The neurosyphilis it is a complication derived from untreated syphilis. It consists of an infection of the nervous system that mainly affects the brain and spinal cord. In its chronic stage it manifests as an inflammation of the meninges (membranes that cover the nervous system).
Neurosyphilis occurs when syphilis is not adequately treated, eventually invading the nervous system. Syphilis is a sexually transmitted disease caused by the bacteria Treponema pallidum. This disease is treatable and relatively easy to avoid, the problem is that its symptoms are varied and can take years to manifest..
The treponemal bacteria usually infect the cerebrospinal fluid within 3 to 18 months after inoculation. If after that period of time no involvement of the cerebrospinal fluid is observed, there is only a 1 in 20 chance that neurosyphilis will develop. This possibility decreases to 1% if there is no affectation after the first 5 years..
When neurosyphilis occurs, the first manifestation that appears is meningitis, which consists of an inflammation of the cerebral meninges. All forms of neurosyphilis begin with meningitis. This occurs in approximately 25% of syphilis cases..
At first, meningitis does not produce symptoms and can only be discovered by performing a lumbar puncture. Exceptionally, and in more advanced stages, it can cause cranial nerve palsy, increased intracranial pressure or cerebrovascular accidents..
Because meningitis may not cause symptoms, damage to the brain parenchyma (functional brain tissue) may develop after several years..
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Treponema pallidum It is the bacterium that causes syphilis and that later can generate neurosyphilis. The disease usually develops 10 to 20 years after the initial infection with the bacteria..
Syphilis or untreated HIV is a risk factor for developing neurosyphilis. This is because if you contract HIV you are much more likely to also contract syphilis (and therefore develop neurosyphilis more easily).
Syphilis is a highly contagious disease that is spread primarily through sexual activities, including oral sex and anal sex. This disease is transmitted by sores on the genitals, although the infected person is usually not aware of their disease (at least at first).
Pregnant women can pass syphilis to their baby. This is called congenital syphilis and it can have serious consequences for the child..
Syphilis can be early or primary, secondary, latent, and tertiary.
In the primary syphilis one or more sores develop, which are small painless ulcers. They appear on the genitals or around the mouth 10 to 90 days after infection. Sometimes ulcers can go away without treatment.
The secondary syphilis lasts from one to 3 months after exposure. Reddish-brown rashes develop on the soles of the hands and feet. This type of syphilis can also go away without treatment sometimes..
In the latent syphilis, instead, the infection remains inactive without causing symptoms. This stage arises after one or two years after infection..
The tertiary syphilis it is an untreated infection that becomes chronic. In addition to affecting the heart, it can damage the nervous system by triggering neurosyphilis.
When the patient has been infected with syphilis for less than a year, a dose of penicillin can clear the infection. People allergic to penicillin can be treated with tetracycline or doxycycline..
Early neurosyphilis mainly affects the meninges and blood vessels of the brain. While in final stages it affects the parenchyma (functional tissue) of the spinal cord.
The main symptoms of neurosyphilis are the following, ordered according to their frequency:
- Personality change (including cognitive impairment).
- Ataxia.
- Strokes.
- Ophthalmic symptoms. For example: blurred vision, altered visual acuity, decreased color perception, etc..
- Urinary incontinence.
- Shooting pains. That is, a very intense pain that occurs spontaneously and with a very short duration.
- Dizziness.
- Headache.
- Continuous fatigue.
- Seizures.
The following may also be listed as signs of neurosyphilis:
- Hyporeflexia, that is, decreased reflex responses.
- Romberg's sign, which is a clinical manifestation that indicates a lack of balance and coordination.
- Charcot's joint, characterized by loss of sensitivity to pain, spasms, and cramps in the affected area.
- Sensory impairments such as vertigo, sensory ataxia, decreased proprioception (reduced ability to sense the position of your own body parts).
- Changes in the eyes, such as ocular oblique deviation and anisocoria (pupils of different sizes).
- Optic atrophy, which is a lesion or loss of function of the optic nerve that causes loss of vision or deficit of this.
- Cranial neuropathy, that is, damage to one of the cranial nerves. Mainly the nerves surrounding the eyes are affected.
- Dementia, which involves severe and progressive cognitive decline.
- Mood swings, irritability.
- Depression.
There are different types of neurosyphilis depending on the clinical picture and the parts affected.
In this type there are no symptoms or other physical signs. Exceptionally, Argyll-Robertson pupils may be present. These are small and uneven and do not react to light. However, if they respond to accommodation (focus on near and distant objects).
