What is Syphilitic Meningitis & How is it Treated? | Causes, Symptoms, Prevention, Diagnosis of Syphilitic Meningitis

What is Syphilitic Meningitis?

Meningitis is an infection of layers of tissue that covers the brain and spinal cord. Syphilitic meningitis is a complication of syphilitic infection. It is a form of neurosyphilis a phase when syphilis affects the central nervous system. It is a treatable condition but can be life-threatening.

Syphilis is a sexually transmitted infection that if untreated can lead to a serious health issue such as syphilitic meningitis.

It is not that every case of untreated syphilis develops meningitis. Syphilis is seen affecting the nervous system of up to 40 percent of people with secondary syphilis(1). And, only 1 to 2 percent is seen going on to syphilitic meningitis.(2)

Syphilitic meningitis is caused by Treponema pallidum. It may be asymptomatic at first, or the symptoms might be similar to those of meningitis. Most often the symptoms go unnoticed or are mistaken for other illnesses such as flu.

If left untreated it can further progress to life-threatening conditions such as stroke, paralysis, or heart disease.

The condition is preventable. Early diagnosis and treatment can reduce the risk of developing syphilitic meningitis.

What Causes Syphilitic Meningitis?

Syphilitic meningitis is caused by Treponema pallidum, a bacterium responsible for causing syphilis. It is a type of neurosyphilis that occurs when syphilis involves the central nervous system.

It usually begins as a primary or secondary phase of syphilis i.e. few weeks to several years of syphilis infection.

Syphilitic meningitis is the first symptomatic stage of neurosyphilis and is seen affecting the central nervous system. The more serious neurological symptoms can take several years or even a decade to develop. The first symptom of late syphilitic meningitis is stroke.

Stages of Syphilis

People with syphilis may go on for several years without any noticeable symptoms. Often the symptoms that occur mimic some other illness and are left untreated or misdiagnosed.

If detected and treated early the chances of complications are rare.

According to the Centers for Disease Control and Prevention (CDC), there are four progressive stages of syphilis(3):

Primary Syphilis: This is marked by small and painful multiple sores. These sores are seen occurring usually around the genitals, mouth, and rectum. They heal mostly in 3-6 weeks.

Secondary Syphilis: In this stage further symptoms of syphilis start occurring, which include fever, rash, and swollen lymph nodes. These are minor symptoms and are often overlooked.

Latent Syphilis: In this stage, there are no signs and symptoms.

Tertiary Syphilis: This stage leads to serious medical problems that involve the heart, brain, and other body organs.

What is Neurosyphilis?

Neurosyphilis is a condition when syphilis affects the central nervous system. It can occur at any stage of syphilis but is seen mostly occurring in the first two stages(4). According to research, neurosyphilis can be difficult to diagnose(5).

Being asymptomatic often it is overlooked or left misdiagnosed.

Neurosyphilis is of 5 types:

  • Asymptomatic neurosyphilis
  • Meningeal neurosyphilis
  • Meningovascular neurosyphilis
  • General paresis
  • Tabes dorsalis

Symptoms of Syphilitic Meningitis

Syphilis meningitis can be asymptomatic at first or may go unnoticed due to its symptoms resembling other illnesses.

Most of the symptoms of Syphilis meningitis often resolve on their own. The symptoms include:

  • Fever
  • Headache
  • Seizures
  • Nausea and vomiting
  • Changes in vision
  • Change in mental status
  • Muscle aches
  • Sensitivity to light and noise
  • Unexplained fatigue

If left untreated it can progress into more serious health complications years later. A person might have syphilis years before the advanced meningitis symptoms occur.

The advanced meningitis symptoms occur in the meningovascular stage of neurosyphilis i.e. around 6-7 years after infection (5).

The symptoms of syphilitic meningitis in later stages include:

  • Heart disease
  • Strokes
  • Seizures
  • Aneurysms
  • Death

How is Syphilitic Meningitis Diagnosed?

Syphilitic meningitis can be diagnosed with physical examination and the following laboratory test:

  • VDRL (Venereal Disease Research, Laboratory) test done to diagnose syphilis
  • RPR (rapid plasma regain) test for syphilis
  • Imaging scans of the brain
  • Blood test for T.pallidum
  • Lumbar puncture also known as the spinal tap, is done to test the cerebrospinal fluid (CSF)

Treatment of Syphilitic Meningitis

Antibiotics are prescribed for several weeks to treat the infection if diagnosed with syphilitic meningitis.

The infection leads to life-threatening symptoms that also need to be addressed. The symptoms include:

Surgery is needed to drain fluid from brain and sinus cavities.

How to Prevent Syphilitic Meningitis?

  • Syphilis spreads through sexual contact. Using protection during sex is important to prevent it from occurring.
  • If sexually active, getting tested for STI regularly is necessary.
  • If syphilis is detected early treat it early to prevent developing syphilitic meningitis
  • If, pregnant, get screened for syphilis as the condition can increase the risk of stillbirth.

 Syphilitic meningitis, if left untreated, can progress quickly and lead to complications. Some people recover early from the condition. However, nerve damage is permanent.

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