It is caused by the bacterium Treponema pallidum, a sexually transmitted infection (STI). When the bacterium infects the central nervous system (CNS), which includes the brain and spinal cord, it causes neurosyphilis. Symptoms of neurosyphilis include headache, vision loss, hearing loss, stroke, dementia, or paralysis. However, neurosyphilis can be prevented by diagnosing and treating it early. Neurosyphilis, however, can cause permanent damage or death if left untreated.
Causes of Neurosyphilis
The same bacterium that causes syphilis, Treponema pallidum, causes neurosyphilis. Syphilis is an STI that can be transmitted by sexual contact, blood transfusion, or mother-to-child transmission during pregnancy. Syphilis can occur at any stage of the disease, but it is more common in the late stages. Syphilis has four stages: primary, secondary, latent, and tertiary.
The bacterium that causes syphilis can enter the CNS through the bloodstream or the nerves. As the bacterium multiplies, it can cause inflammation and damage to the brain, spinal cord, and meninges (protective membranes surrounding the brain). It depends on the extent and location of the damage whether neurosyphilis has symptoms or complications.
Symptoms of Neurosyphilis
Neurosyphilis symptoms vary depending on the type and severity of the disease. There are five types:
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The most common form of neurosyphilis is asymptomatic. If left untreated, asymptomatic neurosyphilis can progress to symptomatic neurosyphilis. It does not cause any noticeable symptoms, but it can be detected by testing cerebrospinal fluid (CSF), the fluid that surrounds and protects the central nervous system.
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Symptoms of meningeal neurosyphilis include headaches, stiff necks, fever, nausea, vomiting, and sensitivity to light. It is characterized by inflammation and irritation of the meninges. Early or late stages of syphilis can result in meningeal neurosyphilis.
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The meningovascular neurosyphilis affects the blood vessels that supply the CNS, narrowing or blocking them. This can result in strokes, seizures, confusion, memory loss, or personality changes. In the early or late stages of syphilis, meningovascular neurosyphilis can develop.
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The parenchymatous form of neurosyphilis affects the brain or spinal cord by causing degeneration or destruction. It may cause symptoms such as dementia, psychosis, hallucinations, delusions, or paralysis. There are two types of parenchymatous neurosyphilis: general paresis and tabes dorsalis. Parenchymatous neurosyphilis occurs in the late stages of syphilis.
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Parenchymatous neurosyphilis causes mental deterioration and personality changes when it affects the brain. People with general paresis can experience mood swings, depression, anxiety, irritability, apathy, or aggression as well as speech, memory, judgment, or reasoning impairments.
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As part of parenchymatous neurosyphilis, tabes dorsalis damages nerve fibers that carry sensory information within the spinal cord. In addition to causing symptoms such as loss of coordination, numbness, tingling, pain, or weakness in the limbs, Tabes dorsalis can also affect bladder, bowel, or sexual function.
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The eye can be affected by ocular neurosyphilis at any stage of the disease, causing inflammation and damage to the optic nerve or retina. Symptoms include blurred vision, reduced vision, or blindness.
Diagnosis of Neurosyphilis
An individual's medical history, physical examination, and several tests and procedures are used to diagnose neurosyphilis. Symptoms, when and how long they have been present, sexual history, and risk factors may be discussed with the doctor. Additionally, the doctor may examine the patient for signs of syphilis, such as skin lesions, enlarged lymph nodes, and nerve damage.
Neurosyphilis is diagnosed by the following tests and procedures:
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As a result of the syphilis bacterium, the body produces antibodies that can be measured in blood tests. Rapid plasma reagin (RPR) tests and treponemal antibody tests (TPPA or FTA-ABS) are the most common blood tests used to confirm the diagnosis and determine the stage of syphilis.
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It is possible to detect and analyze the presence and activity of the syphilis bacterium in the CSF by collecting and analyzing the CSF, which surrounds and protects the central nervous system. The most common CSF tests for neurosyphilis are the venereal disease research laboratory (VDRL) test and the CSF-FTA-ABS test.
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An imaging test can provide information about the structure and function of the central nervous system and the eyes, such as an X-ray, computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET). Using these tests, neurosyphilis damage can be identified and the extent of it can be determined.
Treatment of Neurosyphilis
Treatment of neurosyphilis is dependent on the type and severity of the condition, as well as the person's age, health, and preferences. The main goals of treatment are to:
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Prevent or reduce neurosyphilis complications and symptoms by killing the syphilis bacterium
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Follow the person's recovery and address any residual or permanent effects of neurosyphilis
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Syphilis and neurosyphilis transmission and recurrence prevention
Neurosyphilis may be treated with the following options:
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An antibiotic is a drug that kills or stops the growth of the syphilis bacterium. It is recommended to inject penicillin into the muscle or vein to treat neurosyphilis. If the patient is allergic to penicillin or has other medical conditions, other antibiotics, such as doxycycline or ceftriaxone, may be prescribed. The dosage and duration of penicillin treatment depends on the type and stage of neurosyphilis.
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Taking steroids reduces inflammation and swelling caused by syphilis bacteria or antibiotics. As part of the Jarisch-Herxheimer reaction, which occurs when the bacterium is rapidly killed, steroids may be given by mouth, injection, or infusion in combination with antibiotics to prevent or treat neurosyphilis symptoms.
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Symptomatic treatment: Using drugs or other methods to alleviate or reduce neurosyphilis' symptoms, such as pain, fever, headaches, or seizures. Symptomatic treatment may include medications, surgery, or physical therapy, depending on the individual's needs and preferences.
Prevention of Neurosyphilis
Prevention of syphilis is the best way to prevent neurosyphilis. Syphilis can be prevented by:
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By using condoms, limiting the number of sexual partners, and avoiding sex with people who show signs or symptoms of syphilis or other STIs, you can practice safe sex.
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Regularly testing and treating for syphilis and other STIs, especially if the individual is sexually active or has risk factors
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If a person is diagnosed with syphilis or neurosyphilis, they should inform and encourage their sexual partners to get tested and treated for STIs.
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Injecting drug users should avoid sharing needles, syringes, or other drug paraphernalia
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Getting prenatal care and testing for syphilis and other STIs while pregnant or planning to become pregnant
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Preventing and treating syphilis and neurosyphilis in newborns if the mother has syphilis or neurosyphilis during pregnancy or delivery
