Neurosüüfilis

Neurosüüfilis, or neurosyphilis, is an infection of the central nervous system by Treponema pallidum. It can develop at any stage of syphilis and may present long after the initial infection. Neurosüüfilis encompasses several syndromes caused by meningeal inflammation, brain involvement, or spinal cord disease, including asymptomatic CSF infection and various symptomatic forms.

Clinical forms include asymptomatic neurosyphilis; syphilitic meningitis; meningovascular syphilis, which can cause stroke; tabes dorsalis with sensory ataxia and lightning pains; and general paresis with cognitive and psychiatric symptoms. Gummatous CNS disease is rare. Presentation can vary, and HIV coinfection may influence the clinical course.

Diagnosis relies on CSF testing and serum serology. CSF VDRL (or other non-treponemal tests) is highly specific but not fully sensitive; CSF may show pleocytosis and elevated protein. Serum non-treponemal tests (RPR or VDRL) screen for infection, while treponemal tests (FTA-ABS, TP-PA) remain positive for life. HIV coinfection can affect findings and progression. Neuroimaging supports assessment but is not diagnostic; MRI may reveal meningeal enhancement or other CNS changes.

Treatment is high-dose intravenous penicillin G, typically 18–24 million units per day, given for 10–14 days. For penicillin allergy, desensitization is recommended; alternatives such as ceftriaxone have limited evidence. Monitoring includes clinical evaluation and follow-up CSF testing to assess response.

Prognosis depends on stage and rapid initiation of therapy; early neurosüüfilis often improves, but established CNS damage may persist. CSF should be re-evaluated periodically (e.g., every 6–12 months) until abnormalities resolve. Prevention focuses on early detection and treatment of syphilis and safe sexual practices.