Cluster of eye syphilis cases prompts CDC concern

A cluster of ocular presentation of syphilis has experts questioning whether this rare finding suggests the bacterium has mutated, according to a report by the Centers for Disease Control and Prevention (CDC). With the incidence of syphilis infection in women increasing in the United States, experts are asking clinicians to be on the lookout for unusual eye conditions. “This is the first time such a cluster has been reported in the US,” the International Society for Infectious Diseases posted on ProMED. Five women in Southwest Michigan who had a common male sex partner developed syphilis infections in their eyes. No new cases have been found related to these five cases after the women and the man received medical care. 

If left untreated, the bacterium, Treponema pallidum, can infect the eyes, the ears, and the central nervous system. The women, identified as non-Hispanic White, were aged 40-60 years and were not infected with HIV. They were diagnosed with early-stage syphilis and all were hospitalized and treated with intravenous penicillin. Routes of sexual exposure among the women included anal (40%), oral (40%), and vaginal (100%), the report states. The common male sex partner they all met online was found to have early latent syphilis but never developed ocular syphilis. The 5 women presented with a variety of symptoms.

It is not the eyes that are being exposed. Rather, it is an ocular presentation brought about by a systemic infection carried through the bloodstream after sexual exposure, explains William Nettleton, MD, MPH, medical director of the Kalamazoo and Calhoun public health departments in Michigan and lead author of the report. “If we screen, identify, and treat syphilis promptly we can prevent systemic manifestations,” he says.  Clinicians should be aware that the ocular manifestations can come at different stages of syphilis. “For patients you think may have ocular syphilis,” Nettleton says, “an immediate ophthalmologic evaluation is indicated.” 

Multiple attempts to contact the male partner by telephone and text were made by Michigan Department of Health and Human Services, but he did not respond. Local public health physicians reviewed the man’s electronic health record and discovered that he had sought care at a hospital emergency department in January 2022 for ulcerative penile and anal lesions. He reported having multiple female sex partners during the previous 12 months but declined to disclose their identities; he reported no male or transgender sexual contact, according to the CDC report. Eventually he agreed to an evaluation, was found to have early latent syphilis, and was treated with penicillin. Cases of syphilis  have been soaring in the United States in recent years, reaching a 70-year high.

Source: Marcia Frellick, Medscape Medical News, December 18, 2023; see source article