It can arise at any time after inoculation, but it usually appears in the first two years. This type of neurosyphilis has symptoms such as headache, cranial nerve palsy, a stiff neck, and seizures. If properly treated, the prognosis is very good and symptoms disappear within weeks..
This type of neurosyphilis is suspected if the patient has suffered a stroke during youth. It is the most frequent type at present, since it occurs in 35% of cases.
Meningovascular syphilis usually appears 6 to 7 years after the original infection. Although in some cases it can appear very early. Either late, at 10 or 12 years old.
This disorder can affect medium or large blood vessels, causing severe inflammation of the arteries, which can lead to blockage of the arteries. It can also affect small blood vessels, leading to thrombosis and strokes..
It presents the same picture as a long-lasting meningitis. In this case, there is a deterioration in cognitive functioning caused by damage to the brain by not treating syphilis. Paralysis may present about 15-20 years after the original infection.
The earliest symptoms are problems with memory, reasoning or executive functions, decreased motivation, muscle weakness, and personality changes..
As the disease progresses, dementia, dysarthria, seizures, hypo or hyperreflexia, etc..
In addition, there is a serious physical deterioration that is accompanied by disorders of standing, weakness and tremors. This little by little generates a disability that forces the patient to remain lying in bed.
However, it is not a very common disease today. It is known that, in the past, when there were more cases, the prognosis could be very good. Between 40 and 50% of patients could stop the disease with treatment and lead their normal life.
On the other hand, if it is not treated, there is a progressive mental weakening, death may appear in 3 or 4 years..
This type of neurosyphilis commonly develops 15 to 20 years after the onset of infection. In this disease, the spinal cord is progressively affected. Ataxia, urinary incontinence, and shooting pains are the main symptoms..
The patient is not stable in walking and walks with his feet apart. Tremors and spasms occur throughout the body. The person loses sensitivity to pain and therefore joint injuries may occur.
It presents as a progressive blindness that affects first one eye and then the other. It can coexist with tabetic neurosyphilis. The prognosis is poor if vision is lost in both eyes. If only one eye is affected, the vision of the other can be saved with proper treatment.
For the diagnosis of neurosyphilis, it is essential to first check for syphilis and other sexually transmitted diseases with a blood test. Although the most advisable thing is to perform a lumbar puncture to take a sample of cerebrospinal fluid.
The doctor can perform a physical exam to verify that the muscle reflexes are normal and thus determine if there is any atrophy or loss of tissue.
Imaging tests are also indicated to diagnose neurosyphilis. A CT or MRI scan is helpful in looking at evidence of disease in the brain, spinal cord, or brainstem..
The main treatment for neurosyphilis is the application of antibiotics, mainly penicillin. It can be injected or orally. Treatment can last from 10 to 14 days. The drugs used are ceftriaxone and probenecid.
Controls should be carried out by means of the blood test for 3 to 6 months. After this period, an analysis should be carried out every year for 3 years.
Cerebrospinal fluid levels should also be checked by lumbar puncture every 6 months..
Neurosyphilis is common in people who have HIV, since syphilitic ulcers make it easier to become infected with HIV. Concurrent infection of syphilis with HIV has increased its prevalence, as HIV accelerates the rate of onset of syphilis. Also, HIV infection can cause antibiotic treatment to fail..
For these reasons, neurosyphilis occurs more in countries with high HIV rates and where access to antibiotics is more difficult..
The prognosis depends on the type of neurosyphilis that has developed and how quickly it has been diagnosed and treated..
Antibiotic treatment is used to stop the infection and prevent further damage. However, it is difficult to repair the damage already done. In mild cases, antibiotics are very effective and the person can regain full health.
When neurosyphilis is severe, most of the consequences are irreversible. The patient may improve a lot, but not fully recover his health.
Neurosyphilis prevention is simply focused on preventing the spread of syphilis. This is a sexually transmitted disease (STD), for this reason, it is best to practice safe sex.
Although the use of a condom can reduce the risk, there are other practices by which you can get syphilis that do not involve penetration. An example is unprotected oral sex with an infected person.
It is important to know that people infected with syphilis do not know they have the disease after a while, as symptoms can remain hidden. Ulcers or sores usually occur that can heal on their own, but the disease is still in the body.
Over time, rough, non-itchy, brownish patches may appear. Headaches, weight and hair loss, fatigue, and muscle aches can also occur. Faced with these signs, it is best to go to the doctor for a test..
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