What are the symptoms of neurosyphilis (infection of the nervous system caused by Treponema pallidum)?

From the Guidelines

Neurosyphilis symptoms can manifest as headache, meningitis-like symptoms, altered mental status, vision problems, hearing loss, facial weakness, stroke-like symptoms, cognitive decline, personality changes, and psychiatric manifestations, and prompt diagnosis through cerebrospinal fluid analysis and treatment is essential to prevent irreversible neurological damage. The symptoms of neurosyphilis vary widely depending on the stage and area of nervous system involvement. Early symptoms may include headache, meningitis-like symptoms (neck stiffness, fever), and altered mental status 1. As the disease progresses, patients may develop vision problems (including pupillary abnormalities like Argyll Robertson pupils), hearing loss, facial weakness, and stroke-like symptoms. Cognitive decline, personality changes, and psychiatric manifestations such as mania or psychosis can occur. Late-stage neurosyphilis may present as tabes dorsalis (characterized by lightning pains, ataxia, and sensory deficits) or general paresis (progressive dementia with grandiose delusions) 1. Seizures, bladder dysfunction, and impotence are also possible. Neurosyphilis can be asymptomatic in some cases, making regular screening important for at-risk individuals. The disease results from Treponema pallidum infection spreading to the central nervous system, which can happen at any stage of syphilis infection. Some key points to consider in the diagnosis and management of neurosyphilis include:

• Clinical signs of neurosyphilis, such as cranial nerve dysfunction, meningitis, stroke, acute or chronic altered mental status, loss of vibration sense, and auditory or ophthalmic abnormalities, warrant further investigation and treatment for neurosyphilis 1.
• Laboratory testing, including cerebrospinal fluid analysis, is helpful in supporting the diagnosis of neurosyphilis, but no single test can be used to diagnose neurosyphilis in all instances 1.
• Treatment with high-dose intravenous penicillin G (18-24 million units daily for 10-14 days) is essential to prevent irreversible neurological damage 1.
• Patients who have neurosyphilis or syphilitic eye disease should be treated with the recommended regimen, and alternative regimens may be considered if compliance with therapy can be ensured 1.

From the Research

Symptoms of Neurosyphilis

• Neurosyphilis is a form of tertiary syphilis infection caused by the spirochete bacterium Treponema pallidum 2
• Patients suffering from this illness can present with neurological manifestations such as:
  • Headaches
  • Seizures
  • Hearing loss
  • Ataxia
• The typical presentation of neurosyphilis is the insidious onset of psychiatric symptoms including personality changes 2
• Other symptoms may include:
  • CNS, ocular and/or otic symptomatology 3
  • Psychiatric manifestations such as psychosis, depression, and anxiety 4

Diagnosis and Treatment

• A good history and clinical work-up is essential in the diagnostic process 2
• Cerebrospinal fluid (CSF) examination should be performed in all persons with serologic evidence of syphilis infection and neurologic symptoms 5
• The first-line treatment for neurosyphilis is aqueous crystalline penicillin 6
• Other antibiotic regimes can be used in cases such as penicillin allergy 6
• Oral doxycycline has been shown to be effective in treating early neurosyphilis, with similar rates of clinical and serological response and seroreversion compared to procaine G penicillin 3