Neurosyphilis

Overview

Incidence of syphilis, a sexually transmitted disease caused by T. pallidum subsp. pallidum spirochete, is growing worldwide. Neurosyphilis is one of the most serious forms of the disease. T. p. pallidum invades CNS in 30–70 % of patients with syphilis. However, the invasion usually subsides spontaneously. Progression of neuroinfection is depending on biological features of the T. p. pallidum strain, which can be highly neurotropic.

There is a variety of clinical forms of neurosyphilis. They include cerebrospinal fluid (CSF) abnormities, syphilitic meningitis, meningovascular syphilis, chorioretinitis, uveitis, optic atrophy, progressive paralysis, tabes dorsalis, and cerebral gummas. Currently, incidence of early neurosyphilis is on increase; progressive paralysis is rare.

Clinical symptoms can imitate other diseases or they are even missing. Antitreponemal and anticardiolipin antibodies are assessed in serum samples, pleocytosis and protein concentration are detected in the CSF. The positive cardiolipin test from the CSF is highly pathognomic for syphilis in patients with specific serum antibodies confirmed. Absence of the specific antibodies in serum virtually excludes neurosyphilis. Drug of choice in neurosyphilis is penicillin administered i.v.

All forms of syphilis must be reported and dispensed; therapy of syphilis and epidemiological screening are mandatory.

Key words:
neurosyphilis, syphilis serology, T. pallidum subsp. pallidum, CSF, HIV