Neurosyphilis
Syphilis - neurosyphilisNeurosyphilis is a bacterial infection of the brain or spinal cord. It usually occurs in people who have had untreated syphilis for many years.
Syphilis
Syphilis is a bacterial infection that is most often spread through sexual contact.
Read Article Now Book Mark ArticleCauses
Neurosyphilis is caused by Treponema pallidum bacteria. 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)
Asymptomatic
Asymptomatic means there are no symptoms. You are considered asymptomatic if you:Have recovered from an illness or condition and no longer have symp...
Read Article Now Book Mark Article - General paresis
General paresis
General paresis is a problem with mental function due to damage to the brain from untreated syphilis.
Read Article Now Book Mark Article - Meningovascular
- Tabes dorsalis
Tabes dorsalis
Tabes dorsalis is a complication of untreated syphilis that involves muscle weakness and abnormal sensations.
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Asymptomatic neurosyphilis occurs before symptomatic syphilis. Asymptomatic means there aren't any symptoms.
Symptomatic
Symptomatic can mean showing symptoms, or it may concern a specific symptom. Symptoms may be signs of disease or injury. They are what a person fee...
Read Article Now Book Mark ArticleSymptoms
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
Abnormal walk
Walking abnormalities can be caused by many different types of problems. Problems with the joints, (such as arthritis), bones (such as deformities),...
Read Article Now Book Mark Article - 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
Seizures
A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...
Read Article Now Book Mark Article - Loss of bladder control (incontinence)
Incontinence
Urinary (or bladder) incontinence occurs when you are not able to keep urine from leaking out of your urethra. The urethra is the tube that carries ...
Read Article Now Book Mark Article - Tremors, or weakness
- Visual problems, even blindness
Visual problems
There are many types of eye problems and vision disturbances, such as: Halos Blurred vision (the loss of sharpness of vision and the inability to see...
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Exams and Tests
Your health care provider will do a physical examination and may find the following:
- Abnormal reflexes
- Muscle atrophy
Muscle atrophy
Muscle atrophy is the wasting (thinning) or loss of muscle tissue.
Read Article Now Book Mark Article - Muscle contractions
- Mental changes
Blood tests can be done to detect substances produced by the bacteria that cause syphilis, this includes:
- Treponema pallidum particle agglutination assay (TPPA)
- Venereal disease research laboratory (VDRL) test
VDRL
The VDRL test is a screening test for syphilis. It measures substances (proteins), called antibodies, which your body may produce if you have been i...
Read Article Now Book Mark Article - Fluorescent treponemal antibody absorption (FTA-ABS)
FTA-ABS
The FTA-ABS test is used to detect antibodies to the bacteria Treponema pallidum, which causes syphilis.
Read Article Now Book Mark Article - Rapid plasma reagin (RPR)
RPR
RPR (rapid plasma reagin) is a screening test for syphilis. It measures substances (proteins) called antibodies that are present in the blood of peo...
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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
Cerebral angiogram
Cerebral angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the brain.
Read Article Now Book Mark Article - Head CT scan
Head CT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
Read Article Now Book Mark Article - Lumbar puncture (spinal tap) and cerebrospinal fluid (CSF) analysis
Lumbar puncture
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...
Read Article Now Book Mark ArticleCerebrospinal fluid (CSF) analysis
Cerebrospinal fluid (CSF) analysis is a group of laboratory tests that measure chemicals in the cerebrospinal fluid. CSF is a clear fluid that surro...
Read Article Now Book Mark Article - MRI scan of the brain, brainstem, or spinal cord
MRI
A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...
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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 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. The goal of treatment is to prevent further deterioration. Many of these changes are not reversible.
Possible Complications
The symptoms can slowly worsen.
When to Contact a Medical Professional
Contact 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
Euerle BD. Spinal puncture and cerebrospinal fluid examination. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 60.
National Institute of Neurological Disorders and Stroke website. Neurosyphilis. www.ninds.nih.gov/health-information/disorders/neurosyphilis. Updated July 19, 2024. Accessed September 8, 2024.
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. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 237.
Central nervous system and peripheral nervous system - illustration
The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes nerves outside the brain and spinal cord.
Central nervous system and peripheral nervous system
illustration
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 and peripheral nervous system - illustration
The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes nerves outside the brain and spinal cord.
Central nervous system and peripheral nervous system
illustration
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
Review Date: 12/4/2022
Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 09/08/2024.