Here’s an exciting conversation starter to start during your family’s Thanksgiving feast this year: Health officials in Michigan have identified an alarming cluster of syphilis eye infections in women.
The first cluster of its kind (in five women, all linked to an infected man) raises the possibility that a new strain of syphilis bacteria has adapted to more easily cause systemic syphilis, particularly a disease that affects the eyes and the central nervous system. Michigan health officials today release a report on the cluster and what it could mean for the Centers for Disease Control and Prevention. Weekly Morbidity and Mortality Report.
Ocular syphilis, also known as ocular syphilis, is not new. syphilis bacteria, Treponema pallidum (before Spirochaeta pallida) are known to be able to spread to the eyes, as well as the inner ear and central nervous system when the sexually transmitted infection is left untreated. This spread can lead to blindness, deafness, and life-threatening neurosyphilis if left untreated.
But ocular syphilis is rare. It is only found in about 1 percent of syphilis cases, similar to inner ear and neurosyphilis, according to a large analysis published last year. When ocular syphilis develops, it is most commonly seen in people who have late-stage syphilis, people 65 years of age or older, people who report injection drug use, and HIV-positive people.
But, in this group, all five women had early-stage infections. All were between 40 and 60 years old and none reported injection drug use. This group of ocular syphilis is also the first documented related to heterosexual transmission.
Group cases
The series of cases began to unravel in March 2022, when an ophthalmologist referred the first woman, Patient A, to the Kalamazoo County Health and Community Services Department (KCHCSD). The woman reported blurred vision, fear of going blind, and genital injuries. Tests indicated syphilis and she reported only one sexual partner in the past 12 months: a man she met online. Within days, the state health department approached the man but was turned away.
Weeks later, in April 2022, Patient B was admitted to a hospital with neurosyphilis. An ophthalmologist had identified cranial nerve abnormalities and sent her to the emergency department. There she reported headache, mild hearing loss, blurred vision and double vision. She named the same recent sexual partner reported by Patient A, saying she also met him online.
In May 2022, Patient C was reported to a local health department in southwest Michigan. He had a rash all over his body, floaters in his eyes, sensitivity to light, and cranial nerve abnormalities. He again reported the same couple as patients A and B and said she had met him online.
Patient D was diagnosed with ocular syphilis in June 2022, again naming the same partner. And in July 2022, patient E was admitted to the hospital with ocular syphilis and neurosyphilis, again naming the same partner as the other cases.
From March to May, state health officials approached the common male sexual partner several times. But he provided little information, saying she had left the state and failed to show up for a scheduled doctor’s appointment in April. In May, after Patient C was identified, a public health physician searched the man’s electronic medical records and discovered that in January 2022 he had presented to a hospital emergency department for ulcerative genital and anal lesions. At that time, he was treated for a suspected herpes infection, but his herpes test was negative and he was not tested for syphilis.
Implications for public health
Also in May, a state disease intervention specialist was able to renew contact with the man and he showed up for an appointment at KCHCSD. At the appointment, doctors observed that the man had no signs of syphilis, no vision problems or hearing problems. Laboratory tests confirmed that he had early latent syphilis, a stage of the disease that occurs within a year of an initial infection when symptoms appear to resolve but the disease is still present. The man reported having had multiple sexual partners over the past year, but refused to reveal their identities.
Patients B to E also reported having other sexual partners. Of those who were identified, health officials reported that they tested negative for syphilis. Patient E did not identify her other partners and officials were unable to contact them.
Given the strange nature of this group, Michigan health officials speculated that the man could have been infected with a strain of pallidum which is more likely to cause ocular neurosyphilis and than others. But they couldn’t identify the strain. Genetic testing for syphilis works best when there are primary ulcers or moist lesions from which bacteria can be removed. Only patient A had primary stage syphilis with genital lesions at the time of diagnosis.
All of the women and the man were treated for their infections, and no other cases in Michigan have since been linked to anyone in the group. The fact makes health officials hopeful that they have stopped the spread of this disastrous unidentified disease. pallidum strain, but it is impossible to know without broader surveillance and identification of all sexual partners.
Even without a worrying new strain of pallidum Around the world, the state of sexually transmitted infections in the United States is dire. Rates of STIs, including syphilis, chlamydia and gonorrhea, have been skyrocketing for years. In a report earlier this year, the CDC noted that national syphilis cases increased 74 percent between 2017 and 2021. In 2022, the number of babies born with syphilis was more than 10 times higher than in 2012.
