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Definition Return to top
Neurosyphilis is a slowly progressive and destructive infection of the brain or spinal cord. It occurs in untreated syphilis many years after the primary infection.Causes, incidence, and risk factors Return to top
Neurosyphilis occurs in 15 to 20% of all late or tertiary syphilis infections and is a progressive, life-threatening complication. There are 4 different forms of neurosyphilis: asymptomatic, meningovascular, tabes dorsalis, and general paresis.Symptoms Return to top
Signs and tests Return to top
Tests to detect syphilis include detection of antibodies in blood. These are non-treponemal tests (VDRL, RPR). These are not specific and are used as screening tests. If positive the diagnosis of syphilis is confirmed using treponemal tests (e.g., FTA-Abs or MHATP). In neurosyphilis, it is important to test for VDRL in the spinal fluid.
Tests to evaluate the nervous system may include:Treatment Return to top
The treatment of syphilis is determined by the length of time the individual has been infected. Primary, secondary or latent syphilis of less than one year duration is treated as follows:Syphilis during pregnancy:
Penicillin is recommended as the only real drug of choice. Tetracycline can not be used because of toxicity to the fetus and erythromycin may fail to prevent congenital syphilis in the fetus. Penicillin-allergic individuals should be desensitized and then treated with penicillin.
Several hours following treatment of early stages of syphilis individuals may undergo a febrile reaction called Jarish-Herxheimer reaction. Symptoms of this reaction include:
Expectations (prognosis) Return to top
The outcome depends upon the type and extent of disability before treatment is begun.Complications Return to top
Complications include a progression of symptoms.
Calling your health care provider Return to top
Call for an appointment with your health care provider if neurologic symptoms develop in a person who has had syphilis in the past.Prevention Return to top
Neurosyphilis can be prevented by the timely diagnosis and treatment of primary syphilis and secondary syphilis. Good follow-up is necessary to prove a cure and prevent neurosyphilis from developing following incomplete treatment (either by inadequate medication or non-compliance of the individual taking the medication). Update Date: 5/8/2003 Updated by: Elaine T. Kiriakopoulos, M.D., M.Sc., Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |