What is Neurosyphilis?

Neurosyphilis is a disease of the human nervous system. As a sexually transmitted disease, the name of syphilis is known to common people. When syphilis remains untreated for a long time, the patients remain at risk of getting neurosyphilis. It mainly affects brain and spinal cord. In medical fraternity, neurosyphilis is considered as a fatal disease leading to death of the patient if necessary treatment is not provided on time.

What is Neurosyphilis?

Types of Neurosyphilis

There are five different forms of neurosyphilis. These are as follows –

  • Asymptomatic Neurosyphilis: This is the most commonly occurring type of neurosyphilis. It generally occurs before the signs of syphilis are visible. In this form of neurosyphilis, the patient won't feel sick or get any signs of any neurologic diseases.
  • Meningeal Neurosyphilis: This type of neurosyphilis shows different symptoms after a few weeks or even a few years of contacting syphilis. Such symptoms may be headache, nausea, vomiting, and stiff neck etc. In more advanced stage, patient may complain of vision or hearing impairment.
  • Meningovascular Neurosyphilis: This is a more advanced type of meningeal Neurosyphilis when a patient has at least one cerebral attack. It can happen within a month of getting infected by Treponema pallidum bacteria or might even show its symptoms many years later.
  • General Paresis: This type of neurosyphilis occurs 10-12 years after getting infected with syphilis. Though it is rare nowadays, if affected by General paresis, patients complain of several health issues like paranoia, mood swings, personality changes, painful muscular movements, inability to utilize language and emotional troubles etc. It can even lead to dementia.
  • Tabes Dorsalis: It is another form of neurosyphilis. As per the statistics available, this form of neurosyphilis shows symptoms 15-20 years after the patient is infected with syphilis. Some symptoms of Tabes Dorsalis are trouble in balancing, altered walk, incontinence, vision impairment, pains in abdomen, hands and legs etc.

Symptoms of Neurosyphilis

Following are the most visible symptoms of neurosyphilis:

  • Abnormality in walking or unable to walk
  • Difficulties in movement of toes, feet, or legs is one of the symptoms of neurosyphilis
  • Problems in thinking or concentrating on specific matters for a long time
  • Tremors in body or in limbs without any reason can also be a symptom of neurosyphilis.
  • Problems in vision or blindness
  • Depression
  • Incontinence
  • Dementia

In many people, one or more than one of these problems may occur.

Prognosis of Neurosyphilis

Prognosis in this disease changes depending on the type of neurosyphilis detected in a patient and how patients with neurosyphilis get diagnosed and treated. Individuals with asymptomatic neurosyphilis or meningeal neurosyphilis usually return to normal health after getting proper treatment, whereas, patients diagnosed with meningovascular syphilis, general paresis, or tabes dorsalis generally do not come back to the normal state of health, although they recover to a great extent. Persons who have received delayed treatments after getting infected have a worse prognosis.

Causes of Neurosyphilis

The disease is caused by a bacterium called Treponema Pallidum, the bacterium which causes syphilis. If syphilis remains untreated for a long period say 10-20 years, it may form neurosyphilis. As per the research evidence, not all patients with syphilis develop neurosyphilis.

Diagnosis for Neurosyphilis

In modern medical science, several pathological and physical tests are undertaken for diagnosing neurosyphilis, detecting the type of neurosyphilis and level of the disease in a patient.

  • Muscle Movement Tests to Diagnose Neurosyphilis: Primarily doctors check certain muscle movements to understand the presence of certain abnormalities, like the following ones:
    • Abnormalities in muscular reflex
    • Muscle contractions
    • Muscle atrophy
  • Blood Tests to Identify Neurosyphilis: A blood test can spot middle level of neurosyphilis. There are a various blood tests that could detect whether the patient is currently affected by syphilis or had an infection in the long past. Following blood tests are undertaken to detect ingredients formed due to presence of bacteria that cause syphilis, these include:
    • Venereal disease research laboratory (VDRL) test
    • Treponema pallidum particle agglutination assay (TPPA) test
    • Fluorescent treponemal antibody absorption (FTA-ABS) test
    • Rapid plasma reagin (RPR) test
  • Spinal Tap to Diagnose Neurosyphilis: If doctor suspects that the patient has a late-stage neurosyphilis, he will ask for a lumbar puncture, or spinal tap. In this procedure, a sample of the fluid from spinal cord is collected. This sample is then tested for infection and if confirmed, doctors then plan treatment accordingly.
  • Imaging Tests to confirm the Diagnosis of Neurosyphilis: Imaging tests which look for problems with the nervous system may include:
    • Cerebral angiogram
    • CT scan for head
    • MRI of brain or spinal cord.

Treatment Options for Neurosyphilis

The antibiotic, Penicillin is applied in the form of injections and capsules to treat syphilis and neurosyphilis. The regimen lasts for 10 to 14 days. Along with penicillin, the antibiotics Probenecid and Ceftriaxone are also used in some severe situations. Depending on the seriousness of the case, a patient may be admitted to hospital.

Blood tests are conducted after every three months till 36 months to ensure that the bacteria have disappeared completely. Doctors also prefer to inspect cerebrospinal fluids through spinal tap every year to monitor disappearance of the bacteria.

It is found by the researchers that neurosyphilis is common in patients with HIV. This happens because syphilitic lesions are easily infected with HIV. Treponema pallidum interacts with HIV very closely which makes the treatment procedure more complicated. To treat neurosyphilis in HIV patients, frequency of penicillin injections are increased; even then, there remains lower chance of complete recovery.

Prevention of Neurosyphilis

Prevention of neurosyphilis is possible only if syphilis is prevented. Since, syphilis is a sexually transmitted infection; hence, it can be controlled to a great extent by practicing safe sex. People often remain ignorant on how did they get the disease, because in most of the cases, syphilis appears after several months or even years. Initial sores in the infection site may disappear after a few days, but that doesn't mean that the bacteria are eradicated. Often, symptoms relapse after several years. So, it is feasible for the sexually active people to periodically test their blood for syphilis infection.

Conclusion

Treponema pallidum is a typical bacterium which doesn't disappear from human body easily. On the contrary, these bacteria can stay in human body for several years in recessive state. As the bacteria proliferate in human body over time, chance of neurosyphilis increases manifold. Problem worsens if syphilis still remains unnoticed or the symptoms are ignored. Neurosyphilis is a harmful disease that can even be life threatening if necessary measures are not taken in time. Modern medical science can detect neurosyphilis accurately and through necessary treatment procedure most neurosyphilis can be cured successfully. Hence, as soon as the symptoms are noticed, one must seek medical help to rule out the condition and get proper treatment.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: September 12, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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