Neurosyphilis
What is Neurosyphilis?
Neurosyphilis is a serious infection that happens when syphilis bacteria invade your brain or spinal cord. It develops when syphilis goes untreated for months or years. The bacterium Treponema pallidum causes this infection.
Syphilis typically starts as a genital infection that spreads through sexual contact. Without treatment, the bacteria can travel through your bloodstream to your central nervous system. This can happen at any stage of syphilis, even in the early months after infection.
Neurosyphilis can cause permanent damage to your brain, spinal cord, eyes, and ears. Early detection through blood testing helps prevent serious complications. Treatment with antibiotics can stop the infection from progressing further.
Symptoms
- Severe headaches that may come and go
- Trouble with muscle movement or weakness
- Numbness in your arms, legs, or feet
- Vision problems or sudden blindness
- Changes in personality or behavior
- Confusion or trouble concentrating
- Memory loss or dementia
- Seizures or convulsions
- Stiff neck or sensitivity to light
- Hearing loss or ringing in your ears
Many people with early neurosyphilis have no symptoms at all. The infection can quietly damage your nervous system for years before symptoms appear. This is why blood testing is critical if you have been exposed to syphilis.
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Causes and risk factors
Neurosyphilis develops when the Treponema pallidum bacterium spreads from an initial syphilis infection to your nervous system. This usually happens when syphilis goes untreated for months or years. However, it can occur at any stage of infection, even within the first few weeks.
Your risk increases if you have untreated syphilis, HIV infection, or a weakened immune system. People who do not complete their syphilis treatment are also at higher risk. Sexual contact with someone who has syphilis is the primary way the infection spreads. Pregnant women with syphilis can pass the infection to their babies, which may lead to congenital neurosyphilis.
How it's diagnosed
Doctors diagnose neurosyphilis using blood tests that detect antibodies to Treponema pallidum bacteria. The Treponema pallidum antibody test and particle agglutination test can identify if you have been exposed to syphilis. The RPR test with reflex titer helps determine if the infection is active and how severe it may be.
If blood tests suggest syphilis, your doctor may perform a spinal tap to check your cerebrospinal fluid. CSF oligoclonal bands testing can reveal if the infection has reached your nervous system. Rite Aid offers blood testing for syphilis antibodies and RPR titers as an add-on to your annual panel. These tests help catch the infection before it causes permanent nerve damage.
Treatment options
- Intravenous penicillin for 10 to 14 days is the standard treatment
- Alternative antibiotics like doxycycline may be used if you are allergic to penicillin
- Follow-up blood tests every 3 to 6 months to ensure the infection is clearing
- Repeat spinal taps to monitor cerebrospinal fluid improvement
- Treatment for any sexual partners who may have been exposed
- HIV testing, as the two infections often occur together
- Avoiding sexual contact until treatment is complete and tests show improvement
- Monitoring for any long-term complications like vision or hearing loss
Need testing for Neurosyphilis? Add it to your panel.
- Simple blood draw at your nearest lab
- Results in days, not weeks
- Share results with your doctor
Frequently asked questions
Syphilis is a sexually transmitted bacterial infection that typically starts with genital sores. Neurosyphilis occurs when the syphilis bacteria spread to your brain or spinal cord. While syphilis can be treated with a single antibiotic injection, neurosyphilis requires intravenous antibiotics for up to 14 days. Not everyone with syphilis develops neurosyphilis, especially if treated early.
Neurosyphilis can be treated with antibiotics, usually intravenous penicillin. Treatment kills the bacteria and stops the infection from progressing further. However, any nerve damage that occurred before treatment may be permanent. Early detection and treatment offer the best chance of preventing long-term complications.
Neurosyphilis can develop at any stage of syphilis infection. In some cases, it occurs within weeks or months of initial infection. In others, it may take years or even decades for symptoms to appear. This is why regular testing is important if you have had syphilis or been exposed to it.
You should get tested if you have been diagnosed with syphilis and have neurological symptoms like headaches, vision changes, or confusion. People with HIV, pregnant women with syphilis, and anyone with untreated syphilis for months or years should also be tested. Your doctor may recommend testing if you have new sexual partners or multiple partners.
Blood tests for Treponema pallidum antibodies and RPR titers can indicate syphilis infection. High RPR titers may suggest the infection has progressed to neurosyphilis. A spinal tap to test cerebrospinal fluid is usually needed to confirm neurosyphilis. CSF oligoclonal bands testing helps identify nervous system involvement.
Neurosyphilis itself is not directly contagious through casual contact. However, if you have active syphilis sores or symptoms, you can still spread syphilis to sexual partners. The bacteria spread through direct contact with syphilis sores during vaginal, anal, or oral sex. You should avoid sexual contact until your doctor confirms treatment is working.
Untreated neurosyphilis can cause progressive brain damage, paralysis, blindness, and dementia. It can lead to stroke, meningitis, or damage to your spinal cord. Some people develop tabes dorsalis, a condition that causes severe pain and loss of coordination. Untreated neurosyphilis can be fatal.
The best prevention is avoiding syphilis infection through safe sexual practices like using condoms. If you get syphilis, prompt treatment prevents it from progressing to neurosyphilis. Regular testing is important if you are sexually active with new or multiple partners. Early treatment of syphilis with antibiotics nearly eliminates the risk of neurosyphilis.
No, early neurosyphilis often causes no symptoms at all. The infection can silently damage your nervous system for months or years before you notice problems. This is called asymptomatic neurosyphilis. Blood tests and spinal fluid analysis can detect the infection even without symptoms.
Your doctor will recheck your blood tests every 3 to 6 months after treatment. RPR titers should decrease by at least four times within 6 to 12 months if treatment is working. You may need a repeat spinal tap at 6 months to confirm the infection is clearing from your nervous system. Some people need retesting for up to 2 years.