What are the other Names for this Condition? (Also known as/Synonyms)

• Chorioretinitis caused by Syphilis
• Chorioretinitis due to Syphilis

What is Syphilitic Chorioretinitis? (Definition/Background Information)

• Chorioretinitis is an eye condition that results in the inflammation of both the choroid and the retina. It can be caused by both infectious and non-infectious factors and any individual may be affected, particularly those with poor immunity
• When chorioretinitis develops from exposure to the bacterium Treponema pallidum, it is known as Syphilitic Chorioretinitis. Syphilis is a multi-system sexually-transmitted illness that develops over many months and years; the involvement of the eye usually takes place during the second stage of syphilis development
• Syphilitic Chorioretinitis signs and symptoms may include eye flashes, partially blocked vision, and reduced vision. Due to the pervasive nature of the disease, an involvement of both the eyes is noted (bilateral eye condition). Also, in most cases, the entire eye may be involved if treatment for syphilis is further delayed
• A healthcare provider may use physical exams, eye exams, and various blood tests to diagnose Syphilitic Chorioretinitis. Upon diagnosis, the treatment for syphilis is undertaken using the drug penicillin that can bring about a complete recovery, depending on the stage of the disease
• However, early recognition and management of the condition is extremely important. Syphilitic Chorioretinitis can lead to severely impaired vision and complete blindness. The prognosis is dependent upon various factors, such as the stage of syphilis, early administration of medication, and associated symptoms and complications

Who gets Syphilitic Chorioretinitis? (Age and Sex Distribution)

• Sexually mature men and women infected by Treponema bacteria can contract syphilis, including occasionally teenagers (as young as 15 years). Most cases of Syphilitic Chorioretinitis are noted in the 40-60 year’ age group
• Both males and females are affected, but studies have shown a male predominance for syphilis
• No racial or ethnic predilection is observed
• Women who are infected with syphilis and are untreated before or during pregnancy, have an extremely high risk of transmitting it to their unborn offspring. Thus, even newborn infants may be affected

What are the Risk Factors for Syphilitic Chorioretinitis? (Predisposing Factors)

Syphilitic Chorioretinitis develops from the advancement of syphilis, and hence, the risk factors for syphilis are included:

• Not practicing safe sex; having sex with individuals who have various sexually-transmitted diseases (STDs)
• Having a new sex partner (a carrier of syphilis); having multiple sex partners
• Having same-sex partner(s); the incidence of syphilis is extremely high among men due to this factor
• Individuals with HIV infection or AIDS
• Increased use of drugs (cocaine, methamphetamine, and Viagra) leading to the high-risk ‘sex for drugs’ behavior
• Congenital syphilis: Untreated pregnant women with syphilis have a very high risk (90% chance) of passing on the infectious bacteria to the baby in the womb
• Infected blood transfusion or organ transplant recipients

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Syphilitic Chorioretinitis? (Etiology)

Syphilis is a contagious bacterial infection that is transmitted through sex with an affected individual. It is caused by the bacterium Treponema pallidum. It has three distinct stages of progression, namely primary, secondary, and tertiary; each stage being more severe and aggressive than the previous one.

• Skin lesions and mucus membranes can carry the pathogen and it spreads to other sexual partner(s) during any form of sexual contact (even through kissing), causing an infection
• Initially, the infection affects the mouth, anus, and genitals of males and females. When the infection reaches the eye, it results in a condition known as ocular syphilis that causes eye-related signs and symptoms
• Syphilitic Chorioretinitis specifically affects the choroid and retina of the eye resulting in their inflammation and other associated symptoms

Congenital transmission of syphilitic infection can take place inside the uterus, from a mother to the infant child. This can happen any time in pregnancy or even during delivery. Untreated syphilis can affect the mother and child lifelong.

What are the Signs and Symptoms of Syphilitic Chorioretinitis?

The signs and symptoms of Syphilitic Chorioretinitis may vary between individuals and occur slowly over a period of time. It may include:

• Reduced vision or blurred vision; progressive vision loss
• Hazy vision; poor vision at night/in low light
• Redness of the eyes
• Itching and burning sensation in the eye
• Excessive tearing (flowing of tears)
• Eye floaters: The individuals experience illusions that some small objects such as spots, hairs, or strings are moving in the eye
• Light-sensitivity (photophobia)
• Impaired color vision
• Eye pain, in some cases
• Flashes in the eye: Sudden appearance of ‘flashing’ bright lights causing vision distortion (photopsia)
• Uveitis: Inflammation of the uvea
• Interstitial keratitis or corneal scarring from inflammation of the cornea
• Only one eye (unilateral) or both the eyes (bilateral) may be affected; although, in most cases, both eyes are involved

The signs and symptoms of syphilis involving various other body regions and systems may be present.

How is Syphilitic Chorioretinitis Diagnosed?

