Neurosyphilis is an infection of the brain or spinal cord caused by the spirochaete Treponema pallidum. It usually occurs in people who have had chronic, untreated syphilis, usually about 10 to 20 years after first infection and develops in about 25%–40% of persons who are not treated. The Center for Disease Control (CDC) in the USA advises that neurosyphilis can occur at any stage of a syphilis infection.
Symptoms and signs
- Abnormal gait
- Confusion, disorientation
- Memory problems
- Mood disturbances
- Numbness in the toes, feet, or legs
- Poor concentration
- Neck stiffness
- Visual disturbances. There may be the sign of Argyll Robertson pupils, which are bilateral small pupils that constrict when the patient focuses on a near object, but do not constrict when exposed to bright light.
- Muscle weakness
Upon further diagnostic workup, the following signs may be present:
- Abnormal reflexes
- Muscle atrophy
- Muscle contractions
- Venereal Disease Research Laboratory test (VDRL)
- Fluorescent treponemal antibody absorption (FTA-ABS)
- Rapid plasma reagin (RPR)
- Treponema pallidum particle agglutination assay (TPPA)
Additional tests to look for problems with the nervous system may include:
- Cerebral angiogram
- Head CT scan
- Lumbar puncture ("spinal tap") to acquire a sample for cerebrospinal fluid analysis
- MRI scan of the brain, brainstem, or spinal cord
- Aqueous penicillin G 3-4 million units q4h for 10-14 days.
- One daily intramuscular injection and oral probenecid 4 times a day, both for 10 - 14 days.
Follow-up blood tests are generally performed at 3, 6, 12, 24, and 36 months to make sure the infection is gone. Lumbar punctures for CSF fluid analysis are generally performed every 6 months.
Neurosyphilis was almost at the point being unheard of in the United States after penicillin therapy was introduced.(4) However, concurrent infection of T. pallidum with human immonudeficiency virus has been found to affect the course of syphilis. Naturally, syphilis can lie dormant for 10-20 years before progressing to neurosyphilis, but HIV may accelerate the rate of the progress. Also, infection with HIV has been found to cause penicillin therapy to fail more often. Therefore, neurosyphilis has once again been prevalent in societies with high HIV rates and limited access to penicillin.(3)
- Neurosyphilis at PubMed Health. Review Date: 9/15/2010. Reviewed by: David C. Dugdale, Jatin M. Vyas. Also reviewed by David Zieve
- Murray ED, Buttner N, Price BH (2012). "Depression and Psychosis in Neurological Practice". In Bradley WG, Daroff RB, Fenichel GM, Jankovic J. Bradley's Neurology in Clinical Practice: Expert Consult - Online and Print, 6e (Bradley, Neurology in Clinical Practice e-dition 2v Set) 1 (6th ed.). Philadelphia, PA: Elsevier/Saunders. pp. 101–102. ISBN 1-4377-0434-4.
3. Gordon, Steven; Eaton, Molly; George, Rob; Larsen, Sandra. "The Response of Symptomatic Neurosyphilis to High Dose Intravenous Penicillin G in Patients Human Immunodeficiency Infection." The New England Journal of Medicine. 1994. Massachusetts Medical Society. pp 1469-1473.]]
4. Musher, Daniel. "Syphilis, Neurosyphilis, Penicillin, and AIDS." The Journal of Infectious Diseases. 1991. The University of Chicago. pp 1201-1206]]