How STDs Can Become Eye Diseases

close-up of woman's eye
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What do the eyes and the genitals have in common? A surprising amount! The eyes and many parts of the genitals are mucosal surfaces. Those surfaces are also known as mucus membranes found in a number of areas including the:

  • eyes
  • inside of the nose
  • inside of the mouth
  • lips
  • urethra
  • anus
  • vagina
  • lining of the foreskin

Mucus membranes are all similar, but not identical, in structure. What does that have to do with sexually transmitted diseases?

Many STDs infect the mucosal surfaces of the genitals. These diseases can also infect other mucus membranes.

One place that sexually transmitted infections can be particularly dangerous is the eyes. When STDs become eye diseases, they can cause serious problems. In fact eye diseases caused by STDs have historically been one of the leading causes of blindness around the world.

It is relatively uncommon for STDs to be seen as eye diseases in adults. They are far more often seen in very young children who are exposed to infections during birth. One major reason that these diseases are now rare in the developed world is the routine treatment of infants' eyes at the time of birth. However, as treatment can itself cause eye problems, this may be changing. Some doctors prefer to test and treat pregnant women for STDs before they give birth in order to limit the need to use eye medications in a newborn.

Many countries are moving away from routine preventative treatment, also known a prophylaxis.

STDs That Can Be Eye Diseases

Not all STDs can become eye diseases. For example, HIV does not infect the eyes, although the virus and its treatments can sometimes make people more susceptible to eye problems.

Instead, the STDs that can cause eye diseases are the ones that more directly infect the skin and mucus membranes. As such, the STDs most commonly associated with eye diseases are chlamydia, gonorrhea, syphilis, and herpes.

Chlamydia infections of the eye are sometimes referred to as trachoma. These infections are one of the leading infectious cause of blindness in the developing world. Less severe infections can lead to reduced vision. Most of the eye problems caused by chlamydia infection are due to inflammation and scarring. Fortunately, early treatment can prevent the most severe consequences. In general, this treatment involves antibiotics either taken by mouth or applied directly to the eyes. In areas where the disease is common, there is a big focus on facial cleanliness for prevention.

As with chlamydia eye infections, gonorrhea of the eye is primarily seen in newborns. In adults, most eye diseases caused by gonorrhea are caused by autoinoculation. In other words, people's eyes get infected when they touch their eyes after touching infected fluid or secretions. It is also possible for a person's eyes to be infected after direct exposure to a partner's infected secretions. Eye disease caused by gonorrhea is treated with antibiotics, usually given as an injection.

If not treated appropriately, gonorrhea eye disease can lead to vision damage or even blindness.

Ocular syphilis infections are less common than eye disease caused by chlamydia and gonorrhea. However, in 2015, an unusually large number of eye infections caused by syphilis were seen in the United States. These cases were mostly seen in men who have sex with men, and about half were in men who were HIV positive. Eye infections caused by syphilis can cause redness, blurry vision, and blindness. The recommended treatment is intravenous aqueous penicillin G. This is also the treatment recommended for people with neurosyphilis.

The herpes simplex viruses can cause eye disease as well as lesions on the face and the genitals. Because herpes is not curable, people with herpes eye infections often have them repeatedly over time. This can cause a significant decrease in quality of life. Vision problems tend to be worse during active outbreaks but can also persist when no lesions are present.

Fortunately, eye disease isn't a particularly common complication of herpes. In addition, herpes antivirals such as acyclovir have been shown to help reduce the frequency with which eye symptoms occur. Antiviral treatment can also be used for eye infections caused by the varicella zoster virus (VZV). VSV is the herpes virus that causes chicken pox and shingles. Some research suggests that herpes eye diseases are more likely to occur in people who are HIV positive or have diabetes.

A Word From Verywell

These days, eye diseases caused by sexually transmitted pathogens are relatively rare in the United States. In large part, this is due to doctors using preventative measures at the time of childbirth—when many such diseases are transmitted. However, it is still possible to end up with an eye disease caused by an STD or other infection. That's why it's a good idea to try and avoid rubbing or picking at your eyes. If you must do so, make certain to clean your hands first before touching your face. And don't forget to check in with your doctor if you start to have unusual eye symptoms or discharge. Eye infections aren't fun, but they're usually quite treatable with the proper medication.

Sources:

Kreisel K, Weston E, Braxton J, Llata E, Torrone E. Keeping an Eye on Chlamydia and Gonorrhea Conjunctivitis in Infants in the United States, 2010-2015. Sex Transm Dis. 2017 Jun;44(6):356-358. doi: 10.1097/OLQ.0000000000000613.

Last A, Burr S, Alexander N, et al. Spatial clustering of high load ocular Chlamydia trachomatis infection in trachoma: A cross-sectional population-based study. Pathog Dis. 2017 May 3. doi: 10.1093/femspd/ftx050.

McAnena L, Knowles SJ, Curry A, Cassidy L. Prevalence of gonococcal conjunctivitis in adults and neonates. Eye (Lond). 2015 Jul;29(7):875-80. doi: 10.1038/eye.2015.57. 

Oliver SE, Aubin M, Atwell L, et al. Ocular Syphilis - Eight Jurisdictions, United States, 2014-2015. MMWR Morb Mortal Wkly Rep. 2016 Nov 4;65(43):1185-1188. doi: 10.15585/mmwr.mm6543a2. 

Sobol EK, Fargione RA, Atiya M, Diaz JD, Powell JA, Gritz DC. Case-Control Study of Herpes Simplex Eye Disease: Bronx Epidemiology of Human Immunodeficiency Virus Eye Studies. Cornea. 2016 Jun;35(6):801-6. doi: 10.1097/ICO.0000000000000814.

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