Can Syphilis Cause Wrist Drop?
Syphilis does not typically cause wrist drop as a direct manifestation, though neurosyphilis can theoretically affect peripheral nerves in rare cases, but this is not a recognized or documented clinical presentation in the medical literature or guidelines.
Understanding the Neurological Manifestations of Syphilis
The neurological complications of syphilis are well-characterized but do not include wrist drop as a typical feature:
- Neurosyphilis can occur at any stage of infection and typically manifests as meningitis, uveitis, hearing loss, or stroke 1
- Tertiary syphilis occurs in approximately 25% of untreated patients after 3-12 years of latency, with manifestations including gummatous lesions, cardiovascular syphilis, and neurologic involvement 2
- The neurologic involvement in tertiary syphilis typically includes central nervous system complications rather than peripheral nerve pathology 3
Why Wrist Drop Is Not Associated with Syphilis
Wrist drop is a specific clinical sign indicating radial nerve dysfunction, which results from:
- Peripheral nerve injury or compression (not a feature of syphilitic infection)
- Lead poisoning, trauma, or other metabolic/toxic neuropathies (unrelated to treponemal infection)
The documented neuropsychiatric manifestations of neurosyphilis are distinct:
- Neurosyphilis can cause psychosis, mania, depression, anxiety, and personality changes 4
- Secondary syphilis can mimic acute primary HIV infection with constitutional symptoms and CSF abnormalities 2
- The central nervous system complications are the hallmark of neurosyphilis, not peripheral nerve palsies 5
Clinical Pitfall to Avoid
If a patient presents with wrist drop, do not attribute it to syphilis without thoroughly investigating other causes of radial nerve palsy. While syphilis should be part of a comprehensive sexually transmitted infection screening in at-risk populations, wrist drop should prompt evaluation for:
- Radial nerve compression or trauma
- Lead toxicity
- Other peripheral neuropathies
- Structural lesions affecting the radial nerve
The diagnosis of syphilis requires both clinical recognition and serologic confirmation with nontreponemal tests and treponemal tests 2, but wrist drop is not among the recognized clinical manifestations that would prompt syphilis testing.