It’s a conversation that can fill anyone with dread. You’ve just been told you have syphilis, and then another term comes up: neurosyphilis. Your mind might immediately jump to the worst-case scenarios. What does it mean when this infection starts to involve the brain or spinal cord? It’s a heavy thought, and I completely understand why you’d be concerned. Let’s talk about it, clear up some confusion, and figure out what this means for you.
What Exactly Is Neurosyphilis, Doc?
So, neurosyphilis isn’t a separate infection; it’s what can happen when syphilis, that sexually transmitted infection (STI) we talk about, isn’t treated or isn’t caught early enough. The culprit is a tiny bacterium called Treponema pallidum. If this little troublemaker manages to invade your brain and/or spinal cord – what we doctors call the central nervous system (CNS) – that’s when we’re dealing with neurosyphilis.
It’s important to know that not everyone who gets syphilis will develop this complication. And while neurosyphilis and syphilis are caused by the same bug, they present differently. Syphilis has its own set of signs, while neurosyphilis brings on neurological symptoms because it’s affecting your command center, so to speak. If it’s left untreated, things can get very serious, leading to problems like permanent paralysis, dementia, and can even be life-threatening. That’s why catching it and treating it quickly is so incredibly important.
The Different Faces of Neurosyphilis
We tend to see neurosyphilis show up in a few different ways, and we group them into early and late forms. It really depends on how long the syphilis infection has been around and how it’s affecting the nervous system.
Early Neurosyphilis: The Sooner Signs
These forms can pop up relatively sooner after the initial syphilis infection:
- Asymptomatic neurosyphilis (ANS): This one is sneaky. Asymptomatic” means you don’t have any neurological symptoms. We usually find it if we do a test on your cerebrospinal fluid (CSF) – that’s the fluid cushioning your brain and spinal cord – and see signs of syphilis, even before any syphilis symptoms show up. If syphilis isn’t treated, ANS can appear anywhere from a few weeks to a few years after getting infected.
- Meningeal neurosyphilis: Here, the syphilis bacteria cause inflammation of your meninges. Think of the meninges as three protective layers wrapped around your brain and spinal cord. When they get inflamed, you might experience things like a bad headache, nausea, and vomiting. This can happen within the first few months to several years after an untreated syphilis infection.
- Meningovascular neurosyphilis: This form gets a bit more complicated. The bacteria cause inflammation not just in the meninges but also in the walls of arteries in that area. This can lead to thrombosis (blood clots blocking vessels) and cut off blood flow to parts of the brain, sometimes causing a stroke. This, too, can develop within months to several years if syphilis isn’t addressed.
Late Neurosyphilis: When It’s Been Awhile
These forms tend to show up much later, sometimes many years after the initial syphilis infection was ignored:
- General paresis: This happens due to long-term inflammation of the meninges (meningoencephalitis), leading to a breakdown of brain tissue. It can cause a real shift in personality and mood. We might see mood disturbances or personality changes first. This can occur anywhere from 3 to 30 years after the initial infection if it’s gone untreated.
- Tabes dorsalis: This is the most severe form, thankfully less common now with better syphilis detection and treatment. It involves the breakdown of the back part (dorsal column) and roots of your spinal cord. This can cause serious movement problems, nerve pain, and even bladder issues. It can take a long time to show up, sometimes 5 to even 50 years after the initial infection.
Who’s More Likely to See Neurosyphilis?
Anyone who has a syphilis infection that hasn’t been treated for months or years is at risk for neurosyphilis. Since syphilis is spread through sexual contact, anyone having unprotected sex can get syphilis.
I’ve also seen in my practice, and studies back this up, that folks living with HIV might develop symptoms of neurosyphilis a bit sooner if they also have syphilis. We think this might be because HIV can weaken the immune system, making it easier for the syphilis bacteria to take hold in the nervous system.
It’s a bit tricky to get exact numbers on how common neurosyphilis is, as cases aren’t always reported consistently. But we know syphilis itself is quite common. The most frequent type of neurosyphilis we encounter is the asymptomatic kind. Thankfully, with better screening and treatment for syphilis these days, those really severe late forms like general paresis and tabes dorsalis are much rarer than they used to be.
