Neurosyphilis
Syphilis infection affecting the brain and nervous system
Quick Facts
- Type: Complication of syphilis
- Affects: Brain, spinal cord, and eyes
- Cause: Untreated or inadequately treated syphilis
- Treatment: Antibiotics, usually penicillin
Overview
Neurosyphilis is a serious complication that can occur when syphilis, a bacterial infection usually spread through sexual contact, is not treated and spreads to the nervous system. The bacteria can invade the brain, spinal cord, the membranes around them, and the eyes, leading to a wide range of neurological problems.
It can develop at different stages of syphilis, sometimes early in the infection and sometimes many years later. Because the symptoms can be varied and may mimic other conditions, neurosyphilis can be easy to overlook. The encouraging news is that, when diagnosed, it is treatable with antibiotics, and early treatment can prevent permanent damage, which makes testing and recognition important.
Symptoms
Symptoms depend on which part of the nervous system is affected and may develop slowly. They can include:
- Headache and stiff neck (from inflammation of the brain's coverings)
- Changes in vision or eye pain
- Confusion, memory problems, or changes in personality
- Difficulty with coordination or walking
- Numbness, tingling, or weakness in the limbs
- Mood changes, including depression or irritability
- In advanced cases, dementia, paralysis, or seizures
Some people have few or no symptoms early on, which is why testing is important when syphilis is diagnosed.
Causes
Neurosyphilis is caused by the same bacterium that causes syphilis, called Treponema pallidum. It develops when the infection is not treated, or not treated adequately, and the bacteria reach the nervous system.
Syphilis itself is usually spread through sexual contact, and less commonly from a pregnant person to their baby. Once in the body, untreated bacteria can travel to the brain, spinal cord, and eyes at various stages. People with weakened immune systems, including those with HIV, may be at higher risk of the infection involving the nervous system.
Risk Factors
- Untreated or inadequately treated syphilis
- HIV infection or a weakened immune system
- Delayed diagnosis of syphilis
- Behaviors that increase exposure to sexually transmitted infections
Anyone diagnosed with syphilis who develops neurological or eye symptoms should be evaluated for neurosyphilis.
Diagnosis
Diagnosis combines blood testing with examination of the spinal fluid:
- Blood tests: To detect syphilis infection.
- Lumbar puncture (spinal tap): Sampling the fluid around the brain and spinal cord to look for signs of infection in the nervous system; this is key to diagnosing neurosyphilis.
- Brain and eye examination: Including imaging and eye assessment when symptoms suggest involvement.
Because syphilis and HIV often occur together, HIV testing is usually recommended as well.
Treatment
Neurosyphilis is treated with antibiotics, and treatment is effective at clearing the infection:
- Penicillin: Intravenous penicillin is the standard treatment, often given over a number of days, and alternatives are used for those with penicillin allergy under medical guidance.
- Follow-up testing: Repeat spinal fluid and blood tests to confirm the infection is responding to treatment.
- Managing complications: Treatment of any lasting neurological problems and support as needed.
Antibiotics can stop the infection from causing further damage, but they cannot reverse harm that has already occurred, which is why early treatment is so important. Sexual partners should also be tested and treated.
After treatment, doctors usually arrange follow-up to confirm that the infection is clearing, which may include repeat blood tests and, in some cases, another examination of the spinal fluid. People who also have HIV may need closer monitoring. Because neurosyphilis is a complication of an infection that is largely preventable and curable when caught early, raising awareness of testing and treatment for syphilis is an important way to avoid it.
Prevention
- Prevent syphilis through safer sex practices, including condom use
- Get tested for sexually transmitted infections if you may have been exposed
- Treat syphilis promptly and completely to prevent it reaching the nervous system
- Ensure sexual partners are tested and treated
- People with HIV should follow recommended screening for syphilis
When to See a Doctor
See a doctor if you have been diagnosed with syphilis and develop headaches, vision changes, confusion, memory problems, or weakness, or if you may have an untreated infection. Seek urgent care for:
- Sudden vision loss or severe eye pain
- New confusion, seizures, or difficulty speaking or walking
- Severe headache with a stiff neck and fever
Frequently Asked Questions
What is neurosyphilis?
Neurosyphilis is a complication of untreated syphilis in which the infection spreads to the brain, spinal cord, or eyes. It can cause a wide range of problems, from headaches and vision changes to confusion, memory loss, and difficulty walking.
Can neurosyphilis be cured?
The infection can be cleared with antibiotics, usually intravenous penicillin. Early treatment can prevent further damage, but it cannot reverse harm that has already occurred, so prompt diagnosis and treatment are important.
How is neurosyphilis diagnosed?
Doctors use blood tests for syphilis along with a lumbar puncture, or spinal tap, to examine the fluid around the brain and spinal cord for signs of infection. HIV testing is usually recommended as well, since the two infections often occur together.
When does neurosyphilis develop?
It can develop at different stages of syphilis, sometimes early in the infection and sometimes many years later if syphilis is left untreated. Because symptoms vary widely, testing is important whenever syphilis or suggestive symptoms are present.
How can neurosyphilis be prevented?
It is prevented by avoiding and promptly treating syphilis. Safer sex practices, testing for sexually transmitted infections after possible exposure, and full treatment of syphilis all reduce the risk of the infection reaching the nervous system.
References
- Centers for Disease Control and Prevention (CDC). Syphilis.
- MedlinePlus, U.S. National Library of Medicine. Neurosyphilis.
- National Institute of Neurological Disorders and Stroke (NINDS). Neurosyphilis.
- Mayo Clinic. Syphilis.