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. These tissues are called the meninges.

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), but it doesn't develop as quickly.

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
Changes in vision
There are many types of eye problems and vision disturbances, such as: Halos Blurred vision (the loss of sharpness of vision and the inability to see...
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Fever
Headache
Mental status changes, including confusion, decreased attention span, and irritability
Confusion,
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
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Nausea and vomiting
Stiff neck or shoulders, muscle aches
Seizures
Seizures
A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...
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Sensitivity to light (photophobia) and loud noises
Photophobia
Photophobia is eye discomfort in bright light.
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Sleepiness, lethargy, hard to wake up
Lethargy
Fatigue is a feeling of weariness, tiredness, or lack of energy.

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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
Cerebral angiography
Cerebral angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the brain.
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Electroencephalogram (EEG) to measure electrical activity in the brain
EEG
An electroencephalogram (EEG) is a test to measure the electrical activity of the brain.
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Head CT scan
Head CT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
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Spinal tap to obtain a sample of cerebrospinal fluid (CSF) for examination
Spinal tap
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...
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Blood test to screen for a syphilis infection

If screening tests indicate a syphilis infection, more tests are done to confirm the diagnosis.

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.

Contact 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.

Open References

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.

Meninges of the brain - illustration
The organs of the central nervous system (brain and spinal cord) are covered by connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.
Meninges of the brain
illustration
Meninges of the spine - illustration
The organs of the central nervous system (brain and spinal cord) are covered by 3 connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.
Meninges of the spine
illustration
Central nervous system and peripheral nervous system - illustration
The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes nerves outside the brain and spinal cord.
Central nervous system and peripheral nervous system
illustration
Primary syphilis - illustration
Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. Primary syphilis presents as a small painless open sore 3 to 6 weeks after exposure. Although the lesion heals within 6 to 8 weeks, the untreated organism will continue to multiply unchecked, causing many complications. Infection may last for 30 years or more and result in severe neurological complications.
Primary syphilis
illustration
Syphilis - secondary on the palms - illustration
Secondary syphilis is one of the few infectious diseases that produces rashes on the palms and soles, as well as a generalized rash. If an ulcer on the penis is followed several weeks later by a rash, the person should always be evaluated for syphilis.
Syphilis - secondary on the palms
illustration
Late-stage syphilis - illustration
Tertiary syphilis is a late stage of the disease which can follow the initial infection, primary syphilis, by several years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive.
Late-stage syphilis
illustration
CSF cell count - illustration
CSF (cerebrospinal fluid) is a clear fluid that circulates in the space surrounding the spinal cord and brain. A CSF cell count is a test to measure the number of red and white blood cells that are in CSF.
CSF cell count
illustration
CSF test for syphilis - illustration
Venereal disease research laboratory test (VDRL) of the cerebrospinal fluid (CSF) is used to screen for syphilis. CSF is a clear fluid that circulates in the space surrounding the spinal cord.
CSF test for syphilis
illustration

Meninges of the brain - illustration
The organs of the central nervous system (brain and spinal cord) are covered by connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.
Meninges of the brain
illustration
Meninges of the spine - illustration
The organs of the central nervous system (brain and spinal cord) are covered by 3 connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.
Meninges of the spine
illustration
Central nervous system and peripheral nervous system - illustration
The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes nerves outside the brain and spinal cord.
Central nervous system and peripheral nervous system
illustration
Primary syphilis - illustration
Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. Primary syphilis presents as a small painless open sore 3 to 6 weeks after exposure. Although the lesion heals within 6 to 8 weeks, the untreated organism will continue to multiply unchecked, causing many complications. Infection may last for 30 years or more and result in severe neurological complications.
Primary syphilis
illustration
Syphilis - secondary on the palms - illustration
Secondary syphilis is one of the few infectious diseases that produces rashes on the palms and soles, as well as a generalized rash. If an ulcer on the penis is followed several weeks later by a rash, the person should always be evaluated for syphilis.
Syphilis - secondary on the palms
illustration
Late-stage syphilis - illustration
Tertiary syphilis is a late stage of the disease which can follow the initial infection, primary syphilis, by several years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive.
Late-stage syphilis
illustration
CSF cell count - illustration
CSF (cerebrospinal fluid) is a clear fluid that circulates in the space surrounding the spinal cord and brain. A CSF cell count is a test to measure the number of red and white blood cells that are in CSF.
CSF cell count
illustration
CSF test for syphilis - illustration
Venereal disease research laboratory test (VDRL) of the cerebrospinal fluid (CSF) is used to screen for syphilis. CSF is a clear fluid that circulates in the space surrounding the spinal cord.
CSF test for syphilis
illustration

A Closer Look

Tests for Syphilitic aseptic meningitis

Review Date: 9/10/2022

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

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Health Library

Syphilitic aseptic meningitis

Meningitis

Syphilis

Causes

Neurosyphilis

Gonorrhea

Symptoms

Changes in vision

Confusion,

Seizures

Photophobia

Lethargy

Exams and Tests

Cerebral angiography

EEG

Head CT scan

Spinal tap

Treatment

Outlook (Prognosis)

Possible Complications

When to Contact a Medical Professional

Prevention

Practice safer sex

References

Meninges of the brain - illustration

Meninges of the brain

Meninges of the spine - illustration

Meninges of the spine

Central nervous system and peripheral nervous system - illustration

Central nervous system and peripheral nervous system

Primary syphilis - illustration

Primary syphilis

Syphilis - secondary on the palms - illustration

Syphilis - secondary on the palms

Late-stage syphilis - illustration

Late-stage syphilis

CSF cell count - illustration

CSF cell count

CSF test for syphilis - illustration

CSF test for syphilis