A healthcare professional may diagnose Syphilitic Chorioretinitis using the following tests and procedures:

• Physical examination and analysis of previous medical history
• Eye examination by an eye specialist (ophthalmologists or retinal experts)
• Blood tests such as the following:
  • To check for the presence of antibodies in blood
  • Blood culture for infections
  • Complete blood count (CBC) with differential
  • Erythrocyte sedimentation rate (ESR)
• Antibody titer in aqueous humor and vitreous humor fluid samples
• Analysis of lesion fluids in the laboratory, under a microscope (dark field microscopy)
• Examination of cerebrospinal fluid via a lumbar puncture
• Imaging studies of the cranium, brain, and spinal cord
• Cerebral angiogram
• Fundoscopic (ophthalmoscopic) examination by an eye specialist, who examines the back part of the eye (or the fundus)
  • Fundus fluorescein angiography (FFA): In this technique, the eye blood vessels are examined using a fluorescein dye
  • Fundus autofluorescence (FAF): It is a non-invasive diagnostic technique to examine the fundus of the eye without using a fluorescent dye by a specialized fundus camera
• Visual acuity test using a special and standardized test chart (Snellen chart)
• Slit-lamp examination: Examination of the eye structure using a special instrument called a slit-lamp. In this procedure, the pupils are dilated and the internal eye structure is examined
• Tonometry: Measurement of intraocular pressure or eye fluid pressure, especially to detect conditions such as glaucoma
• Indocyanine green (ICG) angiography: It is used to examine the blood vessels of the choroid using a dye, called indocyanine green, particularly to study the choroid
• B-scan ultrasonography: Special ultrasound scan of the eye through a non-invasive diagnostic tool, to assess health of eye structures
• Electroretinogram (ERG): It is a technique to measure electrical activities in the retinal cells
• Optical coherence tomography (OCT) of eye: It is an ocular imaging technique to visualize the eye structure

A differential diagnosis may be undertaken to eliminate the following conditions that may present similar signs and symptoms:

• Tuberculosis
• Intraocular lymphoma

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Syphilitic Chorioretinitis?

The complications of Syphilitic Chorioretinitis may include:

• Glaucoma: A condition that can cause blindness due to higher intraocular pressure
• Optic nerve atrophy: A permanent visual impairment that occurs when the optic nerve is damaged
• Cystoid macular edema
• Retinal detachment: An eye condition wherein the retina gets separated from the eye structures that holds the retinal layers together
• Retinal vasculitis: Inflammation of the retinal arterioles (small blood vessels)
• Vitreitis or vitreous inflammation, which may result in the development of epiretinal membranes
• Permanent damage to eye structures and vision loss: The condition can lead to permanent blindness, if it is left untreated
• Congenital syphilis affecting the newborn child may result in severe bone and joint abnormalities, neurological abnormalities, total loss of vision and hearing, facial deformities, and failure to thrive
• Complications that arise from underlying syphilis in an immunocompromised host

How is Syphilitic Chorioretinitis Treated?

Prompt, early diagnosis and appropriate treatment is very important for syphilis that results in Syphilitic Chorioretinitis. This can help decrease the risk for complications and the further progression of syphilis.

• All manifestations/stages of syphilis are treated using the antibiotic penicillin (parenterally administered or via intramuscular injections)
• If an individual is allergic to penicillin, then it is given in small dosages and in a controlled manner, until the body gets sensitized (accustomed) to the drug
• Long-term follow-up may be necessary to prevent recurrent infections, in some cases

How can Syphilitic Chorioretinitis be Prevented?

To reduce the incidence of Syphilitic Chorioretinitis, the following preventative measures may be considered for syphilis:

• Avoidance of multiple sex partners
• Practicing safe sex (use of condoms)
• Regular screening for sexually transmitted diseases, especially If one is frequently sexually active with multiple partners
• Avoiding excessive craving for drugs and alcohol that may lead to unsafe practices such as ‘sex for drugs’
• Public health screening for pregnant women to reduce risk of fetal infections

What is the Prognosis of Syphilitic Chorioretinitis? (Outcomes/Resolutions)

The prognosis of Syphilitic Chorioretinitis depends on the early diagnosis and appropriate treatment of syphilis.

• With early treatment, the infection may be completely resolved and vision restored
• A late management of the condition can lead to damage to the central nervous system, bones, heart, lungs, and GI system, which may be irreversible and permanent
• The outcomes are poorer in individuals diagnosed with AIDS/HIV infection or other such opportunistic infections

Additional and Relevant Useful Information for Syphilitic Chorioretinitis:

• It is best not to get pregnant, if you have had a recent infection of syphilis. It is advisable to consult your gynecologist to plan your child, in such cases

Please visit our Eye & Vision Health Center for more physician-approved health information:

http://www.dovemed.com/health-topics/vision-center/