From the Research
Yes, tertiary syphilis can cause syncope and collapse in a 34-year-old male. Tertiary syphilis typically develops 10-30 years after initial infection if left untreated, but can occasionally progress more rapidly. In this stage, the infection can affect the cardiovascular system (causing aortitis or aortic aneurysms) or the central nervous system (neurosyphilis), both of which can lead to syncope and collapse. Neurosyphilis specifically can cause tabes dorsalis or general paresis, which may present with autonomic dysfunction leading to orthostatic hypotension and syncope.
Key Points to Consider
- The most recent study 1 highlights the importance of considering tertiary syphilis in patients with cardiovascular complications, such as aortic aneurysm or coronary ostial involvement.
- Tertiary syphilis can lead to increased morbidity and mortality due to cardiovascular involvement, as noted in the study 2.
- For suspected tertiary syphilis, immediate evaluation with serologic testing (RPR/VDRL and treponemal-specific tests) and CSF analysis is essential, as recommended by various studies 3, 4.
- Treatment consists of benzathine penicillin G 2.4 million units IM weekly for 3 weeks, or doxycycline 100mg twice daily for 28 days if penicillin allergic.
- Hospitalization may be necessary for severe manifestations, and despite treatment, some neurological damage may be irreversible, making early diagnosis crucial, as emphasized in the study 1.
Recommendations
- Any young adult with unexplained syncope should be screened for syphilis, especially if they have risk factors or other neurological symptoms.
- Healthcare providers should be aware of the potential for tertiary syphilis to cause syncope and collapse, and consider this diagnosis in patients with unexplained cardiovascular or neurological symptoms.