A complication of syphilis that causes serious neurological issues (such as paralysis and stroke). Moreover, this condition has multiple forms and may occur at any stage of this sexually transmitted infection (STI). One way to prevent neurosyphilis is to get treatment for syphilis as soon as possible.
Generally, this is a possible life-threatening complication of syphilis that occurs due to a bacterium called Treponema Pallidum. This complication often occurs when this bacterium invades the brain or spinal cord. These conditions are distinct but related. While neurosyphilis affects the central nervous system (CNS), syphilis is an STI that causes different symptoms.
If you leave neurosyphilis untreated, it may lead to other life-threatening complications, such as permanent paralysis, dementia, and even death.
Types of Neurosyphilis
In general, there are 5 types of neurosyphilis that doctors have divided into 2 categories, including early and late neurosyphilis.
Early Neurosyphilis
- Asymptomatic neurosyphilis (ANS) – This type of neurosyphilis often does not cause any symptoms, and it occurs before you develop the symptoms of syphilis itself. Physicians often diagnose ANS by testing the cerebrospinal fluid (CSF). Moreover, ANS may occur within a few weeks to years after being diagnosed with the infection.
- Meningeal neurosyphilis – This form of neurosyphilis occurs when the bacteria cause inflammation in the meninges (the protective layer of the brain and spinal cord). It may cause headaches, nausea, and vomiting. People who do not get treatment for syphilis may develop this form of the disease within a few weeks to several years after the infection.
- Meningovascular neurosyphilis – In such cases, this bacterium causes inflammation of the meningeal arterial walls (endarteritis). As a result, it leads to thrombosis and obstruction of the blood vessels that limit blood flow to the brain. Therefore, some people with meningovascular neurosyphilis may experience stroke and other serious health conditions.
Late Neurosyphilis
- General paresis – This is a late form of neurosyphilis caused by long-term (chronic) inflammation in the meninges. Usually, it leads to a breakdown of brain tissue and multiple psychological symptoms and disorders. In some cases, people may develop general paresis even after 30 years if they do not get treatment for the initial infection.
- Tabes dorsalis – This is the last and most severe form of neurosyphilis. It occurs due to the breakdown of the posterior column and roots of the spinal cord. As a result, you may experience the following symptoms. For example, nerve pain, bladder dysfunction, and others. In addition, tabes dorsalis may occur from 5 to 50 years after the initial STI.
How Common is Neurosyphilis?
In general, it is difficult to determine how many people experience this complication of syphilis. For instance, there were over 133,000 diagnosed cases in the U.S. in 2020. In most cases, people develop asymptomatic neurosyphilis, and general paresis and tabes dorsalis occur rarely because of advancements in the prevention, screening, and treatment of syphilis.
Symptoms
The symptoms appear differently among people with this condition because it depends on several factors. These include the type and severity of the condition, existing health problems, and age. However, people with asymptomatic neurosyphilis do not experience any symptoms. Check some symptoms below:
Meningeal Neurosyphilis Symptoms
These include:
- Neck stiffness
- Photophobia (sensitivity to light)
- Vision or hearing changes
- Cranial nerve dysfunction
- Headaches
- Nausea
- Vomiting
Meningovascular Neurosyphilis Symptoms
The symptoms of this type of neurosyphilis include the following, along with those of meningeal neurosyphilis. For example:
- Muscle weakness or atrophy (loss), especially in the legs
- Stroke
- Vertigo
General Paresis Symptoms
Usually, doctors divide the symptoms of this form of neurosyphilis into 2 categories. These include early and late symptoms. Moreover, some of them can develop gradually or suddenly. Check some examples below:
- Forgetfulness
- Sleep disturbances
- Personality changes
- Mood swings
- Irritability
- Memory loss (also known as amnesia)
- Confusion
- Delusion
- Seizures
- Impaired judgment
- Depression
- Psychosis
Tabes Dorsalis Symptoms
- Bladder control problems
- Vision changes
- Abnormal sensations (including burning or tingling)
- Loss of coordination and reflexes
- Charcot joint (neuropathic arthropathy)
- Difficulty walking
- Nerve pain
- Ataxia
However, the syphilis itself also causes symptoms, but they also depend on its stage. Check below some symptoms often noticed in people with syphilis:
- Small and painless sores on the genitals (in early stages)
- Skin rash
- Fatigue (extreme tiredness)
- Fever
- Sore throat
- Muscle aches
Immediately contact your healthcare professional if any of the previous symptoms occur.
