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Warning over syphilis-related vision loss

05/09/2018By Matthew Woodley
An Australian uveitis specialist has warned people are at risk of unnecessarily losing sight due to a sharp increase in the number of ocular syphilis cases being recorded around the world.

Ophthalmologist and uveitis specialist Professor Justine Smith from Flinders University said while the disease is easily treatable, its symptoms were often misdiagnosed as other conditions due to its previously low rates of infection. Smith recently collaborated on the largest ocular syphilis study ever undertaken with researchers in Brazil, which identified 127 cases across four clinics over a 2.5 year period.

“If you want to understand a disease as it's happening right at the moment, you need a large population to work with and Brazil has 10x the population of Australia,” Smith explained.

“Anyone who presents at our clinic with inflammation in the eye we test for syphilis.”
Justine Smith, Flinders

“The infection manifests in similar ways in different populations, so that was a reason why this was a great collaboration.”

Nearly 90 of the patients reported in the study were suffering inflammation in both eyes and exams had revealed that some had suffered structural and functional complications inside the eye, such as retinal detachment. However, according to Smith these symptoms are easily treated with penicillin – if they’re detected early enough.

“Anyone who presents at our clinic with inflammation in the eye we test for syphilis. It will be a minority of those people who have syphilis in the eye, but you don’t want to miss even one, because it’s very treatable,” she said.

“You can get the results back within a day, it’s really cheap, it’s very robust testing now and the treatment takes about two weeks and that gets rid of it.”

Statistics from the US Center for Disease Control (CDC) indicate a sharp increase in the number of people diagnosed with syphilis recently. In 2015 there were 7.5 cases per 100,000 persons, which represented the highest annual number and the highest rate of reported syphilis cases in approximately 20 years, and a 19% increase since 2014.

Meanwhile, during 2012–2016 the Australian notification rate of infectious syphilis increased 107% from 6.9 per 100,000 to 14.3 per 100,000. A recent ABC report also indicated the disease had reached “epidemic proportions” in North Queensland, where more than 1,100 cases had been recorded since 2008 – a year in which only two new cases were identified.


The most common symptoms of ocular syphilis is blurry vision, but Smith says more than half of the patients studied lost vision to below driving level.

“Patients didn’t present to clinics for treatment until they had a problem for some months, but it is not completely the fault of the patient. Doctors are no longer accustomed to seeing syphilis these days, so it may not be picked up for an extended period of time, during which patients may develop eye complications,” she said.

“Our most important observation is the role of testing in making a timely diagnosis of ocular syphilis, which should limit the risk of vision loss.”

More reading: The full study.


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