What is neurosyphilis and what symptoms does it generate?

Neurosyphilis is a serious disease that can have catastrophic consequences. Sometimes it does not produce symptoms, so it is only detected when it is too late. The best option is to prevent it.

Last update: September 11, 2021

Neurosyphilis is a bacterial infection of the brain or spinal cord.. It is a life-threatening disease that is a spread of syphilis. It usually occurs when the underlying disease has not been treated.

Syphilis is a sexually transmitted disease that develops from coming into contact with the sores of an infected person. It is caused by a bacteria called Treponema pallidum. Over time, it can lead to neurosyphilis.

The difference between syphilis and neurosyphilis is that the latter attacks the nervous system. In the same way, its symptoms are more severe and the consequences become very serious and even fatal. In some cases it leaves permanent sequelae.

Symptoms of neurosyphilis

When syphilis is not detected and treated early, it can lead to neurosyphilis.

The symptoms of neurosyphilis are highly variable. In fact, there are people who do not present any manifestation of the disease. On the contrary, others have very severe symptoms. Usually, it all depends on the nerves that have been attacked by the infection and their degree of advancement. The main symptoms of neurosyphilis are as follows.

Mental symptoms

A person affected by neurosyphilis may develop one or more of the following symptoms:

  • Difficulty controlling emotions.
  • Sudden mood swings
  • Changes in personality.
  • Memory problems.
  • Depression.
  • Psychosis, with possible visual or auditory hallucinations.
  • Progressive dementia.

Physical symptoms

Among the most common physical symptoms in neurosyphilis are the following:

  • Changes in sensation in the extremities.
  • Syphilis infections of the eye or ocular syphilis.
  • Gait abnormalities or inability to walk.
  • Difficulties in coordinating movement.
  • Headache.
  • Stiff neck.
  • Seizures
  • Urinary incontinence.
  • Vertigo.
  • Numbness in the toes, feet, or legs.
  • Tremors or weakness

Why happens?

The bacteria Treponema pallidum is the one that gives rise to syphilis and, later, to neurosyphilis. The latter can take between 10 and 20 years to manifest, after the contagion. The bacteria are transmitted almost exclusively through oral, genital, or anal sex.

Nevertheless, syphilis can be passed from mother to child during pregnancy. This is usually fatal to the newborn. Neurosyphilis is believed to be more common when there is untreated syphilis, but science does not know the exact reasons why it occurs in some people and not in others.



Most people with syphilis will not develop neurosyphilis. However, the probability is higher in the following cases:

  • Women in pregnancy.
  • People who have HIV and are sexually active.
  • Those who take pre-exposure prophylaxis, or PrEP, to prevent HIV.

How is neurosyphilis diagnosed?

Syphilis is detected by a blood test. However, neurosyphilis is not so easy to identify. In general, the diagnosis is made based on the symptoms and the performance of one or more tests like the following.

Physical exploration

The usual is that a physical exam is started to detect some of the characteristic symptoms. Among them are mental changes, abnormal reflexes, muscle contractions or muscle atrophy.

Blood test

Blood tests only detect neurosyphilis if it is already in a middle stage of its development. They may be ordered tests to detect the presence of substances produced by the bacteria that gives rise to the disease.

Lumbar puncture

This is one of the most commonly used tests to diagnose neurosyphilis. It involves inserting a needle between the bones of the lower back and removing some of the substance that surrounds the spine, or "cerebrospinal fluid." This is analyzed in the laboratory. It allows to corroborate the presence of the disease, determine its severity and plan the treatment.

Imaging tests

There are several imaging tests that can be done to diagnose neurosyphilis. The most widely used are computed tomography and magnetic resonance imaging.. They allow the brain, brainstem, and spinal cord to be viewed for evidence of disease.

Available treatments

There is no one treatment applicable to all cases of neurosyphilis. The measures to be followed will depend on the damage that the disease has caused in each case and the general health of the patient.

However, when neurosyphilis is detected in its first phase, the treatment to be followed is pharmacological. Penicillin should be administered, either orally, intravenously, or intramuscularly.. Typically this is done continuously for 10 to 14 days.

It is common for this measure is accompanied by the administration of the antibiotic probenecid and ceftriaxone, a substance that prolongs the antimicrobial effect of penicillin. In some cases it is necessary for the person to remain hospitalized during treatment. If a person has HIV, different treatment may be required.

Recovery from neurosyphilis and projection

Recovering from neurosyphilis is possible, as long as treatment is carried out on time.

Once the treatment is finished, blood tests should be done at 3, 6, 12, 24 and 36 months to monitor progress of the patient. In addition, control lumbar punctures are required every six months.

The prognosis of neurosyphilis will depend on how early it was detected., what type it is and how much damage it has caused to the body. When an early treatment is done, the possibility of recovery is very high. Pharmacological measures are effective and problems can be reversed.

If neurosyphilis is detected late, treatment may not be effective in restoring full health. Many times the effects caused by the infection are irreversible.



Prevention and lifestyle

The first preventive measure is to avoid getting syphilis. This is accomplished with safe sexual practices. The use of condoms reduces the possibility of contracting this sexually transmitted disease, but it does not protect from areas not covered by the condom.

It is a good idea for a sexually active person to be tested for sexually transmitted disease on a regular basis. This is even more important if you have multiple sexual partners. You need to remember that syphilis and neurosyphilis often have no symptoms, so they may go unnoticed.

Safe sex is the best prevention

It is very important that people become aware of the importance of safe sex. This practice is the best way to avoid sexually transmitted diseases, such as syphilis that can lead to neurosyphilis.

Whenever you suspect that you have a sexually transmitted disease, you should consult your doctor. to order the evidence of the case. It should not be forgotten that early diagnosis of neurosyphilis can prevent serious sequelae and even save life.