Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Neurosyphilis occurs whensyphilisspreads to thecentral nervous system. It can happen at any stage of the infection, causing a host of psychiatric and physical symptoms ranging from headaches, personality changes, and loss of coordination to delirium, visual changes, and loss of bladder control,
The diagnosis of neurosyphilis is based largely on alumbar puncture(“spinal tap”) and an evaluation ofcerebrospinal fluid (CSF). Neurosyphilis can be treated in a hospital with multiple daily doses of penicillin G administered for up to 14 days.
This article looks at the causes and symptoms of neurosyphilis, including how this potentially serious complication of syphilis is diagnosed and treated.
Thomas Barwick / Getty Images
What Are the Symptoms of Neurosyphilis?
Symptoms of neurosyphilis are highly variable. Some people have multiple major symptoms, while others may have one relatively mild symptom that largely goes unrecognized.
Physical symptoms of neurosyphilis may include:
Psychiatric symptoms of neurosyphilis may include:
Syphilis infections of the eye and ears also sometimes fall under the umbrella of neurosyphilis. Referred to as ocular syphilis andotosyphilisrespectively, these infections can lead to vision and hearing loss if left untreated.
What Is Neurosyphilis Caused By?
Scientists do not understand why some people with syphilis develop neurosyphilis and others do not. With that said, neurosyphilis is common in people whose syphilis has goneundiagnosedanduntreatedfor a long time. As such, people with tertiary syphilis (the most advanced stage of the disease) tend to have worse outcomes.
Although syphilis infections have long been on the decline in the 20th century, there has been an uptick in the infection rate since 2000, most notably amongmen who have sex with men. Increasing rates of antibiotic-resistant syphilis and lower rates of condom use (due to the advent of HIVPrEP) largely account for the increases.
Most cases of syphilis will not become neurosyphilis, particularly with prompt screening and treatment. However, partial or incomplete treatment of syphilis may significantly increase your risk.
A Guide to Regular STI Screenings
How Is Neurosyphilis Diagnosed?
Syphilis is normallydiagnosedwith a blood test. However, neurosyphilis is harder to diagnose and requires the testing of cerebrospinal fluid (CSF) obtained through a spinal tap paired with a review of your physical and/or psychiatric symptoms.
During a spinal tap, a needle is stuck between the bones of your lower spine to obtain a sample of CSF. The fluid is then tested for syphilis using the same antibody test—called aVDRL test—used to detect syphilis in the blood.
False positive results are possible, especially in the early stages, as there are often fewerTreponema pallidumantibodiesin CSF fluid than in the blood. As such, it is possible to have symptoms of neurosyphilis, a positive blood test result, a negative CSF result, and still have neurosyphilis.
How Neurosyphilis Is Treated
The treatment of neurosyphilis requires multiple doses of penicillin given on a strict schedule over many days. Because of this, treatment will almost invariably take place in a hospital.
Intramuscular injections are paired with oral doses ofprobenecidtaken four times daily for 10 to 14 days. Probenecid prevents the excretion of penicillin and prolongs the activity of the antibiotic drug in the body.
Is Syphilis Curable? Learn About Treatment Options and Prevention
Summary
Neurosyphilis is a complication of syphilis that affects the central nervous system (composed of the brain and spinal cord). It can cause a wide range of symptoms ranging from subtle to severe, including physical symptoms like headaches and vision changes and psychiatric symptoms like forgetfulness and psychosis.
Neurosyphilis is diagnosed based on a review of your symptoms and testing of cerebrospinal fluid obtained from a spinal tap. The treatment is typically administered in a hospital and involves multiple daily doses of penicillin G delivered over 10 to 14 days.
