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Syphilitic aseptic meningitis

Definition

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.

Alternative Names

Meningitis - syphilitic; Neurosyphilis - syphilitic meningitis

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.

Gallery

Central nervous system and peripheral nervous system
The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.
The female condom
The female condom, like the male condom, is a barrier contraceptive made of latex or polyurethane. The condom has a ring on each end. The ring that is placed inside the vagina fits over the cervix, while the other ring, which is open, rests outside of the vagina and covers the vulva. The female condom is sold over-the-counter.
Primary syphilis
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.
Primary syphilis
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.
CSF cell count
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.
CSF test for syphilis
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.

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.

Last reviewed September 10, 2022 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..

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