Neurosyphilis

• 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:

  • Primary syphilis
  • Secondary syphilis
  • Syphilis
  • Tertiary syphilis
• 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.