Health Encyclopedia

Neurosyphilis

Definition

Neurosyphilis is an infection of the brain or spinal cord. It occurs in persons with untreated syphilis many years after they are first infected.

Causes, incidence, and risk factors

Neurosyphilis is caused by Treponema pallidum, the bacteria that cause syphillis. It occurs about 10 - 20 years after a person is first infected with syphilis. Not everyone who has syphilis will develop this complication.

There are four different forms of neurosyphilis:

Asymptomatic
General paresis
Meningovascular
Tabes dorsalis

Asymptomatic neurosyphilis occurs before symptomatic syphilis.

Symptoms

Abnormal walk (gait)
Blindness
Confusion
Dementia
Depression
Headache
Incontinence
Inability to walk
Irritability
Loss of muscle function
Mental decline
Paralysis
Poor concentration
Seizures
Stiff neck
Tremors
Visual disturbances
Weakness, numbness of lower extremities

Note: There may be no symptoms

Signs and tests

Signs include:

Abnormal reflexes
Muscle atrophy
Muscle contractions

Blood tests can be done to detect substances produced by the bacteria that cause syphilis. The oldest test is the VDRL test.

Other tests include:

Fluorescent treponemal antibody absorption (FTA-ABS)
Rapid plasma reagin (RPR)
Treponema pallidum particle agglutination assay (TPPA)

In 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 a cerebrospinal fluid analysis ( CSF fluid analysis)
MRI scan of the brain, brainstem, or spinal cord

Treatment

Penicillin is used to treat neurosyphilis. The medicine may be given in various ways.

It may be injected into a vein every day for 10 - 14 days.
You may take probenecid by mouth 4 times a day, combined with daily muscle injections -- both for 10 - 14 days.

You must have follow-up blood tests and lumbar punctures for CSF fluid analysis at 3, 6, 12, and 24 months to make sure the infection is gone.

For information on treating syphilis, see the following articles:

Expectations (prognosis)

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

Complications

The symptoms can get slowly worse.

Calling your health care provider

Call for an appointment with your health care provider if you have had syphilis in the past and now have signs of neurological problems.

Prevention

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

References

Hook EW. Syphilis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 340.

Tramont EC. Treponema pallidum (syphilis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005: chap 235.

Screening for syphilis infection: Recommendation statement. Rockville MD, US Preventive Services Task Force: July 2008.

Review Date:9/28/2008
Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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