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‘The great masquerade’: Ocular syphilis rates rise in Victoria

The Royal Victorian Eye and Ear Hospital (RVEEH) is concerned about the exponential rise in ocular syphilis presentations, particularly in women, stemming from what experts have described as a syphilis epidemic in Victoria.

Dr Danielle Ong, who worked with a team of doctors at the hospital researching the condition from 2006 to 2019, said in the early 2000s RVEEH was recording approximately two cases of ocular syphilis per year.

Dr Danielle Ong.

But in 2018, cases had risen to 17, which then increased to 21 in 2019, seven whom were women. The disease can lead to permanent vision loss.

It comes after recent analysis by Alfred Health’s Melbourne Sexual Health Centre found a 45% increase in notified syphilis cases from 950 cases in 2015 to 1,375 cases in 2018 in Victoria.

While the number of syphilis infections among gay men continued to rise (21% increase), there was a sharp increase in cases among women (220% increase) and heterosexual men (129% increase). The alarming rise has prompted experts to warn that an “epidemic” is in place and swift action is required to bring it under control.

Ong, who specialises in medical retinal and uveitis at RVEEH, said she was concerned “by the exponential increase” in ocular syphilis presentations. She said it was a manifestation of the syphilis endemic occurring in Victoria and across the country.

“Ocular syphilis occurs when the bacteria enters the body and if left untreated can spread to the eye, and causes vision loss,” she said.

“We call syphilis the great masquerade because it can cause many different eye conditions, such as panuveitis, optic disc swelling, posterior placoid chorioretinitis or retinal vasculitis. When interviewing people with ocular syphilis, we find the most common symptoms are blurred vision or floaters. However, these can also be common symptoms of other eye conditions.”

The Royal Victorian Eye and Ear Hospital recorded 21 cases of ocular syphilis in 2019.

Ong said the disease was often treated with two weeks of intravenous antibiotics. But the challenge from a diagnostic point of view is was the possibility of syphilis in high-risk groups.

She said the treatment was readily available and accessible, and the outcome often favourable if the patients are willing to finish their course of treatment.

“Early detection is paramount. We strongly recommend to general public to present to an eyecare health professional if they notice any sudden changes in their vision,” Ong said.

“Optometrists and ophthalmologists work together as a team to care for patients. Optometrists are at the frontline screening people with eye symptoms. People with first presentation of uveitis are then referred to an ophthalmologist for uveitis work up following the standard protocol.”

Alarming rise among women

Epidemiologist Associate Professor Eric Chow, who was involved in the recent Alfred Health syphilis analysis, said the increasing number of cases in women was of most concern.

“The major concern with the rise in syphilis among women of reproductive age is infection during pregnancy and congenital syphilis,” he said.

“We know syphilis can cause major complications during pregnancy and even result in the death of the child so we’re urging all women at high risk to get screened during their third trimester in addition to the universal screening during the first.”

Chow said the re-emergence of syphilis among heterosexuals in Victoria means that prevention messaging should also be targeted at heterosexuals, particularly those residing in outer metropolitan areas.

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