Syphilitic aseptic meningitis
Meningitis - syphilitic; Neurosyphilis - syphilitic meningitis
Syphilitic aseptic meningitis, or syphilitic meningitis, is a complication of untreated syphilis. It involves inflammation of the tissues covering the brain and spinal cord caused by this bacterial infection. These tissues are called the meninges.
The organs of the central nervous system (brain and spinal cord) are covered by connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.
The organs of the central nervous system (brain and spinal cord) are covered by 3 connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.
The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.
Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. Primary syphilis presents as a small painless open sore 3 to 6 weeks after exposure. Although the lesion heals within 6 to 8 weeks, the untreated organism will continue to multiply unchecked, causing many complications. Infection may last for 30 years or more and result in severe neurological complications.
Secondary syphilis is one of the few infectious diseases that produces rashes on the palms and soles, as well as a generalized rash. If an ulcer on the penis is followed several weeks later by a rash, the person should always be evaluated for syphilis.
Tertiary syphilis is a late stage of the disease which can follow the initial infection, primary syphilis, by several years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive.
CSF (cerebrospinal fluid) is a clear fluid that circulates in the space surrounding the spinal cord and brain. A CSF cell count is a test to measure the number of red and white blood cells that are in CSF.
Venereal disease research laboratory test (VDRL) of the cerebrospinal fluid (CSF) is used to screen for syphilis. CSF is a clear fluid that circulates in the space surrounding the spinal cord.
Causes
Syphilitic meningitis is a form of neurosyphilis. This condition is a life-threatening complication of syphilis infection. Syphilis is a sexually transmitted infection.
Syphilitic meningitis is similar to meningitis caused by other germs (organisms), but it doesn't develop as quickly.
Risks for syphilitic meningitis include a past infection with syphilis or other sexually transmitted illnesses such as gonorrhea. Syphilis infections are mainly spread through sex with an infected person. Sometimes, they may be passed by nonsexual contact.
Symptoms
Symptoms of syphilitic meningitis may include:
- Changes in vision, such as blurred vision, decreased vision
- Fever
- Headache
- Mental status changes, including confusion, decreased attention span, and irritability
- Nausea and vomiting
- Stiff neck or shoulders, muscle aches
- Seizures
- Sensitivity to light (photophobia) and loud noises
- Sleepiness, lethargy, hard to wake up
Exams and Tests
The health care provider will perform a physical exam. This may show problems with the nerves, including nerves that control eye movement.
Tests may include:
- Cerebral angiography to check blood flow in the brain
- Electroencephalogram (EEG) to measure electrical activity in the brain
- Head CT scan
- Spinal tap to obtain a sample of cerebrospinal fluid (CSF) for examination
- Blood test to screen for a syphilis infection
If screening tests indicate a syphilis infection, more tests are done to confirm the diagnosis.
Treatment
The goals of treatment are to cure the infection and stop symptoms from getting worse. Treating the infection helps prevent new nerve damage and may reduce symptoms. Treatment does not reverse existing damage.
Medicines likely to be given include:
- Penicillin or other antibiotics (such as tetracycline or erythromycin) for a long time to make sure the infection goes away
- Medicines for seizures
Outlook (Prognosis)
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.
Late-stage syphilis can cause nerve or heart damage. This can lead to disability and death.
Possible Complications
Complications may include:
- Inability to care for self
- Inability to communicate or interact
- Seizures that may result in injury
- Stroke
When to Contact a Medical Professional
Go to the emergency room or call 911 or the local emergency number if you have seizures.
Contact your provider if you have a severe headache with fever or other symptoms, especially if you have a history of syphilis infection.
Prevention
Proper treatment and follow-up of syphilis infections will reduce the risk of developing this type of meningitis.
If you are sexually active, practice safer sex and always use condoms.
All pregnant women should be screened for syphilis.
References
Hasbun R, van de Beek D, Brouwer MC, Tunkel AR. Acute meningitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 87.
Radolf JD, Tramont EC, Salazar JC. Syphilis (Treponema pallidum). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 237.
Version Info
Last reviewed on: 9/10/2022
Reviewed by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
