Neurosyphilis is a disease condition that commonly affects the brain and the spinal cord of a person who has lived with chronic and untreated syphilis for 10 to 30 years. At this tertiary stage of syphilis in the body, there are obvious lesions on the brain and the spinal cord, which may not be there at the earlier stage of the disease, even though syphilis spreads to these areas of the central nervous system right from the onset.

Pathophysiology of Neurosyphilis

Syphilis is a venereal disease caused by a spiral bacterium called Treponema pallidum. This bacterium only infects the human body and can be contracted by another human through a direct contact with the syphilitic sore in an infected person. Syphilitic sore (chancre) can break out on or around the penis, in the vagina, around the anus, in the rectum, as well as in or around the mouth. It is through sexual acts involving penetration leading to abrasion of the skin that syphilis can be contracted.

From the earliest stage, syphilis invades the cerebrospinal fluid and unfortunately, there is no symptom that shows its presence there until it progresses to the tertiary stage where the signs and symptoms become quite manifest and, of course, problematic.

Who is at risk to suffer from Neurosyphilis?

The most at-risk-population of syphilis include

  • HIV patients (it can be difficult to treat syphilis alongside HIV. Chance of survival is comparatively low for Africans, also),
  • people who abuse methamphetamine,
  • users of crack cocaine and,
  • gay and bisexual men.

Symptoms of Neurosyphilis

Some of the symptoms that would be noticed are:

  • Headaches
  • Dizziness
  • Problems with walking and in the movement of the toes and fingers
  • Muscle loss and irregular involuntary muscle movement
  • Dementia
  • Incontinence
  • Depression
  • Blurred vision or loss of vision, etc.
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How is Neurosyphilis Diagnosed?

Dr. Mitsonis C.H. and his co-researchers, in 2008, outlined six categories of signs and presentations that could be looked out for by medical professionals. They are:

  • Category 1: Neuropsychiatric disorders as psychosis, delirium, and dementia.
  • Category 2: Cerebrovascular accident.
  • Category 3: Ocular presentation, marked by visual loss, uveitis (inflammation of the pigmented middle layer of the eye) or optic nerve dysfunction.
  • Category 4: Myelopathy, marked by acute, sub-acute or chronic dysfunction of the spinal cord.
  • Category 5: Seizures, marked by partial seizures or myoclonus (involuntary muscle contraction that has become irregular due to damages to motor neurons).
  • Category 6: Brain stem/cranial nerves’ diagnosis.

How do doctors test for Neurosyphilis?

There are testing options that can be undertaken by a patient as required by a doctor. The testing options include:

  • Physical examination where the doctor inspects for normal muscle reflexes to determine the loss of a muscle (muscle atrophy);
  • Spinal tap or lumbar puncture. This procedure requires the extraction of fluid from the spinal cord. This fluid is then tested for the presence of syphilis;
  • Blood test, where different blood tests will be conducted that will show a patient's present or last status of syphilis. Some of these blood tests include Venereal Disease Research Laboratory (VDRL) test, Treponema Pallidum Particle Agglutination Assay (TPPA) test, Fluorescent Treponemal Antibody Absorption (FTA-ABS) test, and Rapid Plasma Reagin (RPR);
  • Imaging tests that involve CAT scan, cerebral angiogram, and Magnetic Resonance Imaging (MRI) procedure aid the spinal cord, the brain and the brainstem to be viewed by a doctor for the presence of syphilis.
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How To Diagnose And Treat Syphilis

How is Neurosyphilis Treated?

Penicillin is the main drug of choice for treating neurosyphilis. It can be taken orally or by injection.  It can be combined with other antibiotics like ceftriaxone. The treatment can last between ten to thirty days.

When diagnosed at the early stage of syphilis and treated, there is a good chance that the affected patient will bounce back to health without any complications.

However, if neurosyphilis progresses to the late stage due to syphilis that was not diagnosed and treated on time, there is a poor chance that the patient will recover fully without complications in his/her health state.

How to prevent Neurosyphilis

Neurosyphilis can be prevented if and when syphilis is prevented. Simple! This means that abstaining from sex and being faithful to one's partner can help in the prevention of neurosyphilis. Practicing safe sex also can help in preventing one from contracting syphilis in the first place.

Because syphilis is usually asymptomatic at the earliest stage of its presence in the body of an infected person, it is advisable that sexually active persons, and persons who have had sexual encounters with others, frequently go for blood tests to detect the presence of syphilis.

The earlier its discovery, the healthier the chances of survival!