In this article, you will find a compilation of rare cases that indicate the spread of a new strain of gonorrhea. This compilation suggests that the gonorrhea bacteria may have adapted to more easily cause systemic gonorrhea, particularly illnesses affecting the eyes and central nervous system. A report on this compilation and what it might mean today has been published by health officials in Michigan in the weekly disease and mortality surveillance report from the Centers for Disease Control and Prevention.
Gonorrhea in the Eye
Gonorrhea in the eye, also known as ocular gonorrhea, is not a new phenomenon. The gonorrhea bacteria, Treponema pallidum (previously known as Syphilis), are known to spread to the eye, as well as to the inner ear and the central nervous system when sexually transmitted infections are left untreated. This spread can lead to blindness, deafness, and severe neurological inflammation if not treated.
Case Compilation
The series of cases began in March 2022 when the first patient, Patient A, was referred to the Kalamazoo County Health Department in Michigan by an eye doctor. The woman reported blurred vision, fear of blindness, and genital ulcers. Tests revealed gonorrhea, and she reported only one sexual partner in the past 12 months – a man she had met online. Within a few days, state health officials contacted the man but he declined to provide information.
Weeks later, in April 2022, Patient B was hospitalized due to central nervous system inflammation. An eye doctor revealed abnormalities in cranial nerves and referred her to the emergency department. There, she reported headache and slight hearing loss, along with blurred vision and double vision. She mentioned the same recent sexual partner as Patient A, stating she had also met him online.
In May 2022, Patient C was reported to a local health department in southwest Michigan. She was suffering from a rash over her entire body, floaters in her eyes, light sensitivity, and cranial nerve abnormalities. She again reported the same partner mentioned by Patients A and B, saying she met him online.
Patient D was diagnosed with ocular gonorrhea in June 2022 and mentioned the same partner. In July 2022, Patient H was hospitalized due to ocular gonorrhea and central nervous system inflammation, reporting the same partner mentioned in previous cases.
From March to May, state health officials attempted to contact the shared sexual partner several times. However, he did not provide much information, stating he left the state and missed a scheduled medical appointment in April. In May, after identifying Patient C, the public health doctor looked into the man’s electronic medical records and discovered that in January 2022, he had gone to the emergency department of a hospital for genital and anal ulcers. At that time, he was treated for the possibility of herpes – but his herpes test was negative, and he was not tested for gonorrhea.
Public Health Implications
In May as well, a state disease intervention specialist was able to reconnect with the man, who attended an appointment at the Kalamazoo County Health Department. During the appointment, doctors noted that the man had no signs of gonorrhea, nor any vision or hearing impairments. Laboratory tests confirmed he was experiencing early latent gonorrhea, a stage of the disease that occurs within a year of primary infection when symptoms appear 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.
He reported
Patients B to H had other sexual partners. Among those identified, health officials reported that gonorrhea tests were negative for them. Patient H did not disclose her other sexual partners, and officials were unable to contact them.
Due to the nature of this unusual cluster, health officials in Michigan speculated that the man may be infected with a strain of T. pallidum more prone to gonorrhea in the eye and central nervous system infections than other strains. However, they were unable to identify the strain. Gonorrhea gene testing works best when primary sores or wet lesions are present from which bacteria can be taken. Only Patient A was experiencing primary stage gonorrhea with genital lesions at the time of diagnosis.
All the women and the man were treated for the infection, and since then, no additional cases in Michigan have been linked to anyone in the cluster. This reality makes health officials optimistic that they have halted the spread of this harmful and unknown strain of T. pallidum, but it is impossible to know without broader surveillance and identification of all sexual partners.
Even without a concerning new strain of T. 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 infants born with syphilis was more than 10 times the number in 2012.
Reader Comments
Here’s an interesting conversation starter for this year’s family Thanksgiving dinner: health officials in Michigan were able to identify a concerning cluster of gonorrhea infections in women’s eyes. This cluster, which involves five women all linked to a man with syphilis, raises the possibility of a new strain of gonorrhea bacteria that may have adapted to cause systemic infections more easily, particularly diseases affecting the eyes and central nervous system. A report on this cluster and what it may mean today was published by health officials in Michigan in the CDC’s Morbidity and Mortality Weekly Report.
Beth Mole is a senior health reporter at Ars Technica. Beth holds a Ph.D. in microbiology from the University of North Carolina at Chapel Hill and participated in the scientific communication program at the University of California, Santa Cruz. She specializes in covering infectious diseases, public health, and microbes.
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