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Brain And Nerves

Syphilitic aseptic meningitis

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Definition

Syphilitic aseptic meningitis is a complication of untreated syphilis that involves inflammation of the tissues covering the brain and spinal cord. People with this condition have changes in mental status and problems with nerve function.

Alternative Names

Meningitis - syphilitic

Causes, incidence, and risk factors

Syphilis is a sexually transmitted, infectious disease caused by the spirochete Treponema pallidum. Syphilis has three main stages:

  • Primary syphilis
  • Secondary syphilis
  • Tertiary syphilis

Syphilitic aseptic meningitis is a form of meningovascular neurosyphilis, which is a progressive, life-threatening complication of syphilis infection.

The disorder is similar to meningitis caused by other conditions.

Risks for syphilitic aseptic meningitis include previous infection with syphilis or other sexually transmitted diseases such as gonorrhea. Syphilis infections are mainly transmitted through sexual contact with an infected person, but they may sometimes be transmitted by nonsexual contact.

Symptoms

  • Changes in vision, blurred vision, decreased vision
  • Fever
  • Headache
  • Mental status changes
    • Confusion
    • Disorientation
    • Decreased attention span
    • Irritability
    • Sleepiness, lethargy, hard to wake

  • Nausea, vomiting
  • Neck pain
  • Seizures
  • Sensitivity to light (photophobia)
  • Sensitivity to loud noises
  • Stiff neck
  • Stiffness of shoulders, other muscle aches

Signs and tests

An examination may show signs of meningitis. There may be a loss of nerve functions. A brain and nervous system (neurologic) examination may show reduced function of the cranial nerve, including the nerves that control eye movement.

Tests may include:

  • Cerebral angiography
  • CSF (cerebrospinal fluid) examination
  • Electroencephalogram (EEG)
  • Head CT scan
  • Serum VDRL or serum RPR (used as screening tests to detect syphilis infection) -- if positive, requires one of the following to confirm diagnosis:
    • FTA-ABS
    • MHA-TP


Treatment

The goals of treatment are to cure the infection and stop the disorder from getting worse. Treating the infection helps prevent new nerve damage and may reduce symptoms, but it does not reverse existing damage.

Penicillin or other antibiotics (such as tetracycline or erythromycin) are given to treat the infection. Treatment may be long-term to ensure that the infection is completely cleared. Symptoms may improve dramatically after treatment. A follow-up examination of the cerebrospinal fluid is needed to evaluate whether the antibiotic therapy worked.

Neurologic damage needs to be treated. You may need to have emergency treatment for seizures. Anticonvulsants such as phenytoin are used to control seizures.

Some people may need help eating, dressing, and caring for themselves. Confusion and other mental changes may either improve or continue long-term after antibiotic treatment.

Expectations (prognosis)

Some people with the condition have worsening disability. Early death is common. Death can be caused directly by the neurologic damage or by the cardiovascular damage that also occurs with late syphilis infections.

People with late syphilis infections are at greater risk for other infections and diseases. A seizure disorder can develop after infection.

Complications

  • Inability to care for self
  • Inability to communicate or interact
  • Injury caused during seizures
  • Stroke

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have seizures.

Call your health care provider if you have a severe headache with fever or other symptoms, especially if you have a history of syphilis infection.

Prevention

Adequate treatment and follow-up of primary syphilis infections will reduce the risk of developing syphilitic aseptic meningitis.

If you are sexually active, practice safe sex and always use condoms.

All pregnant women should be screened for syphilis.

References

Centers for Disease Control and Prevention (CDC). Recommendations and reports: sexually transmitted diseases. MMWR Morb Mortal Wkly Rep. 2006;55:1-94.

U.S. Preventive Services Task Force. Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150:705-709.

U.S. Preventive Services Task Force. Screening for Syphilis Infection. Updated July 2004. Accessed February 11, 2012.

Hook EW III. Syphilis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 340.

Tremont EC. Treponema pallidum (Syphilis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009:chap 238.

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