Neurosyphilis
Basics
Description
- A chronic, systemic, infectious disease with any involvement of the CNS at any stage of syphilitic Treponema pallidum infection (primary, secondary, tertiary, and latent)
- Transmitted sexually, via the maternal–fetal route, and via blood infusions
- Early manifestations:
- Asymptomatic neurosyphilis: presence of CSF abnormalities in the absence of neurologic signs/symptoms; peak incidence 12 to 18 months after infection
- Meningeal syphilis: signs and symptoms of meningitis; may be associated with gummas; onset within 12 months after initial infection
- Meningovascular syphilis: meningitis with CNS vascular involvement, resulting in thrombosis, ischemia, and infarction; onset is 5 to 12 years after initial infection.
- Ocular syphilis: ocular symptoms with or without meningitis; usually occurs in early infection
- Otologic syphilis: hearing loss with/without meningitis; can occur at any time
- Late manifestations: parenchymatous syphilis
- General paresis: also known as dementia paralytica; onset is 15 to 20 years after initial infection but may be as early as 2 years after initial infection.
- Tabes dorsalis: also known as progressive locomotor ataxia; onset is 20 to 25 years after initial infection but may be as early as 3 years after initial infection.
Epidemiology
Incidence
See “Syphilis.” Since 2005, the Centers for Disease Control and Prevention (CDC) no longer classifies/reports neurosyphilis as a distinct stage.
Prevalence
More common in the preantibiotic era and now most often seen in patients with HIV, with predominance of early neurosyphilis compared with late neurosyphilis
Etiology and Pathophysiology
- T. pallidum, spirochete
- Meningeal and meningovascular syphilis: lymphocytic infiltration of the meninges and perivascular spaces with diffuse thickening
- General paresis: atrophy of the frontal and temporal lobes with sparing of the motor, sensory, and occipital cortex
- Tabes dorsalis: degeneration of posterior roots and column of the spinal cord
Risk Factors
- High-risk sexual behavior
- Multiple sex partners
- Men having sex with men
- Transplacental transmission
- Exposure to infected body fluids
- Inmates at adult correctional facilities
- IV drug use (rare)
General Prevention
- Routinely obtain the patient’s sexual history.
- Educate and counsel persons at risk on ways to avoid sexually transmitted infections (STIs) through changes in sexual behaviors.
- Recommend abstinence, a reduction of the number of sex partners, and the use of male condoms.
Commonly Associated Conditions
- HIV infection
- Hepatitis B
- Other STIs
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Citation
Domino, Frank J., et al., editors. "Neurosyphilis." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816227/all/Neurosyphilis.
Neurosyphilis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816227/all/Neurosyphilis. Accessed December 7, 2024.
Neurosyphilis. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816227/all/Neurosyphilis
Neurosyphilis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 07]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816227/all/Neurosyphilis.
* Article titles in AMA citation format should be in sentence-case
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