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Neurological Complications of Syphilis

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Neurological Complications of Infectious Diseases

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Syphilis is a bacterial infection caused by Treponema pallidum subspecies pallidum (hereafter T. pallidum) which causes approximately 6 million new infections annually worldwide. It is relevant to neurologists because T. pallidum can invade the central nervous system and cause neurosyphilis. Neurosyphilis can occur at any time after primary infection. In early syphilis, neurosyphilis can be asymptomatic or can present with meningitis, stroke, and/or cranial neuropathies. In late syphilis, neurosyphilis typically presents as dementia or sensory ataxia. The exact prevalence of neurosyphilis is largely unknown worldwide, but neurosyphilis has become more common in the setting of the HIV epidemic as individuals with HIV and syphilis co-infection seem to develop neurosyphilis at higher rates than HIV-uninfected individuals. Diagnosis of neurosyphilis requires serological evidence of syphilis and compatible cerebrospinal fluid (CSF) abnormalities. The diagnosis is not straightforward as the CSF Venereal Disease Research Laboratory (VDRL) test, the gold standard diagnostic test for neurosyphilis, is only 30–70% sensitive. Treatment for neurosyphilis involves 10–14 days of high-dose penicillin, and treatment for uncomplicated syphilis will not adequately treat most cases of neurosyphilis. The pathophysiology of neurosyphilis involves humoral immune responses, at least partially driven by CXCL-13 mechanisms. However, why some individuals with syphilis develop neurosyphilis and others do not is incompletely understood but likely relates to both pathogen factors (i.e. strain type) and host factors (e.g. polymorphisms in genes regulating immune response to the infection and host immune status).

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Authors and Affiliations

  1. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Deanna Saylor

  2. Department of Internal Medicine, John Hopkins Medicine, University Teaching Hospital, Lusaka, Zambia

    Deanna Saylor

  3. Department of Neurology and Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Christina Marra

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Correspondence to Deanna Saylor .

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Editors and Affiliations

  1. UT Health McGovern Medical School, Houston, TX, USA

    Rodrigo Hasbun, MD MPH

  2. Div of Infectious Dis, MCN A-2200, Vanderbilt University, Nashville, TN, USA

    Karen C. Bloch, MD MPH

  3. Dept of Infectious Diseases, Apt 635, Cleveland Clinic Foundation, Cleveland, OH, USA

    Adarsh Bhimraj, MD

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Saylor, D., Marra, C. (2021). Neurological Complications of Syphilis. In: Hasbun, MD MPH, R., Bloch, MD MPH, K.C., Bhimraj, MD, A. (eds) Neurological Complications of Infectious Diseases. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-030-56084-3_6

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