In this article, you will find a report on rare cases of gonorrhea in the eye among women. This rare collection of cases suggests the possibility of a new strain of gonorrhea bacteria spreading. A report on this cluster and what it might mean today was published by health officials in Michigan in the weekly report of the Centers for Disease Control and Prevention’s Morbidity and Mortality Surveillance.
Gonorrhea in the Eye
Gonorrhea in the eye, also known as ocular gonorrhea, is not a new phenomenon. The gonorrhea bacteria, Treponema pallidum (formerly known as Spirochete pallida), are known for their ability to spread to the eye, as well as the inner ear and central nervous system if the sexually transmitted infection is left untreated. This spread can lead to blindness, deafness, and severe inflammation of the nervous system if not treated.
Cluster of Cases
The series of cases began in March 2022, when the first woman, Patient A, was referred to the Kalamazoo County Health Department in Michigan by an ophthalmologist. The woman reported blurred vision and fear of blindness, along with genital sores. Tests showed the presence of gonorrhea, and she reported only one sexual partner in the past 12 months—a man she met online. Within a few days, state health officials contacted the man, but he refused.
Weeks later, in April 2022, Patient B was hospitalized due to a neurological infection. An ophthalmologist identified cranial nerve abnormalities and sent her to the emergency department. There, she reported headaches, slight hearing loss, blurred vision, and double vision. She mentioned the same recent sexual partner that Patient A had mentioned, stating she also met him online.
In May 2022, Patient C was reported to a local health department in southwestern Michigan. She was suffering from a rash all over her body, floaters in her eyes, light sensitivity, and cranial nerve abnormalities. Again, she reported the same sexual partner mentioned by Patients A and B, saying she met him online.
Patient D was diagnosed with ocular gonorrhea in June 2022, again naming the same partner. In July 2022, Patient E was hospitalized due to ocular gonorrhea and neurological infection, and again naming the same partner that other cases mentioned.
From March to May, state health officials contacted the common male sexual partner multiple times. However, he did not provide much information, stating he had left the state and missed a scheduled medical appointment in April. In May, after identifying Patient C, a public health doctor searched his electronic medical records and found that in January 2022 he had gone to the emergency department at a hospital for genital and anal sores. At that time, he was treated for suspected herpes—but the herpes test was negative and he was not tested for gonorrhea.
Public Health Implications
In May, a state disease intervention specialist was able to reconnect with the man, and he attended an appointment at the Kalamazoo County Health Department. At the appointment, doctors noted that the man showed no signs of gonorrhea or issues with vision or hearing. Laboratory tests confirmed that he had early latent gonorrhea, which is a stage of the disease that occurs within a year of the initial infection when symptoms seem to fade but the disease is still present. The man reported having multiple sexual partners in the past year but refused to disclose their identities.
Patient B informed Patient E of additional sexual partners. Among those identified, health officials reported that gonorrhea tests were negative for them. Patient E did not disclose her other sexual partners, and officials were unable to contact them.
Given
Due to the unusual nature of this outbreak, health officials in Michigan believed that the man might be infected with a strain of Treponema pallidum more likely to cause ocular syphilis and neurological inflammation than other strains. However, they were unable to identify the strain. Genetic testing for syphilis works best when there are early sores or moist lesions from which to sample the bacteria. Only Patient A had undergone the early stage of syphilis with genital lesions at the time of diagnosis.
All of the women and the man were treated for the infection, and since then, no other cases in Michigan have been linked to anyone in the outbreak. This has led health officials to hope that they have stopped the spread of this mysterious and unidentified strain of Treponema pallidum, but it is impossible to know that without broader monitoring and identifying all sexual partners.
Even without a new worrying strain of Treponema pallidum, the state of sexually transmitted infections in the United States is tragic. Rates of sexually transmitted diseases, including gonorrhea, chlamydia, and syphilis, have risen over the years. In a report earlier this year, the Centers for Disease Control and Prevention noted that national syphilis cases increased by 74 percent from 2017 to 2021. In 2022, the number of babies born with syphilis was more than 10 times the number in 2012.
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