Signs and Treatment Neurosyphilis
Medically reviewed by Diana Apetauerova, MD
Neurosyphilis occurs when syphilis spreads to the central nervous system. It can happen at any stage of the infection, causing a host of psychiatric and physical symptoms ranging from headaches, personality changes, and loss of coordination to delirium, visual changes, and loss of bladder control,
The diagnosis of neurosyphilis is based largely on a lumbar puncture ("spinal tap") and an evaluation of cerebrospinal fluid (CSF). Neurosyphilis can be treated in a hospital with multiple daily doses of penicillin G administered for up to 14 days.
This article looks at the causes and symptoms of neurosyphilis, including how this potentially serious complication of syphilis is diagnosed and treated.
What Are the Symptoms of Neurosyphilis?
Symptoms of neurosyphilis are highly variable. Some people have multiple major symptoms, while others may have one relatively mild symptom that largely goes unrecognized.
Neurosyphilis symptoms vary by the part of the brain affected as well as the stage of infection. For instance, the symptoms tend to be more physical if the protective membrane covering the brain and spinal cord (called the meninges) is affected, while the symptoms tend to be more psychiatric if the functional tissues of the brain (called the parenchyma) are affected.
Physical symptoms of neurosyphilis may include:
Headache
Neck stiffness
Nausea or vomiting
Sensitivity to bright lights
Visual changes
Dizziness or vertigo
Numbness, burning, or pins-and-needles sensations
Tremors and muscle spasms
Loss of coordination
Sudden, stabbing nerve pain
Partial paralysis or weakness
Loss of bladder control
Seizures
Psychiatric symptoms of neurosyphilis may include:
Emotional lability (difficulty controlling emotions)
Memory problems and forgetfulness
Confusion and delirium
Depression
Syphilis infections of the eye and ears also sometimes fall under the umbrella of neurosyphilis. Referred to as ocular syphilis and otosyphilis respectively, these infections can lead to vision and hearing loss if left untreated.
What Is Neurosyphilis Caused By?
Syphilis is caused by a sexually transmitted bacteria called Treponema pallidum. It can also be passed from mother to child during pregnancy.
Scientists do not understand why some people with syphilis develop neurosyphilis and others do not. With that said, neurosyphilis is common in people whose syphilis has gone undiagnosed and untreated for a long time. As such, people with tertiary syphilis (the most advanced stage of the disease) tend to have worse outcomes.
Although syphilis infections have long been on the decline in the 20th century, there has been an uptick in the infection rate since 2000, most notably among men who have sex with men. Increasing rates of antibiotic-resistant syphilis and lower rates of condom use (due to the advent of HIV PrEP) largely account for the increases.
Takeaway
Most cases of syphilis will not become neurosyphilis, particularly with prompt screening and treatment. However, partial or incomplete treatment of syphilis may significantly increase your risk.
Related: A Guide to Regular STI Screenings
How Is Neurosyphilis Diagnosed?
Syphilis is normally diagnosed with a blood test. However, neurosyphilis is harder to diagnose and requires the testing of cerebrospinal fluid (CSF) obtained through a spinal tap paired with a review of your physical and/or psychiatric symptoms.
During a spinal tap, a needle is stuck between the bones of your lower spine to obtain a sample of CSF. The fluid is then tested for syphilis using the same antibody test—called a VDRL test—used to detect syphilis in the blood.
False positive results are possible, especially in the early stages, as there are often fewer Treponema pallidum antibodies in CSF fluid than in the blood. As such, it is possible to have symptoms of neurosyphilis, a positive blood test result, a negative CSF result, and still have neurosyphilis.
How Neurosyphilis Is Treated
The treatment of neurosyphilis requires multiple doses of penicillin given on a strict schedule over many days. Because of this, treatment will almost invariably take place in a hospital.
There are two treatments recommended for neurosyphilis by the Centers for Disease Control and Prevention (CDC):
Penicillin G: Delivered intravenously (into a vein) either continuously on a slow drip or every 4 hours for 10 to 14 days
Procaine penicillin G: Delivered intramuscularly (with a shot into a big muscle) four times a day for 10 to 14 days
Intramuscular injections are paired with oral doses of probenecid taken four times daily for 10 to 14 days. Probenecid prevents the excretion of penicillin and prolongs the activity of the antibiotic drug in the body.
Summary
Neurosyphilis is a complication of syphilis that affects the central nervous system (composed of the brain and spinal cord). It can cause a wide range of symptoms ranging from subtle to severe, including physical symptoms like headaches and vision changes and psychiatric symptoms like forgetfulness and psychosis.
Neurosyphilis is diagnosed based on a review of your symptoms and testing of cerebrospinal fluid obtained from a spinal tap. The treatment is typically administered in a hospital and involves multiple daily doses of penicillin G delivered over 10 to 14 days.
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