Neurosyphilis

Written by Teresa Bergen | Published on June 13, 2012
Medically Reviewed by George Krucik, MD

What is Neurosyphilis?

Syphilis is a sexually transmitted infection that is spread through direct contact with syphilis sores. The disease has been known about and studied since at least the early 16th century. It is treatable and relatively simple to prevent (Knudsen, 2011). Despite the body of knowledge around it, there was a major uptick in syphilis cases during the 2000s, especially among women ages 20 to 24 and men ages 35 to 39 (CDC).

If syphilis goes untreated, the affected person is at risk of developing neurosyphilis. This is an infection of the nervous system, specifically the brain and the spinal cord. Neurosyphilis is a life-threatening disease.

Causes and Types of Neurosyphilis

Treponema pallidum is the bacterium that causes syphilis and, subsequently, neurosyphilis. Neurosyphilis tends to develop about 10 to 20 years after the initial infection with the bacterium. Untreated syphilis and being HIV-positive are major risk factors for developing neurosyphilis.

There are five different possible forms of neurosyphilis:

Asymptomatic Neurosyphilis

This is the most common type of neurosyphilis. It usually occurs before the symptoms from syphilis become visible. In this form of neurosyphilis, you won’t feel sick or experience any signs of neurologic disease.

Meningeal Neurosyphilis

This form of the disease usually shows up anywhere from a few weeks to a few years after a person contracts syphilis. Its symptoms include nausea, vomiting, a stiff neck, and headache. It may also cause a loss of hearing or vision.

Meningovascular Neurosyphilis

This is a more serious form of meningeal neurosyphilis. In this case, you would also have had at least one stroke.

About 10 to 12 percent of neurosyphilis sufferers develop this form (UCSF, 2002). A stroke may occur in the first few months following a syphilis infection, or it may happen a few years after infection.

General Paresis

This form can appear decades after a person is infected with syphilis and can cause lasting mental damage. However, it is fairly rare today because of advances in the screening, treatment, and prevention of sexually transmitted infections.

If it develops, general paresis may lead to several health problems, including:

  • paranoia
  • mood swings
  • emotional troubles
  • personality changes
  • weakened muscles
  • loss of the ability to utilize language

It can also progress to dementia.

Tabes Dorsalis

This form of neurosyphilis is also rare. It can start to affect the spinal cord 20 years or more after the initial syphilis infection. Its symptoms include difficulties with balance, loss of coordination, incontinence, an altered walk, vision problems, and pains in the abdomen, arms, and legs.

Testing for Neurosyphilis

Physical Exam

To find out if you have neurosyphilis, your doctor may start by checking your normal muscle reflexes and determining whether any of your muscles have atrophied (lost muscle tissue).

Blood Test

A blood test can detect middle-stage neurosyphilis. There are a variety of blood tests that will show whether you currently have syphilis or if you had an infection in the past.

Spinal Tap

If your doctor suspects late-stage neurosyphilis, he or she will also order a lumbar puncture, or spinal tap. This procedure will provide a sample of the fluid around your brain and spinal cord. Your doctor will use this sample to find out the extent of the infection and plan your treatment.

Imaging Tests

Your doctor might also order a computed tomography (CT) scan. This is a series of X-rays that allows your body to be seen in cross sections and from different angles. You might also need a magnetic resonance imaging (MRI) scan. An MRI is a test in which you lie in a tube containing a strong magnet. The machine sends radio waves through your body, allowing your doctor to see detailed images of your organs. These tests allow your doctor to look at the spinal cord, brain, and brainstem, which can also show evidence of the disease.

Treatment Options for Neurosyphilis

The antibiotic penicillin is used to treat syphilis and neurosyphilis. It may be injected or taken orally. The usual regimen lasts 10 to 14 days. The antibiotics probenecid and ceftriaxone are often used in conjunction with penicillin. Depending on your case, you may need to stay in the hospital while being treated.

During your recovery, you will need blood tests at the three- and six-month marks. After that, you should have blood tests every year following your treatment for three years. Your doctor will continue to monitor your cerebrospinal fluid levels with spinal taps every six months.

Neurosyphilis is especially common in HIV-positive people. This is because syphilitic sores make it easier to become infected with HIV. The Treponema pallidum bacteria interact with HIV in a way that makes it harder to treat the syphilis infection.

Those with neurosyphilis who are HIV-positive usually need more penicillin injections and have less chance for a complete recovery.

Long-Term Outlook

Your long-term outlook depends on what type of neurosyphilis you have, and how early your doctor diagnoses it. Penicillin will treat your infection and prevent it from doing any more damage, but it cannot repair the damage already done. However, if your case is mild, the antibiotics may be enough to return you to full health.

If you had any of the other three types, you will probably improve following treatment, but it is unlikely that you will return to perfect health.

Tips to Prevent Syphilis

The first step in neurosyphilis treatment is preventing syphilis. Since syphilis is a sexually transmitted infection (STI), your best option is to use safe sex practices, which you can discuss with your healthcare provider. Condoms can reduce the chance of contracting syphilis. However, syphilis can be contracted through genital touching outside of the area covered by the condom.

People don’t always know they have been infected with syphilis because symptoms can remain hidden for years. An initial sore or sores at the infection site may appear a few weeks or months after contracting the disease. Although these sores heal on their own, the disease can remain. Later, a rash of rough, non-itchy, reddish brown spots will appear at the infection site or on another part of the body. If you plan on being sexually active, get tested for STIs on a regular basis.

Other symptoms of syphilis include swollen lymph glands, headaches, hair loss, weight loss, fatigue, and muscle aches. If you have or have had any of these symptoms, contact your doctor for testing. The sooner you are diagnosed, the better your chances of avoiding neurosyphilis.

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