Syphilis is a sexually transmitted infection (STI) that spreads
through direct contact with syphilis sores. People have known about and studied
this disease since at least the early 16th century. It’s treatable and
relatively simple to prevent. There was a major increase in syphilis cases
during the 2000s, especially among women ages 20 to 24 and men ages 35 to 39.
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
Causes and Risk Factors
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. Having HIV and untreated
syphilis are major risk factors for developing neurosyphilis.
There are five different possible forms of 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
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:
- a stiff neck
- a headache
It may also cause a loss of hearing or vision.
This is a more serious form of meningeal neurosyphilis. In this
case, you would also have had at least one stroke.
to 12 percent of neurosyphilis sufferers develop this form. A stroke may
occur in the first few months following a syphilis infection, or it may happen
a few years after infection.
This form can appear decades after you’re infected with syphilis,
and it can cause lasting issues. However, it’s fairly rare today because of
advances in the screening, treatment, and prevention of STIs.
If it develops, general paresis may lead to several health
- mood swings
- emotional troubles
- personality changes
- weakened muscles
- a loss of the ability to utilize language
It can also progress to dementia.
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
- trouble balancing
- a loss of coordination
- an altered walk
- vision problems
- pains in the abdomen, arms, and legs
There are several testing options when it comes to
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, or lost muscle tissue.
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.
If your doctor suspects you have late-stage neurosyphilis, they
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.
Your doctor might also order a CT scan. This is a series of
X-rays that allows your body to be seen in cross sections and from different
You might also need an 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 your spinal cord, brain,
and brainstem for evidence of the disease.
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 along with penicillin. Depending on your case, you
may need to stay in the hospital while being treated.
During your recovery, you’ll need blood tests at the 3- and 6-month
marks. After that, you should have blood tests every year for three years following
your treatment. Your doctor will continue to monitor your cerebrospinal fluid
levels with spinal taps every six months.
Neurosyphilis is especially common in people who have HIV. This
is because syphilitic sores make it easier to become infected with HIV. Treponema
pallidum interacts with HIV in a way that makes it harder to
treat the syphilis infection.
Those with neurosyphilis and HIV usually need more penicillin
injections and have a decreased chance for a complete recovery.
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, antibiotics may be enough
to return you to full health.
If you had any of the other three types, you’ll probably improve
following treatment, but it’s unlikely that you’ll return to perfect health.
to Prevent Syphilis
The first step in neurosyphilis treatment is preventing syphilis.
Since syphilis is an STI, your best option is to practice safe sex. You can
discuss these with your doctor. Condoms can reduce the chance of contracting
syphilis. However, syphilis can be contracted through touching genitals 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. If you have syphilis, you can pass it on to others
including your unborn baby.
Other symptoms of syphilis include:
- swollen lymph glands
- a headache
- hair loss
- weight loss
- muscle aches
See your doctor to get tested if you have or have had any of
these symptoms. The sooner you are diagnosed, the better your chances of