Syphilitic aseptic meningitis

Alternative names
Meningitis - syphilitic

Definition
Syphilitic aseptic meningitis is a complication of untreated Syphilis infections characterized by changes in mental status and nerve functions.

Causes, incidence, and risk factors

Syphilitic aseptic meningitis is a form of meningovascular neurosyphilis, which is a progressive life-threatening complication of Syphilis infection.

The disorder resembles meningitis caused by other conditions. There is inflammation of the meninges (the membranes that cover the brain and spinal cord). This may cause headaches, cognitive changes, or decrease in nerve functions such as vision, movement, or sensation. Vascular (blood vessel) symptoms, such as Stroke  secondary to syphilis, commonly accompany or follow syphilitic aseptic meningitis.

Risks of syphilitic aseptic meningitis include previous infection with Syphilis or other sexually transmitted diseases such as gonorrhea (which may hide symptoms of Syphilis infection). Syphilis infections are transmitted primarily through sexual contact with an infected person, but they may sometimes be transmitted by nonsexual contact.

Symptoms

     
  • headache  
  • nausea, Vomiting  
  • Stiff neck  
  • Neck pain  
  • Stiffness of shoulders, other muscle aches  
  • Fever  
  • Sensitivity to light (photophobia)  
  • Sensitivity to loud noises  
  • Mental status changes       o Confusion       o Disorientation       o Decreased attention span       o Irritability       o Sleepy, lethargic, hard to arouse  
  • Changes in vision, blurred vision, decreased vision  
  • Seizures

Signs and tests
An examination may indicate meningitis. Focal neurologic deficits (localized loss of nerve functions) may be present. A neurologic examination may show reduced cranial nerve function, including the nerves that control eye movement.

Tests may include:

     
  • EEG (electroencephalogram) if seizures are present.  
  • Head CT scan.  
  • Cerebral Angiography if vascular symptoms are present.  
  • Serum VDRL or serum RPR (used as screening tests to detect Syphilis infection) - if positive, requires one the following to confirm diagnosis:       o FTA-ABS       o MHA-TP  
  • CSF (cerebrospinal fluid) examination

Treatment

The goals of treatment are to cure the infection and to reduce progression of the disorder. Treatment of the infection reduces new nerve damage and may reduce symptoms, but it does not cure existing damage.

Penicillin or other antibiotics (such as tetracycline or erythromycin) are given to treat the infection. Treatment may be prolonged to ensure that the infection is completely cleared. Symptoms may improve dramatically after treatment of the infection. A follow-up examination of the cerebrospinal fluid is required to evaluate the effectiveness of antibiotic therapy.

Note: Oral tetracycline is usually not prescribed for children until after all the permanent teeth have erupted. It can permanently discolor teeth that are still forming.

Symptomatic treatment is required for existing neurologic damage. Emergency treatment of seizures may be required! Anticonvulsants such as phenytoin may be needed to control seizures.

Assistance or supervision may be needed if the person is unable to function in self-care activities (eating, dressing, etc.). Confusion and other mental changes may improve or be prolonged after antibiotic treatment.

Expectations (prognosis)

A progressive disability is possible. Early death is common, with death caused directly by the neurologic damage (resulting in decreased function of body systems) or by cardiovascular damage that also occurs with late Syphilis infections.

People with late Syphilis infections are at a greater risk for other infections and diseases. A seizure disorder can arise after infection.

Complications

     
  • Inability to care for self  
  • Inability to communicate or interact  
  • Injury caused during seizures  
  • Stroke secondary to syphilis

Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if seizures occur.

Call your health care provider if severe headache with fever or other symptoms are present, particularly if there is a known history of syphilis infection.

Prevention
Adequate treatment and follow-up of primary Syphilis infections will reduce the risk of developing syphilitic aseptic meningitis.

Safer sex behaviors and use of protective barriers when in contact with potentially infectious material may reduce the risk of developing a Syphilis infection.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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