Since mid-December 2014, the Washington Department of Health has reported six cases of ocular syphilis, or syphilis of the eyes, causing blindness in at least two patients.

This funduscopic image reveals the effects of late neuro-ocular syphilis on the optic disk and retina/CDC
This funduscopic image reveals the effects of late neuro-ocular syphilis on the optic disk and retina/CDC

Four of the cases occurred in King County, while the other two are from elsewhere in the state.

All four of the recent King County cases occurred in men, three of whom identified as men who have sex with men (MSM), the group most affected by syphilis in King County. Three of the cases were HIV-infected, though two were not receiving HIV medical care. Two of the cases were sex partners and presumed to be epidemiologically linked, prompting health officials to issue advisories for health care providers and the gay and bisexual men population.

All of the patients presented primarily with visual complaints, a combination of loss of vision, floaters, a blue tinge in vision, flashing lights and blurring of vision.

Ophthalmologic examinations revealed uveitis with variable retinal involvement. Three patients underwent lumbar puncture, all of whom had CSF pleocytosis and two of whom had a positive CSF VDRL. Three of the patients were admitted to a hospital for intravenous penicillin. One patient has so far refused treatment; Public Health and medical providers continue to encourage this man to accept therapy.

At present, syphilitic eye disease is typically a complication of early syphilis (i.e. primary or secondary syphilis). Although the infection can affect any part of the eye, uveitis is the most common manifestation of disease. Initial symptoms can be subtle, including floaters, flashing lights (photopsia), blurring of vision and ocular pain. If untreated, these symptoms can progress to loss of vision. Early treatment usually leads to resolution of symptoms without vision loss, while delayed treatment can result in permanent blindness.

Syphilis is common in MSM in King County, particularly among HIV infected MSM in whom approximately 3% acquire syphilis each year. The cause for this cluster of cases of ocular syphilis is

Image/ National Atlas of the United States
Image/ National Atlas of the United States

Some evidence suggests that some strains of Treponema pallidum, the bacterium that causes syphilis, may be more likely to cause CNS disease. It is not known whether some strains of T. pallidum have a greater likelihood of causing ocular infections, but the current cluster of cases raises this concerning possibility.

Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. Symptoms of syphilis are easy to miss, and easy to mistake for something else. Symptoms in each stage look different, ranging from painless sores that go away to a rash to no symptoms at all. But syphilis in the later stages causes paralysis, dementia, blindness, deafness, heart failure and even death.

King County Public Health offers the following advice: Sexually active gay and bi men who are not in mutually monogamous relationships should:

  • Use condoms and limit your number of sex partners.
  • Be aware of symptoms for syphilis and other STIs. Learn more at
  • Get tested for syphilis if you experience any of the vision problems listed above.
  • Get tested for STIs – including syphilis and HIV – at least once a year. Get tested every 3 months if any of the following are true for you in the last year: had 10 or more sex partners, had unprotected anal sex with a partner whose HIV status is positive or not known, used poppers, used meth, had gonorrhea, chlamydia, or syphilis, consider taking PrEP (Pre-Exposure Prophylaxis) for HIV.

One shot of antibiotics will usually cure syphilis.