Neurosyphilis
Overview
Syphilis bacteria frequently invade the nervous system during the early stages of infection, and approximately 3 to 7 percent of persons with untreated syphilis develop neurosyphilis. Some persons with neurosyphilis never develop any symptoms. Others may have headache, stiff neck, and fever that result from an inflammation of the lining of the brain. Some patients develop seizures. Patients whose blood vessels are affected may develop symptoms of stroke with resulting numbness, weakness, or visual complaints. In some instances, the time from infection to developing neurosyphilis may be up to 20 years. Neurosyphilis may be more difficult to treat and its course may be different in people with HIV infection
Symptoms
The list of signs and symptoms mentioned in various sources for Neurosyphilis includes the 40 symptoms listed below: * Cranial nerve palsies * Hydrocephalus * Myeloradiculopathy * Stroke * Hemiparesis * Dysphasia * Seizures * Encephalitic syndrome * Anterior spinal artery syndrome * Frontal-temporal dementia * Psychiatric symptoms * Personality change * Dysarthria * Tremor * Facial tremor * Hand tremor * Tongue tremor * Optic atrophy * Pain * Areflexia * Sluggish pupils * Autonomic dysfunction * Sphincter dysfunction * Small pupils * Irregular pupils * Mood changes * Impaired concentration * Impaired attention * Memory problems * Muscle wasting * Impaired muscle function * Muscle contractions * Vision problems * Depression * Mental confusion * Abnormal walk * Irritability * Headache * Stiff neck * Dementia
Causes
Infection from the spirochete Treponema pallidum causes syphilis. Transmission occurs primarily through sexual contact during the primary, secondary, and early latent stages of infection. Prenatal transmission from an infected mother to her fetus is also possible
Prevention
While abstinence from any sexual activity is very effective at helping prevent syphilis, it should be noted that T. pallidum readily crosses intact mucosa and cut skin, including areas not covered by a condom. Proper and consistent use of a latex condom may be effective against the spread of syphilis through sexual contact, although this cannot be guaranteed due to the ease with which non-genital body parts can be infected.[30] Individuals sexually exposed to a person with primary, secondary, or early latent syphilis within 90 days preceding the diagnosis should be assumed to be infected and treated for syphilis, even if they are currently seronegative. If the exposure was more than 90 days before the diagnosis, presumptive treatment is recommended if serologic testing is not immediately available or if follow-up is uncertain. Patients with syphilis of unknown duration and nontreponemal serologic titers ≥1:32 may be considered as having early syphilis for purposes of partner notification and presumptive treatment of sex partners. Long-term sex partners of patients with late syphilis should be evaluated clinically and serologically and treated appropriately. All patients with syphilis should be tested for HIV. Patient education is important as well
Diagnosis
dentifying T. pallidum from a lesion on a dark-field examination provides immediate diagnosis of syphilis. This method is most effective when moist lesions are present, as in primary, secondary, and prenatal syphilis. The fluorescent treponemal antibody-absorption test identifies antigens of T. pallidum tissue, ocular fluid, cerebrospinal fluid (CSF), tracheobronchial secretions, and exudates from lesions. This is the most sensitive test available for detecting syphilis in all stages. After it becomes reactive, it remains so permanently. Other appropriate procedures include the following: ❑ Venereal Disease Research Laboratory (VDRL) slide test and rapid plasma reagin test detect nonspecific antibodies. Both tests, if positive, become reactive within 1 to 2 weeks after the primary lesion appears or 4 to 5 weeks after the infection begins. ❑ CSF examination identifies neurosyphilis when the total protein level is above 40 mg/100 ml, VDRL slide test is reactive, and CSF cell count exceeds five mononuclear cells/µl.
Treatment
Treatment of choice is administration of penicillin I.M. or I.V. depending on the infection’s stage. After therapy, follow-up RPR tests are usually done to check for adequacy of treatment. The nonpregnant patient who is allergic to penicillin may be treated with tetracycline or doxycycline. Nonpenicillin therapy for latent or late syphilis should be used only after neurosyphilis has been excluded. Tetracycline is contraindicated in the pregnant woman because it causes discoloration of the infant’s teeth. If a pregnant woman with syphilis is allergic to penicillin, desensitization is recommended to permit the use of penicillin.