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Syphilitic aseptic meningitis
Definition
Syphilitic aseptic meningitis is a complication of untreated syphilis. It involves inflammation of the tissues covering the brain and spinal cord.
Alternative Names
Meningitis - syphilitic
Causes
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 illnesses such as gonorrhea. Syphilis infections are mainly spread through sex with an infected person, but they may sometimes be passed by nonsexual contact.
Symptoms
- Changes in vision, blurred vision, decreased vision
- Fever
- Headache
- Mental status changes, including confusion, decreased attention span , and irritability
- Nausea and vomiting
- Neck pain
- Seizures
- Sensitivity to light (photophobia)
- Sensitivity to loud noises
- Sleepiness, lethargy, hard to wake the person up
- Stiff neck
- Stiffness of shoulders, other muscle aches
Exams and Tests
The doctor or nurse will examine you. This may show problems with how your nerves work, including those that control eye movement.
Tests may include:
- Cerebral angiography
- Electroencephalogram (EEG)
- Head CT scan
- Spinal tap to remove a sample of CSF (cerebrospinal fluid) for examination
- VDRL blood test or RPR blood test (to screen for a syphilis infection)
If screening tests show a syphillis infection, more tests are done to confirm the diagnosis. One such test is the FTA-ABS test.
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, but it does not reverse existing damage.
You will receive:
- Penicillin or other antibiotics (such as tetracycline or erythromycin) for a long time to make sure the infection goes away.
- Spinal tap to remove a sample of spinal fluid for testing to see if the antibiotic worked.
- Medicines for 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.
Outlook (Prognosis)
Late-stage syphillis can cause nerve or heart damage, which can lead to disability and death.
Persons with late syphilis infections are more likely to get other infections and other health disorders, such as seizures.
Possible Complications
- Inability to care for self
- Inability to communicate or interact
- Injury caused during seizures
- Stroke
When to Contact a Medical Professional
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
Proper treatment and follow-up of primary syphilis infections will reduce your risk of developing this type of meningitis.
If you are sexually active, practice safe sex and always use condoms.
All pregnant women should be screened for syphilis.
References
Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17;59 (RR-12):1-110.
Hook EW III. Syphilis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 327.
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.
Thigpen MC, Whitney CG, Messonnier NE, et al. Emerging Infections Programs Network. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26;364(21):2016-25.
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. 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. Health Solutions, Ebix, Inc.
