A 52-year-old man was nearly blinded by a syphilis infection that attacked both of his eyes, a stark warning that the sexually transmitted disease can cause catastrophic vision loss.
The unnamed 'promiscuous' patient, according to his doctors in Bulgaria, experienced sight loss so rapid that within a month of the onset of vision symptoms, he could only perceive light in his right eye, according to a medical report.
Doctors diagnosed him with ocular syphilis, a consequence of the sexually transmitted bacterial infection traveling to his eyes and causing severe inflammation.
The condition, which affects around 14,000 Americans and can emerge when the underlying STD goes untreated, manifests as panuveitis, a severe inflammation affecting the entire interior of the eye.
An examination revealed the extensive damage: dense floaters clouded his vision, his retina was swollen, and the inflammation was so severe in his right eye that his optic nerve was completely obscured, rendering him nearly blind.
The spread of the infection can lead to inflammation inside the eye, retinal damage and optic nerve swelling, potentially resulting in permanent blindness if not treated promptly.
Syphilis has been a major driver in a nationwide increase in sexually transmitted infections over the past two decades; most alarmingly, in newborn babies who contract it from their mothers.
The STD rarely causes ocular syphilis. Severe inflammation can damage the retina and optic nerve, risking permanent blindness if not treated quickly.
Ocular inflammation is categorized as either granulomatous or non-granulomatous.
The non-granulomatous form is now more common and presents with finer eye deposits, often accompanied by back-of-the-eye issues like floaters, retinal swelling, and inflamed blood vessels and optic nerve.
The unidentified patient, who doctors reported had a history of paying for sex, first took himself to the University Hospital in Pleven, Bulgaria, on July 3, 2024 for a concerning genital rash, which was accompanied by burning and itching.
Syphilis typically starts as a genital sore. However, if left untreated, the bacteria do not remain localized.
They enter the bloodstream, spreading throughout the entire body and potentially attacking major organs, including the eyes, brain and heart.
Doctors immediately noted a rash with red bumps and pustules on his scalp and groin area, along with scaly red patches on his torso. He also reported his declining eyesight.
Blood tests quickly confirmed a syphilis infection, which affects about 200,000 Americans each year and is experiencing a dramatic rise in the US since 2020 that has seen cases soar by over 50 percent.
According to the most recent CDC data, syphilis rates in the US surged dramatically over a five-year period, reaching a peak in 2023.
Between 2020 and 2023, cases in the US increased by over 54 percent, hitting a rate of 62.5 per 100,000 people.
The man began experiencing a gradual loss of vision, starting in his right eye and then affecting his left, with his sight worsening significantly over the following month.
He was started on an aggressive treatment of intravenous penicillin and steroids for a week, followed by a series of five weekly penicillin shots to ensure the bacteria were eradicated.
The day after he was admitted, an eye specialist examined him and gave him a secondary diagnosis, syphilitic panuveitis, a specific form of ocular syphilis marked by severe inflammation affecting the entire interior of both eyes.
His vision was extremely poor; he could only perceive light in his right eye and had extremely blurry vision in his left.
The examination revealed severe inflammation throughout his eyes, with dense floaters and swelling of the retina and optic nerve so bad it was hidden in his right eye.
Doctors determined that the IV antibiotics to treat his syphilis would also address the severe eye infection. The ophthalmologist prescribed antibiotic-steroid eye drops to relieve the pain and inflammation.
After one week of treatment with IV and eye drop antibiotics, his vision had improved slightly from only seeing light to 20/2000 in his right eye and 20/200 in his left, measurements that indicate profoundly poor vision to near total blindness in his left eye.
His treatment was adjusted over the following months, including the addition of anti-inflammatory eye drops and a steroid injection around his more severely affected right eye.
Over the 14-week follow-up period, the patient ultimately recovered to 20/25 in the right eye, leaving only a slight blur and to a perfect 20/20 in the left. The only lingering side effect was moderate sensitivity to light.
The course of treatment was successful. The dense floaters in his eyes cleared within two months and the swelling of his optic nerve resolved.
Syphilis is often called 'the great imitator' in medicine because its symptoms can look like many other eye diseases, most commonly causing uveitis, an inflammation of the eye's middle layer.
Congenital syphilis is the fastest-growing facet of the US syphilis epidemic and the most concerning to experts.
While overall syphilis rates show a potential recent decline, cases of babies born with syphilis have skyrocketed, rising a staggering 83 percent over the past five years. The rate increased from 60.0 per 100,000 in 2020 to a projected 109.6 in 2024.