Interestingly, research suggests that for many people with syphilis, the bacteria actually do reach the central nervous system, sometimes even before syphilis symptoms appear. But for some, the body manages to clear this CNS involvement on its own without causing any trouble. Weird, right? However, the syphilis infection itself won’t go away without antibiotics.
Listening to Your Body: Symptoms of Neurosyphilis
The symptoms of neurosyphilis are all about your nervous system, so they’re different from the usual syphilis signs. And, as we talked about, the earliest form, asymptomatic neurosyphilis, doesn’t have any symptoms you’d notice.
What Meningeal Neurosyphilis Feels Like
If the meninges are inflamed, you might experience:
- A persistent headache
- Feeling sick to your stomach (nausea) and vomiting
- A stiff neck
- Bothered by bright lights (photophobia)
- Changes in your vision or hearing
- Problems with cranial nerves (these are nerves that control things like facial movements, eye movements, and sensation in your face)
Clues from Meningovascular Neurosyphilis
This form can include the meningeal symptoms above, plus:
- A spinning sensation (vertigo)
- Symptoms of a stroke (like sudden weakness on one side, trouble speaking)
- Muscle weakness or even muscle wasting (atrophy), often in the legs
Spotting General Paresis
The symptoms of general paresis can sneak up on you or come on suddenly.
Early on, you might notice:
- Feeling more irritable or having other mood shifts
- Changes in personality – maybe you’re just not acting like yourself
- Changes in your sleep habits
- Forgetfulness
As it progresses, later symptoms can include:
- More dramatic mood swings
- Significant memory loss
- Trouble with judgment
- Feeling confused
- Believing things that aren’t true (delusions)
- Seizures
Sometimes, general paresis can look a lot like other mental health conditions, such as depression, delirium (sudden confusion), mania (high energy, racing thoughts), or psychosis (losing touch with reality).
Telltale Signs of Tabes Dorsalis
This severe form can bring on:
- Trouble with balance and coordination (ataxia)
- Sharp, shooting nerve pain
- Difficulty controlling your bladder
- Strange sensations like burning or tingling (paresthesia)
- Vision changes, including a specific pupil problem called Argyll Robertson pupils (where pupils don’t react to light properly but do to focusing)
- Loss of coordination and normal reflexes
- Joint damage due to nerve problems, known as neuropathic arthropathy (Charcot joint)
- Problems walking
Quick Reminder: What Syphilis Symptoms Look Like
It’s good to remember what syphilis itself can look like, as early treatment for syphilis is the best way to prevent neurosyphilis.
- In the first (primary) stage, you might see a chancre. This is usually a single, small, painless sore, often on the genitals, anus, or in the mouth.
- During the second (secondary) stage, a rash often appears. It’s typically a pink, bumpy, rough rash, commonly on the palms of your hands or soles of your feet. You might also feel like you have the flu, with fatigue, fever, a sore throat, and muscle aches.
If you notice any of these symptoms, or if a sexual partner tests positive for syphilis, please come see us right away for testing.
How We Figure Out If It’s Neurosyphilis
Diagnosing neurosyphilis usually involves looking at your symptoms and doing a CSF analysis.
First, we’ll have a good chat about your symptoms and your medical history. I’ll do a physical exam and a neurological exam to check how your nervous system is functioning.
If we suspect syphilis and possibly neurosyphilis, we’ll likely suggest a few tests:
- Blood tests: These help us look for evidence of the Treponema pallidum bacteria.
- Lumbar puncture (spinal tap): I know this one can sound a bit scary, but it’s a really important test. A doctor carefully inserts a thin needle into your lower back to collect a small sample of your cerebrospinal fluid (CSF). This fluid bathes your brain and spine, and testing it can tell us a lot.
- CSF analysis: We send that CSF sample to the lab, where they’ll look for signs of the syphilis bacteria under a microscope and do other specific tests.
The CDC (Centers for Disease Control and Prevention) also recommends that everyone diagnosed with syphilis should have an HIV test if they don’t know their status or if they’ve previously tested negative.
Getting You Treated: Our Plan for Neurosyphilis
The main goal of treating neurosyphilis is to stop it in its tracks by getting rid of the underlying syphilis infection.
Antibiotics are our go-to for this.
- Penicillin is usually the first choice. We can give it through an IV (into your vein) or as intramuscular injections (shots).
