Syphilitic aseptic meningitis
Syphilitic aseptic meningitis is a complication of untreated syphilis. It involves inflammation of the tissues covering the brain and spinal cord.
Meningitis - syphilitic
Syphilis is a sexually transmitted disease caused by the spirochete bacteria Treponema pallidum. Syphilis has three main stages:
- Primary syphilis
- Secondary syphilis
- Tertiary syphilis
Syphilitic aseptic meningitis is a form of meningovascular neurosyphilis. This condition is a life-threatening complication of syphilis infection.
Syphilitic aseptic meningitis is similar to meningitis caused by other conditions.
Risks for syphilitic aseptic 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.
- Changes in vision, blurred vision, decreased vision
- Mental status changes, including confusion, decreased attention span, and irritability
- Nausea and vomiting
- Neck pain
- Sensitivity to light (photophobia)
- Sensitivity to loud noises
- Sleepiness, lethargy, hard to wake up
- Stiff neck
- Stiffness of shoulders, other muscle aches
Exams and Tests
The doctor or nurse will examine you. This may show problems with your nerves, including nerves that control eye movement.
Tests may include:
- Cerebral angiography
- Electroencephalogram (EEG)
- Head CT scan
- Spinal tap to remove a sample of cerebrospinal fluid (CSF) for examination
- VDRL blood test or RPR blood test (to screen for a syphilis infection)
If screening tests show a syphilis infection, more tests are done to confirm the diagnosis. Tests include:
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.
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.
Late-stage syphilis can cause nerve or heart damage, which can lead to disability and death.
Persons with late syphilis infections are more likely to have other complications, such as seizures.
- Inability to care for self
- Inability to communicate or interact
- Injury caused during seizures
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.
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.
Hook EW III. Syphilis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 327.
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;364:2016-2025.
Tremont EC. Treponema pallidum (Syphilis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009:chap 238.
Workowski KA, Berman S. Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59:1-110.
Reviewed By: 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, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.