Neurosyphilis: Symptoms, Treatment & Complications

Neurosyphilis is a complication of inadequately treated syphilis that happens when the bacterium Treponema pallidum invades the central nervous system. It can affect the brain, meninges, and spinal cord, causing symptoms such as severe headache, muscle weakness, paralysis, trouble concentrating, or dementia.

Syphilis is a sexually transmitted infection that can progress in different ways through different stages. It may cause genital ulcers, skin rash, or fever, while more serious complications, such as heart or neurologic problems, usually appear in more advanced stages of the disease.

Treatment for neurosyphilis is managed by an infectious disease specialist and usually involves antibiotics given directly into a vein for about 10 to 14 days. A few months after treatment, follow-up testing with cerebrospinal fluid obtained by lumbar puncture is needed to assess whether the infection has been cured.

Main symptoms

The main symptoms of neurosyphilis include:

• Vision changes and blindness

• Memory problems or difficulty concentrating

• Changes in walking or numbness in the legs and feet

• Mood changes or irritability

• Depression, delusions, or mania

• Confusion or seizures

• Tremors, weakness, or progressive generalized paralysis

• Headache, stiff neck, nausea, and vomiting

• Vertigo or increased sensitivity to light

These symptoms usually appear 5 to 20 years after the initial Treponema pallidum infection in people who did not receive adequate treatment, although they can occur at any stage of the infection.

Because the signs and symptoms of neurosyphilis vary widely, the condition can be confused with other neurologic diseases, such as Alzheimer’s disease, multiple sclerosis, meningitis, brain tumor, Parkinson’s disease, stroke, or psychiatric conditions such as schizophrenia and depression.

Online symptom test

Neurosyphilis is a complication of untreated syphilis. To check the possibility of having syphilis, please select the symptoms you have:

This test is only a guidance tool. It is not intended to provide a diagnosis or replace an appointment with a healthcare professional.

Confirming a diagnosis

Neurosyphilis is usually diagnosed by an infectious disease specialist based on the person’s symptoms, medical history, and test results, including cerebrospinal fluid (CSF) analysis obtained by lumbar puncture (spinal tap). CSF findings may show abnormalities that suggest neurosyphilis.

According to the Centers for Disease Control and Prevention (CDC), diagnosis relies on a combination of neurologic signs and symptoms together with reactive serologic and CSF test results. Blood tests such as FTA-ABS and VDRL are serologic tests that help identify antibodies associated with syphilis.

Imaging tests such as computed tomography (CT), magnetic resonance imaging (MRI), or cerebral angiography may also be used to assess brain changes and disease progression.

Treatment options

Treatment for neurosyphilis is done in the hospital and involves daily IV injections of antibiotics such as penicillin G or ceftriaxone for about 10 to 14 days. According to the CDC, intravenous aqueous crystalline penicillin G for 10 to 14 days is the recommended first-line treatment for neurosyphilis.

After treatment, the doctor may order blood tests at 3 and 6 months, and then once a year for 3 years. Lumbar punctures may also be done every 6 months to confirm that the infection has been cured.

Possible complications

Untreated neurosyphilis can cause complications such as:

• Permanent paralysis

• Dementia

• Psychosis

• Slow degeneration of the neurons that carry sensory information to the brain, called tabes dorsalis

Complications from neurosyphilis depend on how the disease progresses in each person, how long the infection has been present, and how long treatment is delayed. In more severe cases, it can lead to death.

Prevention measures

Neurosyphilis is a serious complication of syphilis and should be prevented with appropriate treatment. People with syphilis should carefully follow medical advice to reduce the risk of the infection spreading to the nervous system, especially if they have a weakened immune system.

Prevention of syphilis includes using condoms during sexual activity and taking precautions to avoid contact with contaminated blood and secretions. It is also important not to share items that may be contaminated, such as syringes and needles, and to receive proper prenatal care during pregnancy.