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Syphilitic aseptic meningitis
     
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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.

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).

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
  • VDRL blood test or RPR blood test to screen for a syphilis infection

If screening tests show a syphilis infection, more tests are done to confirm the diagnosis. Tests include:

  • FTA-ABS
  • MHA-TP
  • TP-PA
  • TP-EIA

 

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.

Call 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.

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  • Central nervous system and peripheral nervous system

    Central nervous system and peripheral nervous system

    illustration

  • Primary syphilis

    Primary syphilis

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  • Syphilis - secondary on the palms

    Syphilis - secondary on the palms

    illustration

  • Late-stage syphilis

    Late-stage syphilis

    illustration

  • CSF cell count

    CSF cell count

    illustration

  • CSF test for syphilis

    CSF test for syphilis

    illustration

    • Central nervous system and peripheral nervous system

      Central nervous system and peripheral nervous system

      illustration

    • Primary syphilis

      Primary syphilis

      illustration

    • Syphilis - secondary on the palms

      Syphilis - secondary on the palms

      illustration

    • Late-stage syphilis

      Late-stage syphilis

      illustration

    • CSF cell count

      CSF cell count

      illustration

    • CSF test for syphilis

      CSF test for syphilis

      illustration

    A Closer Look

     

      Tests for Syphilitic aseptic meningitis

       
         

        Review Date: 10/25/2020

        Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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