Causes
This complication of syphilis occurs when the bacterium (Treponema Pallidum) causes damage to the central nervous system, including the brain and spinal cord. However, this bacterium can enter the body through the anus, vagina, penis, mouth, or even broken skin. Neurosyphilis may occur at any stage of syphilis, especially if it is left untreated.
According to some research, in most people who develop syphilis, the bacterium that causes it affects their CNS. In most cases, this bacterium impacts it before you begin to experience syphilis symptoms. Rarely, the CNS infection may go away on its own without causing any symptoms or inflammation.
It is important to know that syphilis does not go away on its own. Usually, doctors prescribe antibiotics to treat it.
Risk Factors
There are some factors that may increase your risk of developing neurosyphilis. These include:
- Untreated syphilis – People who do not get treatment for this STI are at higher risk of developing neurosyphilis.
- Sex between males (MSM) – About 80% of diagnosed cases occur in men who have sex with men in the U.S.
- HIV infection
- Weakened immune system
- Diabetes
What Are The Potential Complications of Neurosyphilis?
Those who do not get treatment even when experiencing neurological symptoms may also experience the following complications. Check some of them below:
- Cranial neuropathies
- Meningitis (a life-threatening infection that causes inflammation of the membranes that surround the brain and spinal cord)
- Ocular syphilis
- Otosyphilis
- Stroke
- Sensory loss
- Paralysis
- Dementia
This article does not contain a full list of neuropathy complications. However, you can consult with your doctor about ways to reduce the risk or even prevent them.
How to Prevent Neurosyphilis?
The only sure way to prevent this condition is to avoid getting syphilis, but the only certain way to prevent this STI is to abstain from sex. However, doctors may recommend some tips that may help reduce the risk. For example:
- Always use protection during sex (including condoms or dental dams)
- Get tested for STIs regularly, especially if you have multiple sexual partners
- Seek medical help as soon as possible if you begin to experience symptoms
Diagnosis
Doctors often diagnose neurosyphilis based on your symptoms and a cerebrospinal fluid (CSF) analysis. CSF is a specific fluid that surrounds the spinal cord and brain. Doctors may also ask some questions about your medical history and perform physical and neurological examinations. However, when neurosyphilis is suspected, they may also perform the following tests to confirm or rule out this condition. Examples include:
- Blood tests – These tests are done to check for the bacterium that causes this STI.
- Lumbar puncture (also known as a spinal tap) – During this procedure, your doctor will insert a needle into the lower back to get a small sample of CSF.
Furthermore, all people who were diagnosed with syphilis should also receive an HIV test to make sure they do not have this infection, according to the U.S. CDC (Centers for Disease Control and Prevention).
Treatment
Healthcare professionals often prescribe intravenous (IV) antibiotics (such as Penicillin) to treat syphilis. However, they may also recommend Ceftriaxone. After treatment, you should perform additional blood tests to make sure you no longer have this bacterium. These blood tests are performed 3 and 6 months after treatment. Sometimes, physicians may also perform a CSF test to make sure it disappeared from the CNS.
Frequently Asked Questions
Can the damage be reversed?
No, it is not possible to reverse the damage caused by this complication. Antibiotics are used to stop the progression of neurosyphilis and destroy the bacterium that causes it. In addition, some people with asymptomatic or meningeal neurosyphilis may notice some improvements after treatment, but they will never return to normal health.
Is neurosyphilis contagious?
While the neurosyphilis itself is not contagious, the bacterium that causes syphilis and this complication can easily spread to other people. It spreads through sexual contact (especially unprotected vaginal, anal, or oral sex).
When should I see my healthcare provider?
In general, you should see a doctor if you suspect you have syphilis or begin to experience symptoms. Ask your healthcare provider if you have additional questions.
