Syphilitic myelopathy
Locomotor ataxia; Syphilitic myelopathy; Syphilitic myeloneuropathy; Myelopathy - syphilitic; Tabetic neurosyphilis
Tabes dorsalis is a complication of untreated syphilis that involves muscle weakness and abnormal sensations.
Superficial muscles are close to the surface of the skin. Muscles which lie closer to bone or internal organs are called deep muscles.
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.
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.
Causes
Tabes dorsalis is a form of neurosyphilis, which is a complication of late-stage syphilis infection. Syphilis is a bacterial infection that is spread sexually.
When syphilis is untreated, the bacteria may damage the spinal cord and peripheral nervous tissue. This leads to the symptoms of tabes dorsalis.
Tabes dorsalis is now very rare because syphilis is usually treated early in the disease.
Symptoms
Symptoms of tabes dorsalis are caused by damage to the nervous system. Symptoms include any of the following:
- Abnormal sensations (paresthesia), often called lightning pains
- Problems walking due to nerve damage causing the person to walk with the legs far apart and feet slapping the ground
- Loss of coordination and reflexes
- Joint damage, especially to the knees
- Muscle weakness
- Vision changes
- Bladder control problems
- Sexual function problems
Exams and Tests
Your health care provider will perform a physical exam, focusing on the nervous system.
If syphilis infection is suspected, tests may include the following:
- Cerebrospinal fluid (CSF-VDRL) exam
- Head CT, spine CT, or MRI scans of the brain and spinal cord to rule out other diseases
- Serum VDRL or serum RPR (used as a screening test for syphilis infection)
If the serum VDRL or serum RPR test is positive, more tests are required to confirm the diagnosis.
Treatment
The goals of treatment are to cure the infection and slow the disease. Treating the infection helps prevent new nerve damage and may reduce symptoms. Treatment does not reverse existing nerve damage.
Medicines likely to be given include:
- Penicillin or other antibiotics for a long time to make sure the infection goes away
- Painkillers to control pain
Symptoms of existing nervous system damage need to be treated. People who are unable to eat, dress themselves, or take care of themselves may need help. Rehabilitation, physical therapy, and occupational therapy may help with muscle weakness.
Outlook (Prognosis)
Left untreated, tabes dorsalis may lead to disability.
When to Contact a Medical Professional
Contact your provider if you have:
- Loss of coordination
- Loss of muscle strength
- Loss of sensation
Prevention
Proper treatment and follow-up of syphilis infections reduces the risk of developing tabes dorsalis.
If you are sexually active, practice safer sex and always use a condom.
All pregnant women should be screened for syphilis. Also, people at increased risk for getting syphilis should be screened for it. Common examples include men who have sex with men, people with HIV infection, young adults, and people with a history of incarceration, sex work, military service or illicit drug use.
References
Dionne JA, Ghanem KG. Syphilis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 295.
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.
US Preventive Services Task Force website. Syphilis infection in nonpregnant adolescents and adults: Screening.
Version Info
Last reviewed on: 8/29/2024
Reviewed by: Jatin M. Vyas, MD, PhD, 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.
