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Central nervous system
Central nervous system


Syphilitic aseptic meningitis

Definition:

Syphilitic aseptic meningitis is a complication of untreated syphilis that involves inflammation of the tissues covering the brain and spinal cord. People with this condition have changes in mental status and problems with nerve function.



Alternative Names:

Meningitis - syphilitic



Causes, incidence, and risk factors:

Syphilis is a sexually transmitted, infectious disease caused by the spirochete Treponema pallidum. Syphilis has three main stages:

  • Primary syphilis
  • Secondary syphilis
  • Tertiary syphilis

Syphilitic aseptic meningitis is a form of meningovascular neurosyphilis , which is a progressive, life-threatening complication of syphilis infection.

The disorder is similar to meningitis caused by other conditions.

Risks for syphilitic aseptic meningitis include previous infection with syphilis or other sexually transmitted diseases such as gonorrhea . Syphilis infections are mainly transmitted through sexual contact with an infected person, but they may sometimes be transmitted by nonsexual contact.



Symptoms:

Signs and tests:

An examination may show signs of meningitis. There may be a loss of nerve functions. A brain and nervous system (neurologic) examination may show reduced function of the cranial nerve, including the nerves that control eye movement.

Tests may include:



Treatment:

The goals of treatment are to cure the infection and stop the disorder from getting worse. Treating the infection helps prevent new nerve damage and may reduce symptoms, but it does not reverse existing damage.

Penicillin or other antibiotics (such as tetracycline or erythromycin) are given to treat the infection. Treatment may be long-term to ensure that the infection is completely cleared. Symptoms may improve dramatically after treatment. A follow-up examination of the cerebrospinal fluid is needed to evaluate whether the antibiotic therapy worked.

Neurologic damage needs to be treated. You may need to have emergency treatment for seizures. Anticonvulsants such as phenytoin are used to control seizures.

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.



Support Groups:



Expectations (prognosis):

Some people with the condition have worsening disability. Early death is common. Death can be caused directly by the neurologic damage or by the cardiovascular damage that also occurs with late syphilis infections.

People with late syphilis infections are at greater risk for other infections and diseases. A seizure disorder can develop after infection.



Complications:
  • Inability to care for self
  • Inability to communicate or interact
  • Injury caused during seizures
  • Stroke


Calling your health care provider:

Go to the emergency room or call the local emergency number (such as 911) if you have seizures.

Call your health care provider if you have a severe headache with fever or other symptoms, especially if you have a history of syphilis infection.



Prevention:

Adequate treatment and follow-up of primary syphilis infections will reduce the risk of developing syphilitic aseptic meningitis.

If you are sexually active, practice safe sex and always use condoms.

All pregnant women should be screened for syphilis.



References:

Centers for Disease Control and Prevention (CDC). Recommendations and Reports: Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep. 2006;55(RR-11).

U.S. Preventive Services Task Force. Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150:705-709.

U.S. Preventive Services Task Force. Screening for syphilis infection. Topic Page. July 2004. Agency for Healthcare Research and Quality, Rockville, MD. Acccessed 6/28/2010.

Hook EW III. Syphilis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 340.

Tremont EC. Treponema pallidum (Syphilis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009: chap 238.




Review Date: 8/30/2010
Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and 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. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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