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General Medicine

Neurosyphilis

Gloria J. Klapstein, PhD Reviewed 06/2019
 


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 ...

DIAGNOSIS

HISTORY

Previous sexual contact with partner with known infection, or partner with high-risk sexual behavior, maternal transmission 

PHYSICAL EXAM

  • Many neurosyphilitic patients are asymptomatic...

TREATMENT

GENERAL MEASURES

All patients with neurosyphilis should be tested for HIV. 

MEDICATION

First Line

Aqueous crystalline penicillin G 18 to 24 million U/day, administered as 3 to 4 million U IV q4h...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • T. pallidum cannot be grown in the laboratory, and there is no microbiologic test of cure.

  • Neurologic and CSF examination at 3 to 6 months and ev...

REFERENCES

1
Workowski KA, Berman S; for Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep.  2010;59(RR-12):1–110. [View Abstrac...

ADDITIONAL READING

  • Berger JR, Dean D. Neurosyphilis. Handb Clin Neurol.  2014;121:1461–1472. [View Abstract on OvidMedline]

  • Chahine LM, Khoriaty RN, Tomford WJ, et al. The changing face of neurosy...

CODES

ICD10

  • A52.3 Neurosyphilis, unspecified

  • A52.2 Asymptomatic neurosyphilis

  • A52.13 Late syphilitic meningitis

  • A52.11 Tabes dorsalis

  • A52.14 Late syphilitic encephalitis

  • A52.17 General paresis

  • A52.10 Symptom...

CLINICAL PEARLS

  • CNS involvement can occur at any stage of syphilis infection.

  • Procaine penicillin is the gold standard for treatment. Penicillin G benzathine does not reach detectable levels in the CSF...

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Related Images
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FIGURE 2-10. The illusion of depth when using scanning electron microscopy clearly reveals the corkscrew shape of cells of the syphilis-causing spirochete, Treponema pallidum.
FIGURE 2-10. The illusion of depth when using scanning electron microscopy clearly reveals the corkscrew shape of cells of the syphilis-cau...
Figure 20-19 Syphilitic aortitis in tertiary syphilis. A, The aortic root is dilated, so that the valve does not seal properly during diastole (regurgitation), and the valve leaflets are thickened because of chronic inflammation and scarring. B, Marked left ventricular dilation and hypertrophy caused by aortic regurgitation associated with dilation of aortic root.
Figure 20-19 Syphilitic aortitis in tertiary syphilis. A, The aortic root is dilated, so that the valve does not seal properly during diast...
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