An Update on Syphilis and the Eye

    • CE credits 2 hours
    • COPE code 57564-SD / 115775
    • Available until May 9, 2021


Learning Objectives

  • To review the epidemiology and risk factors for syphilis
  • To review the pathogenesis and systemic manifestations of syphilis
  • To review the various ocular manifestations and treatment for syphilis


A 45 year old male presents to the eye doctor with symptoms of decreased vision and floaters in his left eye. He says that the symptoms have been gradually worsening for the last several weeks, and has never had such symptoms before. There are no symptoms of flashes or visual field loss, and he has no complaints with the right eye.

The patient reports being otherwise healthy and is on no medications. However, he does tell you he had a painless ulcer on the shaft of his penis about 2 months ago which lasted for several weeks before resolving. His sexual history is significant for multiple male partners. He has never been screened for sexually transmitted infections.

On exam, visual acuity is 6/7.5 and 6/15 in the right and left eyes, respectively. Anterior segment exam is normal in both eyes. In the left eye, multiple yellow-gray inflammatory lesions are seen on the posterior pole and are associated with mild vitritis.

Quick Question

What microorganism, shown in the electron microscope picture above, is a likely culprit for this patient’s presentation?

  • HIV

    Human immunodeficiency virus (HIV) is the virus responsible for AIDS. HIV has many complications in the posterior segment including AIDS retinopathy and opportunistic infections (e.g. CMV retinitis, toxoplasmic retinochoroiditis). HIV, however, is a virus that does not resemble to coiled bacteria depicted in this image obtained from electronic microscopy.

  • Syphilis
  • Toxoplasmosis

    Toxoplasmosis may cause an infectious retinochoroiditis, especially in immunocompromised individuals. It is a parasite that does not resemble the microorganism depicted in the image.

  • Chlamydia trachomatis

    Chlamydia is a sexually transmitted infection caused by the obligate intracellular pathogen Chlamydia trachomatis. The patient's presentation is not typical of Chlamydia.


Syphilis is a sexually-transmitted infection (STI) caused by the spirochete bacterium Treponema pallidum. Although its prevalence and incidence is significantly less common than before the era of antibiotics, it has been increasing in incidence over the last decade or so. It most commonly affects homosexual males but can affect males and females of all age groups.1 It may also be transmitted to the fetus during pregnancy or delivery, causing congenital syphilis. It is often termed the “great mimicker” for its ability to manifest in a variety of ways, especially in the eyes.

Although this module is intended for the eye care professional, the non-ocular manifestations of syphilis will be thoroughly discussed as knowledge of non-ocular manifestations is critical for diagnosing the condition in patients presenting with ocular complaints.

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