scientific report

A new study into recent cases of Ocular Syphilis warns increasing numbers of people in developed countries are at risk of permanent damage to their vision, even with adequate treatment. More cases in the United States, Europe, and Australia show that it is not only a problem in Brazil.

Members of the International Ocular Syphilis Study Group analysed cases at four medical centres in Brazil over two and a half years. In 2012, only one case of Ocular Syphilis was identified per year, but from 2013 onwards, the figure increased to eight per year.

The study identified 127 patients with 87 of these suffering ocular inflammations in both eyes. Exams revealed some patients had suffered structural and functional alterations such as retinal detachment.

Professor Justine Smith, from Flinders University's College of Medicine and Public Health, says the disease can lead to blindness by disrupting light from reaching the retina if not treated in a timely manner.

Professor Smith says the findings in Brazil are a reflection of the diseases re-emergence around the world.

“When Ocular Syphilis is untreated or treated late, it can spread to most internal components inside the eye and cause greater symptoms, such as changes in vision clarity and eventually blindness,”

“However some symptoms can be reversed entirely with early treatment but if more serious complications occur vision loss can unfortunately be permanent.”

Symptoms include redness in eyes, blurry vision but because many signs of Ocular Syphilis can appear to be a variety of other illnesses, it can often go undetected.

Ocular Syphilis is a sexually transmitted infection (STD) caused by the bacterium Treponema pallidu. After returning in the 1980s because of AIDS, it gained epidemic status at the World Health Organization (WHO).

Co-author, Professor Joao Marcello from the University of Sao Paulo, says general practitioners should refer eye complaints to ophthalmologists whenever they diagnose
a case of Syphilis.

"There is no longer a stigma associated with Syphilis. Although the disease affects more men, especially men who have sex with men, anyone can be exposed and infected so early detection is increasingly important. "

The majority of cases identified around the world have been attributed to high risk sexual practices and the growth in global travel, and the impact of immune system functions with HIV.

“The 1990s and 2000s indicated that ocular syphilis was a rare diagnosis, accounting for less than 2% of all treated cases. More recent reports describe cohorts of up to 85 patients with ocular syphilis in the United States, Europe, and Australia which shows it’s not only a problem in Brazil,” Professor Marcello says.

Professor Smith says more than half of the patients studied lost vision to below driving level.

“Our most important observation is the role of testing in a timely diagnosis of syphilitic uveitis which should limit vision loss,”

“Patients didn’t present to clinics for treatment until they had a problem for some months and that’s not completely the fault of the patient,”

“Doctors are no longer accustomed to seeing syphilis so it’s not picked up for an extended period of time which means patients will develop complications.”