Let's learn more about ocular syphilis, which also affects the eyes.

You've probably heard of sexually transmitted infections (STDs). Some of these diseases can affect other parts of the body if not treated properly. Similarly, if not treated properly, a disease called syphilis can also affect your eyes. Today we're talking about a condition called ocular syphilis, which affects the eyes. Although this is a serious story, being properly informed can prevent many problems.

Simply put, what is ocular syphilis?

Simply put, Ocular Syphilis is a complication of syphilis that occurs in the eyes if you have the disease and it is not treated properly. Syphilis is a bacterial infection and a sexually transmitted infection (STI). This infection can also be passed from a pregnant mother to her baby.

If left untreated, syphilis can spread to your nervous system, brain (Neurosyphilis), ears (Otosyphilis), and eyes (Ocular Syphilis). If left untreated, ocular syphilis can cause vision loss and even blindness. This is why it is important to be aware of this.

How common is this condition?

Worldwide, about 12 million new syphilis cases are reported each year. In a country like America, it is said that between 1% and 5% of those who develop ``Neurosyphilis`` develop ``Ocular Syphilis``. This condition is not absent in Sri Lanka, so we should also be concerned about this.

What are the symptoms? How do you recognize it?

Doctors call syphilis "the great deceiver." That's because the disease can mimic the symptoms of many other diseases. That means it can sometimes be difficult to recognize it as syphilis.

Symptoms of `(Ocular Syphilis)` can appear at any stage of syphilis. However, they are most often seen in the later stages of the disease. If you do not receive treatment, the disease will gradually progress through different stages.

Let's also learn about the stages of syphilis.

Syphilis can be divided into several main stages:

• Primary Stage: This stage can begin within two to twelve weeks after you are exposed to someone with syphilis. This is when a painless sore (`chancre`) develops in your genital area. Although this sore heals on its own within a few days, you can still pass the disease on to someone else.
• Secondary Stage: Within one to six months after the aforementioned sore has healed, you will develop a rash. You can still infect others during this stage.
• Latent Stage: If you haven't been treated yet, you still have syphilis at this stage. However, you may not have any symptoms. During this stage, the risk of passing the disease to sexual partners is low.
• Tertiary Stage: This is the final and most severe stage of the disease. Specifically, it is during this stage that serious health problems can occur. Conditions such as `(Ocular Syphilis)` may also be seen more frequently during this period.

What are the symptoms that only appear in the eyes?

Now let's see what symptoms specifically affect the eyes in the case of `(Ocular Syphilis)`:

• Redness of the eyes.
• Seeing small objects floating in front of the eyes (`(Eye floaters)`).
• Eye pain.
• Sensitivity to light, meaning difficulty looking at light (Photophobia).
• Abnormal eye movements.
• Argyll Robertson pupil: This is a condition in which the pupil of the eye contracts, especially when looking at something close up. However, it does not contract when exposed to bright light.
• Blurred vision or complete loss of vision.
• Sores, lumps, or spots in or around the eyes.
• Very rarely, a painless sore (`(Chancre)`) may develop on the eyelid.

Important: If you have one or more of these symptoms, it is very important to seek medical advice immediately. Early recognition and treatment can prevent serious damage.

What parts of the eye does this affect?

Syphilis can actually affect any part of the eye. However, it most often affects the uvea. The uvea is the membrane-like part of the eye that lies beneath the white of the eye (the sclera). It contains the iris, choroid, and ciliary body.

This inflammation and infection of the `(Uvea)` is called `(Uveitis)`. Many doctors believe that everyone with `(Uveitis)` should be tested for syphilis. There may be a connection between the two.

What causes this? How does it spread?

Both syphilis and ocular syphilis are caused by the bacterium Treponema pallidum.

Syphilis is spread through close skin-to-skin contact with an infected person. Most often, syphilis is transmitted through unprotected oral, anal, and vaginal sex.

If you are pregnant, this infection can also be passed on to your baby. That's why it's so important to get tested for syphilis during pregnancy. If you have syphilis, it can harm your baby.

Who is at greater risk?

Some people may be at higher risk of developing Ocular Syphilis. These include:

• People who have unprotected sex, especially if they have more than one sexual partner.
• Men who have sex with men (MSM).
• People who are currently infected with HIV or have been confirmed to have another sexually transmitted infection.
• People who have had sex with someone who has been confirmed to have syphilis.

What are the complications if left untreated?

If Ocular Syphilis is not treated properly, complications such as these can occur over time:

• Cataracts.
• The formation of new blood vessels in the eye (`(Neovascularization of your eye)`).
• Corneal opacity.
• Glaucoma (Glaucoma).
• Wrinkling of the retina of the eye (`(Macular pucker)`).
• Swelling of the macula (macular edema).
• Scarring of the eye tissue.

Hearing these things may sound scary, but remember, all of this can be prevented if the disease is identified early and treated properly.

How do you know exactly where this is?

To find out if you have ocular syphilis, your doctor will ask you questions about your symptoms and your medical history. Then, an ophthalmologist will do a complete eye exam and several other tests. They will check for:

• Your visual acuity.
• The function of the black ring in your eyes.
• The pressure in your eyes.
• Your blood tests.
• Sometimes, even cerebrospinal fluid (CSF) may be tested.