- Another antibiotic we sometimes use is ceftriaxone.
After you finish your antibiotic course, follow-up is absolutely key. You’ll need several blood tests – often at 3 months, 6 months, and then at other intervals – to make absolutely sure the infection is gone from your body. You’ll also need follow-up lumbar punctures so we can check your CSF, usually every six months, to confirm the infection is cleared from your central nervous system too.
Don’t worry, we’ll explain the whole follow-up schedule and what to expect. Please ask any questions you have!
Can We Undo the Damage?
The good news is that antibiotic treatment does stop neurosyphilis from getting any worse. However, and this is a tough part, treatment might not be able to reverse neurological damage that has already happened.
People who have the asymptomatic or meningeal forms of neurosyphilis and get proper treatment generally do very well and often return to their usual state of health. For those with meningovascular neurosyphilis, general paresis, or tabes dorsalis, we might see some improvement in symptoms after treatment, which is great. But, they often don’t fully return to how they were before. The key is to stop further damage.
What’s the Outlook with Neurosyphilis?
Your outlook, or prognosis, with neurosyphilis really depends on which form you have and how quickly we can get you started on treatment.
As I mentioned, if you have asymptomatic or meningeal neurosyphilis and get treated properly, you usually don’t have lasting neurological problems.
For folks with meningovascular neurosyphilis, general paresis, or tabes dorsalis, there are often some lasting neurological symptoms or complications. But treatment is vital because it can help improve symptoms and, most importantly, prevent the neurosyphilis from progressing and causing more harm. If syphilis, particularly the tabes dorsalis form, isn’t treated, it can unfortunately be fatal. This really underscores why early diagnosis and treatment are so crucial.
Staying Ahead: Preventing Neurosyphilis
The best way to prevent neurosyphilis is, quite simply, to avoid getting syphilis in the first place. The only 100% certain way to prevent syphilis is to not have sex (abstinence).
However, if you are sexually active, you can significantly lower your risk of getting syphilis:
- Always use protection, like condoms or female condoms, during any sexual activity. And make sure you’re using them correctly every single time.
- If you notice any symptoms that could be syphilis, please seek medical advice and get tested as soon as possible. Early treatment for syphilis is the most effective way to prevent it from progressing to neurosyphilis.
Living With Neurosyphilis: What to Expect
If you’re diagnosed with neurosyphilis, the absolute most important thing is to complete the full course of treatment for the syphilis infection. You’ll also need to attend all your follow-up appointments for blood tests and CSF checks. We need to be sure that bacteria is gone for good.
If, unfortunately, the neurosyphilis has caused some permanent neurological symptoms or conditions, you’ll likely need ongoing care from your healthcare team. We’ll work with you to manage those specific issues and support you.
Quick Question: What Stage of Syphilis is Neurosyphilis?
That’s a common question! It’s important to remember that syphilis and neurosyphilis are distinct, though related. Neurosyphilis is a complication of syphilis. It’s not a “stage” of syphilis in the same way primary, secondary, or tertiary syphilis are. In fact, neurosyphilis can actually occur during any stage of syphilis if the bacteria invade the central nervous system.
Take-Home Message: Key Things to Remember About Neurosyphilis
I know this has been a lot of information, so let’s boil it down to the most important points about neurosyphilis:
- Neurosyphilis is a serious complication that happens when the bacteria causing syphilis infect your brain or spinal cord.
- It can occur at any stage of syphilis, especially if syphilis isn’t treated.
- symptoms vary widely depending on the form and can range from none (asymptomatic) to severe neurological issues like headaches, weakness, personality changes, coordination problems, or even stroke-like symptoms.
- Diagnosis involves looking at your symptoms, blood tests, and analyzing your cerebrospinal fluid (CSF), usually obtained via a lumbar puncture.
- Treatment is with antibiotics, typically penicillin, to clear the syphilis infection. Early treatment is best.
- While treatment can stop neurosyphilis from worsening, it may not reverse all existing neurological damage.
- Preventing syphilis through safe sex practices and getting early treatment for syphilis are the best ways to avoid neurosyphilis.
You’re not alone in facing this. We’re here to answer your questions, make sure you get the right treatment, and support you every step of the way.