Syphilis is getting strange – The Atlantic

For some, the world suddenly becomes blurry. Others describe it as a dust storm in their eyes, or as swaying inside a snow globe. Others see flashing lights or black dots drifting through their field of vision, or experience a sudden sensitivity to light that is worse than walking in sunlight with dilated pupils. Without treatment, some will go blind.

Many medical professionals never suspect that the cause is syphilis. Syphilis infection usually first appears as hard, painless sores on the genitals, inside the mouth, or anus, and then as a rash, often on the hands and feet. If the infection is found at either of these two stages, treatment is with penicillin injections, which kill the bacteria. If left untreated, syphilis can progress to a more dangerous stage that can affect the heart, bones, brain, and nerves years or decades later. Only about 1-5% of syphilis cases are thought to involve the eye.

But now eye symptoms are beginning to appear on their own. Last year, doctors reported 17 new cases of ocular syphilis to the Chicago Department of Public Health, most of whom were diagnosed as male at birth and had no other symptoms. In southwest Michigan, five women visited a clinic with ocular syphilis in 2022 and were eventually diagnosed with ocular syphilis. Tracked “Experts worry that these cases portend something: Syphilis has spread so widely and for so long that what was once considered a rare event may no longer be so rare.”

Syphilis symptoms in the eyes may be the only noticeable sign, so by the time it is correctly diagnosed, vision may already be permanently damaged. Peter Leone, an infectious disease specialist at the University of North Carolina School of Medicine, is troubled by a patient who came to his hospital in 2015. The 33-year-old man had been suffering from blurred vision, sensitivity to light, and tinnitus for weeks, but was misdiagnosed with sinusitis in the emergency room, prescribed antibiotics, and sent home. When Leone saw the man two weeks later, he could barely count the fingers on his hand as he held it in front of his face. Leone immediately began treating the man for syphilis, but his vision did not improve.

“It's definitely disturbing,” Leone told me. Ocular syphilis “used to be a rare occurrence, but it seems to be coming back.” So disturbed was he by a patient he'd seen in 2015 that he contacted a colleague to document cases of ocular syphilis across the country, warning that it could become “a real epidemic.” Sporadic reports of an increase in ocular syphilis have come from France, Canadaand other countries.

The simplest explanation for the surge in eye cases may be that syphilis of all kinds has been on the rise in the U.S. for decades, said Amy Nam, a CDC Epidemic Intelligence Service official who investigated the Chicago cases. Sexually transmitted diseases of all kinds have been on the rise around the world due to a long-standing lack of access to testing and treatment, increased drug use and decreased condom use.

Syphilis has spread particularly fast in the United States. More than 200,000 Americans were infected with syphilis in 2022, but experts believe the figure is probably an underestimate due to the lack of testing during the coronavirus pandemic. That's nearly 80% more than the number of cases in 2018 and the highest number of cases since 1950. Experts aren't quite sure why. The disease has always been an insidious foe, combining the sneakiest qualities of some other STIs: the immune evasion of chlamydia, herpes' ability to lie dormant for years, and gonorrhea's trick of migrating through the bloodstream to distant organs. Christina Mara, a neurosyphilis expert at the University of Washington School of Medicine, told me that syphilis seems to carry a lot of stigma, even compared to other STIs such as HIV, which causes patients to avoid testing. In her research, Mara spoke to hundreds of men infected with both HIV and syphilis. “They tell their mothers about HIV, but not about syphilis,” she said.

The idea that as infections continue to rise, so too will the number of rare or extreme cases, such as isolated ocular syphilis, is the most accepted explanation among scientists. But some experts worry that a different, more unusual situation is unfolding. Some of the recent ocular syphilis cases may suggest a new lineage of the disease that has a preference for the eye. That would explain the fact that all of the cases in the Michigan cluster occurred at roughly the same time, within a small geographic area, and from a single partner. “This is very strong epidemiological evidence that there was something unusual about the syphilis lineage of these cases,” William Nettleton, a family medicine physician and public health researcher at Western Michigan University, who documented the cluster, told me.

But in Chicago, infections have been recorded for more than eight months and have occurred in hospitals across the city. investigation have Not supported The ocular-preferential strain hypothesis is supported, but evidence of strains more likely to cause neurological symptoms has been found. (No one has attempted to sequence the strain types in the Chicago cases, because genetic sequencing is not part of standard clinical protocol; the CDC is conducting a larger study.) study Research is ongoing to identify strains that may be linked to the eye, and Leone said where in the body symptoms appear may also depend on an individual's immune system and risk factors.

Nam and other experts are less worried about a possible new strain of syphilis than the fact that the disease is on the rise in new populations. In the past, gay men, transgender women and those with HIV were most at risk. But now, syphilis is rise There are also large numbers of HIV-uninfected heterosexual populations of women and heterosexual men. Most of the Chicago cases have occurred among HIV-uninfected heterosexuals who were assigned male at birth. The Michigan cluster consisted of five HIV-negative women and one HIV-negative man. The man who went blind in North Carolina was heterosexual and HIV-negative. Of particular concern is the sudden increase in pregnant women who could transmit syphilis through the placenta. as a result It can affect babies who are stillborn or who grow up with blindness, hearing loss or bone damage.

Today's rise in neurological and ophthalmological symptoms is a throwback to the pre-penicillin era. one third 100% of syphilis patients experienced neurological symptoms. In the 16th-century epic poem from which syphilis takes its name, the poet describes an unfortunate youth whose “beautiful eyes, which were clear mirrors of daylight, were swallowed up by a horrible ulcer.” The Dutch painter Gerard de Lairesse and the Portuguese writer Camilo Castelo Branco are thought to have lost their sight to syphilis. Even Friedrich Nietzsche may have been nearly blinded by the disease.

These unusual symptoms of syphilis are so old that many doctors working today weren't trained to recognize them in medical school. In fact, “there's a whole generation of clinicians, myself included, who never saw syphilis in their medical school training, because when I was training in 1999 and 2000, syphilis was almost unheard of in the United States,” says Ina Park, a sexual health researcher at the University of California, San Francisco and author of the book. Strange Bedfellows: An adventure into the science, history, and surprising secrets of sexually transmitted diseases.

But even if doctors are trained to spot abnormal symptoms, the most at-risk communities — many of which lack access to testing centers, education and treatment — may not benefit from that knowledge. The man who visited Leone in 2015 delayed going to the emergency department in the first place because he didn't have health insurance. If he'd seen Leone two weeks earlier, his vision probably would have been preserved. During the pandemic, many STD clinics closed or switched to virtual care. Last year, Congress proposed appropriating $400 million to help diagnose and treat STDs. cut Shortages have been reported by the country's STI intervention providers, and over the past year doctors have faced severe national shortages of Bicillin LA, the most effective antibiotic for treating syphilis and the only injectable penicillin recommended for pregnant women.

To the untrained eye, a sudden epidemic of ocular syphilis sounds like the plot of a horror movie. But to Leone, the Chicago cases felt like déjà vu. “To be honest, it didn't surprise me at all,” he told me. The cure for syphilis had been known since 1943. The real horror is that the United States had allowed this ancient scourge to take root again.