- Christina M Marra, MD
Christina M Marra, MD
- Professor of Neurology, Adjunct Professor of Medicine (Infectious Diseases)
- University of Washington School of Medicine
- Section Editors
- Francisco González-Scarano, MD
Francisco González-Scarano, MD
- Section Editor — Multiple Sclerosis; Neurovirology & NeuroAIDS
- John P. Howe, III, MD, Distinguished Chair in Health Policy
- The University of Texas Health Science Center at San Antonio
- John G Bartlett, MD
John G Bartlett, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — HIV; Pulmonary Infections
- Professor Emeritus
- Johns Hopkins University School of Medicine
The term "neurosyphilis" refers to infection of the central nervous system (CNS) by Treponema pallidum, subspecies pallidum (hereafter termed T. pallidum). Neurosyphilis can occur at any time after initial infection.
Early in the course of syphilis, the most common forms of neurosyphilis involve the cerebrospinal fluid, meninges, and vasculature (asymptomatic meningitis, symptomatic meningitis, and meningovascular disease). Late in disease, the most common forms involve the brain and spinal cord parenchyma (general paralysis of the insane and tabes dorsalis). Each form has characteristic clinical findings, but in some cases there is overlap between these findings.
This topic will review the pathogenesis, epidemiology, clinical findings, diagnosis, and treatment of neurosyphilis. Other aspects of syphilis are discussed separately. (See "Syphilis: Epidemiology, pathophysiology, and clinical manifestations in HIV-uninfected patients" and "Syphilis: Treatment and monitoring".)
Neurosyphilis begins with invasion of the cerebrospinal fluid (CSF), a process that probably occurs shortly after acquisition of T. pallidum infection. The organism can be identified in the CSF from approximately one-quarter of untreated patients with early syphilis [1,2]. Specific strains of T. pallidum may be more likely to cause neurosyphilis .
Unlike other bacteria that can infect the CSF, invasion of CSF with T. pallidum does not always result in persistent infection, as spontaneous resolution may occur in some cases without an inflammatory response. In other cases, spontaneous resolution may occur after a transient meningitis (figure 1).To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CLINICAL MANIFESTATIONS
- Early neurosyphilis
- - Asymptomatic neurosyphilis
- - Symptomatic meningitis
- - Ocular syphilis
- - Otosyphilis
- - Meningovascular syphilis
- Late neurosyphilis
- - General paresis
- - Tabes dorsalis
- Atypical neurosyphilis
- Unknown syphilis history
- Known syphilis
- Spinal fluid examination
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS
- Epidemiology and clinical manifestations
- Diagnosis summary
- Treatment summary