Syphilitic aseptic meningitis

Definition

Syphilitic aseptic meningitis is a complication of untreated syphilis that involves inflammation of the tissues covering the brain and spinal cord. The condition is marked by changes in mental status and problems with nerve function.

Alternative Names

Meningitis - syphilitic

Causes, incidence, and risk factors

Syphilis is a sexually transmitted, infectious disease caused by the spirochete Treponema pallidum. Syphilis has three main stages: primary syphilis, secondary syphilis, and tertiary syphilis.

Syphilitic aseptic meningitis is a form of meningovascular neurosyphilis, which is a progressive, life-threatening complication of syphilis infection.

The disorder resembles meningitis caused by other conditions. There is inflammation of the meninges (the membranes that cover the brain and spinal cord). This may cause headaches, cognitive changes, or decrease in nerve functions such as vision, movement, or sensation. Vascular (blood vessel) symptoms, such as stroke secondary to syphilis, commonly accompany or follow syphilitic aseptic meningitis.

Risks of syphilitic aseptic meningitis include previous infection with syphilis or other sexually transmitted diseases such as gonorrhea (which may hide symptoms of syphilis infection). Syphilis infections are transmitted primarily through sexual contact with an infected person, but they may sometimes be transmitted by nonsexual contact.

Symptoms

• Changes in vision, blurred vision, decreased vision
• Fever
• Headache
• Mental status changes
  • Confusion
  • Disorientation
  • Decreased attention span
  • Irritability
  • Sleepy, lethargic, hard to arouse
• Nausea, vomiting
• Neck pain
• Seizures
• Sensitivity to light (photophobia)
• Sensitivity to loud noises
• Stiff neck
• Stiffness of shoulders, other muscle aches

Signs and tests

An examination may indicate meningitis. There may be focal neurologic deficits (localized loss of nerve functions). A neurologic examination may show reduced cranial nerve function, including the nerves that control eye movement.

Tests may include:

• Cerebral angiography if vascular symptoms are present
• CSF (cerebrospinal fluid) examination
• EEG (electroencephalogram) if seizures are present
• Head CT scan
• Serum VDRL or serum RPR (used as screening tests to detect syphilis infection) -- if positive, requires one the following to confirm diagnosis:
  • FTA-ABS
  • MHA-TP

Treatment

The goals of treatment are to cure the infection and stop the disorder from getting worse. Treatment of the infection reduces new nerve damage and may reduce symptoms, but it does not cure existing damage.

Penicillin or other antibiotics (such as tetracycline or erythromycin) are given to treat the infection. Treatment may be prolonged to ensure that the infection is completely cleared. Symptoms may improve dramatically after treatment. A follow-up examination of the cerebrospinal fluid is required to evaluate the effectiveness of the antibiotic therapy.

Symptomatic treatment is required for existing neurologic damage. Emergency treatment of seizures may be required! Anticonvulsants such as phenytoin may be needed to control seizures.

Assistance or supervision may be needed if the person is unable to function in self-care activities (eating, dressing, etc.). Confusion and other mental changes may improve or be prolonged after antibiotic treatment.

Expectations (prognosis)

A progressive disability is possible. Early death is common, with death caused directly by the neurologic damage (resulting in decreased function of body systems) or by cardiovascular damage that also occurs with late syphilis infections.

People with late syphilis infections are at a greater risk for other infections and diseases. A seizure disorder can arise after infection.

Complications

• Inability to care for self
• Inability to communicate or interact
• Injury caused during seizures
• Stroke secondary to syphilis

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if seizures occur.

Call your health care provider if severe headache with fever or other symptoms are present, particularly if there is a known history of syphilis infection.

Prevention

Adequate treatment and follow-up of primary syphilis infections will reduce the risk of developing syphilitic aseptic meningitis.

If you are sexually active, practice safe sex and always use condoms.

All pregnant women should be screened for syphilis.

References

Centers for Disease Control and Prevention (CDC). Recommendations and Reports: Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep. 2006;55(RR-11).

U.S. Preventive Services Task Force. Screening for Syphilis Infection: Recommendation Statement. Ann Fam Med. 2004;2:362-365.

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

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