What tests are being done?

These are some of the main tests used to diagnose Ocular Syphilis:

• Blood tests (especially tests for syphilis).
• Tonometry test to measure eye pressure.
• A microscopic examination called a ``slit lamp exam'' (this allows you to see the inside of the eye in detail).
• Fluorescein angiography (This involves injecting a special fluid into the eye and taking pictures of the blood vessels inside).

How is this treated? Can it be cured?

The good news is that Ocular Syphilis can be completely cured with antibiotics! The most common antibiotic used is penicillin. However, the treatment may vary depending on the stage of syphilis. Your doctor may also prescribe eye drops or other oral medications.

What medications are given?

Doctors usually recommend treatments like these:

• An antibiotic called `(Penicillin G)` is given intravenously (`(IV)`) for 10 to 14 days.
• Sometimes, an injection called Benzathine penicillin G, which is injected into the muscle (intramuscular) for three weeks, is also given along with a medicine called Probenecid, which is taken orally.
• If you are allergic to penicillin, you may be given other antibiotics such as ceftriaxone or azithromycin.

The best treatment for ocular syphilis and neurosyphilis is intravenous penicillin. If you are allergic to penicillin, doctors will sometimes try to desensitize you to the drug so that you can use it.

Special: Treatment of Syphilitic Keratitis, a condition caused by syphilis

There is a small difference here. If you have Syphilitic Keratitis, an inflammation of the cornea of ​​your eye caused by syphilis, your doctor will prescribe steroids instead of antibiotics.

After starting antibiotic treatment, your doctor may prescribe oral steroids or eye drops to reduce inflammation in your eyes. They may also prescribe other eye medications, such as:

• Non-steroidal anti-inflammatory drugs (NSAIDS) that reduce inflammation.
• Eye drops that reduce dryness (Lubricants).
• Medicines that dilate the pupil of the eye (`(Mydriatics)`).

Are there any side effects of the treatment?

Syphilis treatments can also cause some side effects or risks. Some of them are:

• `(Jarisch-Herxheimer reaction (JHR))`: This is a reaction that can occur with intravenous medications. It can cause fever and sweating, headache, increased body temperature, or increased inflammation of the eyes. Doctors are on the lookout for this.
• Permanent vision loss: Using steroids alone without antibiotics can cause irreversible vision loss. If you have uveitis due to syphilis, you should definitely take antibiotics as well.
• Complications of Steroid Use: Although steroids are a very useful medication, they can cause side effects when used for a long time. These include weight gain, mood swings, insomnia, and high blood pressure and sugar levels.

How soon will I feel better after treatment?

Treatment for Ocular Syphilis usually takes about two weeks, sometimes longer. You may start to feel better within a few days of starting treatment. However, it is important to take the full course of medication prescribed by your doctor.

What will happen in the future? Will it fully recover?

Syphilis, as well as a condition called `(Ocular Syphilis)` , is a treatable disease. As with all eye diseases, early detection and prompt treatment of `(Ocular Syphilis)` can greatly reduce the damage to your vision. If you have other conditions, such as `(HIV)`, or if you had poor vision to begin with, these can also affect the results.

Can this be prevented from happening?

The only way to prevent syphilis is to avoid having sex with someone who has syphilis and to avoid touching syphilis sores.

How to reduce the risk?

You can do these things to reduce this risk:

• Abstaining from sex.
• Having sexual relations only with one trusted partner who is confirmed to be free of any sexually transmitted diseases.
• Always use latex condoms and dental dams correctly if you have oral, anal, or vaginal sex with other people.

When should you see a doctor?

If you notice any changes in your vision, or if you develop new symptoms or if your existing symptoms seem to be getting worse, see a doctor immediately.

When do you need to go to the emergency room?

In such a situation, go to an emergency room ( ETU ) immediately:

• If you suddenly lose your sight.
• If you experience severe pain in your eyes.
• If you have difficulty breathing due to an allergy to medication.

What questions should you ask the doctor?

When you go to see the doctor, you can ask questions like these:

• What are the most important things I need to know about Ocular Syphilis?
• What treatment do you recommend for me?
• What are the risks with this treatment?
• What side effects should I report immediately?
• How does the process of informing my sexual partners that they may also have syphilis work?

No one likes to hear that they have a sexually transmitted infection, such as syphilis. You might think that this kind of disease only affects the reproductive system. But that's not the case with syphilis. It can also affect your eyes, causing vision loss and blindness. However, if caught early and treated with a full course of antibiotics, your doctor can cure Ocular Syphilis. If you have ever had an allergy to penicillin, be sure to tell your doctor about it. Penicillin is the main treatment for this.

Our Take-Home Message

So, I hope you now have a good understanding of the condition called `(Ocular Syphilis)` that we talked about today. The most important thing to remember is that this is a curable disease, especially if it is recognized early and treated properly. If you have any doubts or symptoms, do not be shy or afraid to seek medical advice. Also, practicing safe sex is the best way to protect yourself from such diseases. Your eyes are a valuable asset, and it is your responsibility to protect them.

` Ocular Syphilis, Syphilis, Syphilis in the eyes, Sexually transmitted diseases, Eye diseases, Uveitis, Syphilis symptoms, Syphilis treatment