screened, as some infections can transmit to newborns during birth, leading to severe ocular issues.
Prompt diagnosis and treatment of any STD prevents systemic spread and ocular involvement. If unusual eye symptoms occur after unprotected sexual activity, seek immediate medical attention. Partner notification and treatment are vital to break the chain of transmission and prevent reinfection.