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Neurosyphilis

Syphilis - neurosyphilis

 

Neurosyphilis is a bacterial infection of the brain or spinal cord. It usually occurs in people who have had untreated syphilis for many years.

Causes

 

Neurosyphilis is caused by Treponema pallidum. This is the bacteria that causes syphilis. Neurosyphilis usually occurs about 10 to 20 years after a person is first infected with syphilis. Not everyone who has syphilis develops this complication.

There are four different forms of neurosyphilis:

  • Asymptomatic (most common form)
  • General paresis
  • Meningovascular
  • Tabes dorsalis

Asymptomatic neurosyphilis occurs before symptomatic syphilis. Asymptomatic means there aren't any symptoms.

 

Symptoms

 

Symptoms usually affect the nervous system. Depending on the form of neurosyphilis, symptoms may include any of the following:

  • Abnormal walk (gait), or unable to walk
  • Numbness in the toes, feet, or legs
  • Problems with thinking, such as confusion or poor concentration
  • Mental problems, such as depression or irritability
  • Headache, seizures, or stiff neck
  • Loss of bladder control (incontinence)
  • Tremors, or weakness
  • Visual problems, even blindness

 

Exams and Tests

 

Your health care provider will do a physical examination and may find the following:

  • Abnormal reflexes
  • Muscle atrophy
  • Muscle contractions
  • Mental changes

Blood tests can be done to detect substances produced by the bacteria that cause syphilis, this includes:

  • Venereal disease research laboratory (VDRL) test
  • Fluorescent treponemal antibody absorption (FTA-ABS)
  • Rapid plasma reagin (RPR)
  • Treponema pallidum particle agglutination assay (TPPA)

With neurosyphilis, it is important to test the spinal fluid for signs of syphilis.

Tests to look for problems with the nervous system may include:

  • Cerebral angiogram
  • Head CT scan
  • Lumbar puncture (spinal tap) and cerebrospinal fluid analysis (CSF fluid analysis)
  • MRI scan of the brain, brainstem, or spinal cord

 

Treatment

 

The antibiotic penicillin is used to treat neurosyphilis. It can be given in different ways:

  • Injected into a vein several times a day for 10 to 14 days.
  • By mouth 4 times a day, combined with daily muscle injections, both taken for 10 to 14 days.

You must have follow-up blood tests at 3, 6, 12, 24, and 36 months to make sure the infection is gone. You will need follow-up lumbar punctures for CSF fluid analysis every 6 months. If you have HIV/AIDS or another medical condition, your follow-up schedule may be different.

 

Outlook (Prognosis)

 

Neurosyphilis is a life-threatening complication of syphilis. How well you do depends on how severe the neurosyphilis is before treatment.

 

Possible Complications

 

The symptoms can slowly worsen.

 

When to Contact a Medical Professional

 

Call your provider if you have had syphilis in the past and now have signs of nervous system problems.

 

Prevention

 

Prompt diagnosis and treatment of the original syphilis infection can prevent neurosyphilis.

 

 

References

Berger JR, Dean D. Neurosyphilis. Handb Clin Neurol. 2014;121:1461-1472. PMID: 24365430 www.ncbi.nlm.nih.gov/pubmed/24365430.

Radolf JD, Tramont EC, Salazar JC. Syphilis (Treponema pallidum). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 239.

 
  • Central nervous system

    Central nervous system - illustration

    The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

    Central nervous system

    illustration

  • Late-stage syphilis

    Late-stage syphilis - illustration

    Tertiary syphilis is a late stage of the disease which can follow the initial infection, primary syphilis, by several years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive.

    Late-stage syphilis

    illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

    • Late-stage syphilis

      Late-stage syphilis - illustration

      Tertiary syphilis is a late stage of the disease which can follow the initial infection, primary syphilis, by several years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive.

      Late-stage syphilis

      illustration

    Tests for Neurosyphilis

     

       

      Review Date: 11/27/2016

      Reviewed By: Arnold Lentnek, MD, Infectious Diseases Medical Practice of NY and Clinical Research Centers of CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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