The Centers for Disease Control and Prevention (CDC) has issued a clinical advisory to all U.S. physicians, alerting them to be on the lookout for cases of potentially blinding ocular syphilis, particularly among HIV-positive men who have sex with men (MSM).

Twelve cases of the disease were reported in San Francisco and Seattle between December 2014 and March 2015. Subsequent investigation found that more than 200 cases have been reported in 20 states during the past two years.

The majority of cases have been among HIV-positive MSM, although a few have occurred among HIV-negative individuals, including MSM as well as heterosexual men and women.

Several of these cases have resulted in significant vision damage, including blindness.

Both ocular and neurosyphilis can develop at any stage of syphilis infection.

The CDC advises clinicians as follows:

  • Screen those at risk for syphilis for visual complaints. This includes MSM, people living with HIV, people with multiple or anonymous sexual partners, and those with other risk factors for the disease.
  • All those who test positive for syphilis should be tested for HIV as well, if they have an unknown HIV status or have previously tested negative for HIV.
  • Those who test positive for syphilis and who have early syphilis without ocular symptoms should undergo a careful neurological exam, including examination of all cranial nerves.
  • Those who have syphilis and complaints of eye problems should receive an immediate ophthalmologic exam.
  • Those in the previous category should also undergo a spinal tap (lumbar puncture with cerebrospinal fluid examination).
  • Treatment of ocular syphilis should follow the recommended treatment for neurosyphilis.
  • Physicians should report cases of ocular syphilis to a state or local health department within 24 hours of diagnosis. Cases of the condition that were diagnosed after December 1, 2014, should be reported through a local or state health department to the CDC via email.
  • Physicians should, immediately after collecting for molecular typing, save and store at -80 degrees Celsius pre-antibiotic clinical samples (whole blood, primary lesions and moist secondary lesions, cerebrospinal fluid or ocular fluid).

To read the CDC’s advisory, which includes contact information for reporting and for questions click here.

To read the Medscape article, click here (free registration with the site is required).