Ocular examination should be a part of the routine assessment of the patients seen at sexually transmitted diseases (STD) clinics due to the importance of these organs in the general wellbeing of patients. It is essential to keep an open eye on ocular signs and symptoms of patients with a history of exposure to common STD pathogens, to ensure prompt investigation and management of ocular complications of the STDs, which, if left unnoticed, otherwise could subject the patients to a great deal of anxiety and distress.
A 41-year-old homosexual man presented with a 10-week history of headache without pressure features commencing 10 weeks after a new sexual contact. Three days after the headache onset he noticed intermittent, bilateral visual blurring, worse in the right eye. The visual disturbance persisted intermittently and led to his referral to a local ophthalmology department where he was found to have bilateral papilloedema. There were no other abnormal signs on full examination of other systems and no other abnormal ocular findings. Cerebral imaging studies were normal. A lumbar puncture revealed a raised opening pressure of 35 mm cerebrospinal fluid (CSF) with a white cell count of 58 cells/mcl (mainly lymphocytes). Venereal disease research laboratory (VDRL), Treponema pallidum haemagglutination (TPHA) and Inno-LIA tests confirmed the presence of neurosyphilis. HIV testing was negative. He was treated with CSF pressure reduction via repeat lumbar puncture and acetozolamide and procaine penicillin intramuscularly. He recovered and remains symptom free at 1 year.
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