2 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mattei PL, Beachkofsky TM, Gilson RT, Wisco OJ.Syphilis: a reemerging infection.Am Fam Physician. 2012;86(5):433-40.Centers for Disease Control and Prevention.Neurosyphilis, ocular syphilis, and otosyphilis.Additional ReadingFriedrich F, Aigner M, Fearns N, Friedrich ME, Frey R, Geusau A.Psychosis in neurosyphilis – clinical aspects and implications.Psychopathology.2014;47(1):3-9. doi:10.1159/000350059Mattei PL, Beachkofsky TM, Gilson RT, Wisco OJ.Syphilis: a reemerging infection.Am Fam Physician. 2012;86(5):433-40.Munjal S, Ferrando SJ, Freyberg Z.Neuropsychiatric Aspects of Infectious Diseases: An Update.Crit Care Clin.2017;33(3):681-712. doi:10.1016/j.ccc.2017.03.007Tuddenham S, Ghanem KG.Neurosyphilis: Knowledge Gaps and Controversies.Sex Transm Dis.2018;45(3):147-151. doi:10.1097/OLQ.0000000000000723
2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mattei PL, Beachkofsky TM, Gilson RT, Wisco OJ.Syphilis: a reemerging infection.Am Fam Physician. 2012;86(5):433-40.Centers for Disease Control and Prevention.Neurosyphilis, ocular syphilis, and otosyphilis.Additional ReadingFriedrich F, Aigner M, Fearns N, Friedrich ME, Frey R, Geusau A.Psychosis in neurosyphilis – clinical aspects and implications.Psychopathology.2014;47(1):3-9. doi:10.1159/000350059Mattei PL, Beachkofsky TM, Gilson RT, Wisco OJ.Syphilis: a reemerging infection.Am Fam Physician. 2012;86(5):433-40.Munjal S, Ferrando SJ, Freyberg Z.Neuropsychiatric Aspects of Infectious Diseases: An Update.Crit Care Clin.2017;33(3):681-712. doi:10.1016/j.ccc.2017.03.007Tuddenham S, Ghanem KG.Neurosyphilis: Knowledge Gaps and Controversies.Sex Transm Dis.2018;45(3):147-151. doi:10.1097/OLQ.0000000000000723
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Mattei PL, Beachkofsky TM, Gilson RT, Wisco OJ.Syphilis: a reemerging infection.Am Fam Physician. 2012;86(5):433-40.Centers for Disease Control and Prevention.Neurosyphilis, ocular syphilis, and otosyphilis.
Mattei PL, Beachkofsky TM, Gilson RT, Wisco OJ.Syphilis: a reemerging infection.Am Fam Physician. 2012;86(5):433-40.
Centers for Disease Control and Prevention.Neurosyphilis, ocular syphilis, and otosyphilis.
Friedrich F, Aigner M, Fearns N, Friedrich ME, Frey R, Geusau A.Psychosis in neurosyphilis – clinical aspects and implications.Psychopathology.2014;47(1):3-9. doi:10.1159/000350059Mattei PL, Beachkofsky TM, Gilson RT, Wisco OJ.Syphilis: a reemerging infection.Am Fam Physician. 2012;86(5):433-40.Munjal S, Ferrando SJ, Freyberg Z.Neuropsychiatric Aspects of Infectious Diseases: An Update.Crit Care Clin.2017;33(3):681-712. doi:10.1016/j.ccc.2017.03.007Tuddenham S, Ghanem KG.Neurosyphilis: Knowledge Gaps and Controversies.Sex Transm Dis.2018;45(3):147-151. doi:10.1097/OLQ.0000000000000723
Friedrich F, Aigner M, Fearns N, Friedrich ME, Frey R, Geusau A.Psychosis in neurosyphilis – clinical aspects and implications.Psychopathology.2014;47(1):3-9. doi:10.1159/000350059
Munjal S, Ferrando SJ, Freyberg Z.Neuropsychiatric Aspects of Infectious Diseases: An Update.Crit Care Clin.2017;33(3):681-712. doi:10.1016/j.ccc.2017.03.007
Tuddenham S, Ghanem KG.Neurosyphilis: Knowledge Gaps and Controversies.Sex Transm Dis.2018;45(3):147-151. doi:10.1097/OLQ.0000000000000723
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
