Neurosyphilis is a syndrome that can develop as a late consequence of a syphilis infection. It manifests itself in psychiatric and neurological failures. Neurosyphilis is also known as neurosyphilis or quaternary syphilis (fourth-stage syphilis).


What is neurosyphilis?

Neurosyphilis can develop when an untreated or not fully healed syphilis disease is at an advanced stage. The disease then spreads to the central nervous system. See nonprofitdictionary for Hemolytic Uremic Syndrome (abbreviated as HUS).

Decades can pass between a syphilis infection and the onset of neurosyphilis. Accordingly, the age of onset is usually in middle to advanced age. Men are affected more frequently than women. If the syphilis disease is treated promptly and thoroughly, there is plenty of time to prevent the outbreak of neurosyphilis.


Neurosyphilis develops at a very advanced stage of infection with syphilis. This is a sexually transmitted disease caused by the bacterium Treponema pallidum.

It is also possible for the unborn child to be infected by an infected mother. Neurosyphilis develops in about 10-20% of all those suffering from syphilis. While neurosyphilis was one of the most common reasons for psychiatric hospitalization in the past century, thanks to good treatment options and better diagnostics, it has now become rare in industrialized countries.

Neurosyphilis continues to be a frequent complication in countries where adequate medical care and thus timely diagnosis and treatment of syphilis is not yet available.

Symptoms, Ailments & Signs

In the early stages of neurosyphilis, irritation of the meninges occurs in particular. These manifest themselves in particular as severe headaches and paralysis of the cranial nerves. Depending on the affected cranial nerve, these pareses can cause different symptoms. Paralysis of the olfactory nerve leads to olfactory disorders, while optic nerve paresis results in visual disturbances.

Early neurosyphilis can also make itself felt through the so-called polyradicular syndrome. Typical symptoms of this nerve root irritation are abnormal sensations such as tingling, pain or numbness in the area of ​​the affected nerve root. Inflammation of the meninges ( meningitis) with neck stiffness and exceptionally severe headaches is only rarely seen as part of early neurosyphilis.

Late neurosyphilis, which occurs in only a tenth of patients with syphilis, often leads to inflammation of blood vessels in the meninges, brain and spinal cord. The areas that are normally supplied by these arteries then show an undersupply of oxygen and nutrients.

This results in symptoms such as paralysis on one or one side, failure of cranial nerves, sensory disturbances and sensory disturbances as well as seizures. In the course of the disease, the clinical picture tabes dorsalis can also develop. Spinal cord consumption is mainly characterized by a disturbance in the perception of vibrations and disturbances in the sense of position and movement.

Diagnosis & History

If neurosyphilis is suspected, the underlying syphilis is first detected by a blood test. Neurosyphilis can be diagnosed by examining the cerebrospinal fluid. The spinal cord is punctured and a sample is taken. Certain antibodies and increased protein values ​​can be detected in the nerve water, which allow conclusions to be drawn about neurosyphilis.

When neurosyphilis breaks out, the meninges become inflamed, which manifests itself in visual disturbances – double vision is typical. After a longer period of time, this so-called meningovascular stage can be followed by the parenchymatous stage, in which the tissue of the brain perishes. This manifests itself in headaches, sleep disorders, paralysis of the extremities, personality changes, delusions, memory disorders, hallucinations and seizures. The patients lose their mental abilities, appear highly confused and disoriented. Some of the symptoms are similar to age-related dementia.

While the transition from the meningovascular stage to the parenchymal stage often takes many years, the deterioration of the brain tissue and thus the mental decline of the patient progresses rapidly. In the last step, the so-called tabes dorsalis occurs, in which the nerve sheaths, nerve roots and nerve nodes are destroyed. This leads to incontinence and insensitivity to pain and temperature stimuli, so that patients sometimes do not notice inflamed wounds or accidentally scald themselves. There are also gait disturbances and a loss of reflexes leading to complete paralysis.


Left untreated, neurosyphilis always leads to late effects that can be fatal due to the complications that arise. Since neurosyphilis is already a complication of syphilis, it requires special treatment at the latest.

Complications associated with the destroyed nerve and brain tissue result, for example, from sensory disorders. Those affected may not notice wounds and inflammation, which can lead to tissue death. Hypersensitivity can also occur. Many everyday things can no longer be carried out by those affected.

The altered personality structure in progressive neurosyphilis causes social alienation. It can happen that those affected often feel misunderstood and become aggressive towards relatives. This can lead to complete isolation, which is particularly stressful for those affected if they are in need of care at the same time.

Since the paralysis of the nerves continues to progress, those affected soon need nursing care with all the associated complications (risk of bedsores, loneliness, malnutrition or malnutrition). This can usually be explained by the progressive inflammation in the brain or meninges. This is referred to as chronically progressive meningitis or encephalitis.

The development of tabes dorsalis (spinal cord atrophy) leads to severe motor impairments and thus to an increased risk of accidents due to falls or incorrect use of objects.

When should you go to the doctor?

If the typical nodules are noticed in the intimate area, the gynecologist or urologist should be consulted. Tumors with a sunken center point to advanced neurosyphilis, which must be clarified and treated immediately. Medical advice is required at the latest when the skin changes are accompanied by other symptoms such as fever or joint pain. The disease occurs in phases and can go unnoticed for weeks or months. This makes it all the more important to seek medical advice after unprotected sex or contact with a potentially infected person.

If unusual physical symptoms are noticed in connection with the triggers mentioned, which cannot be attributed to any other cause, it is best to speak to the doctor. Mothers who notice typical signs of syphilis after the birth of the child should seek medical help. Likewise, people who notice the corresponding symptoms after a blood transfusion and people who have already been diagnosed with a sexually transmitted disease. People with hormonal problems or an immune deficiency talk to their family doctor if they suspect neurosyphilis. In addition to the general practitioner, the gynaecologist, the urologist or an internist can be consulted. Also the dermatologistmay be involved in treatment. Close consultation with the doctor is important during treatment so that the therapy can be adapted to the individual course of the disease.

Treatment & Therapy

It is possible to treat syphilis even after it has progressed to the neurosyphilis stage. Penicillin is primarily used for this purpose. This antibiotic kills the pathogens that cause syphilis. However, nerve tissue in the brain and spinal cord that has been destroyed by neurosyphilis can no longer regenerate. However, a causal treatment of the syphilis infection can prevent the further deterioration of the nerve cells.

Outlook & Forecast

Neurosyphilis occurs as a late consequence of syphilis. If left untreated, the disease will lead to the premature death of those affected. The affected person should consult a doctor as soon as possible for relief of symptoms and a good prognosis, so that necessary treatment steps can be initiated. In a drug therapy, the pathogens are prevented from spreading. At the same time, they are killed by the active ingredients contained in the preparations and then removed from the body. There is a gradual improvement in general health.

A complete recovery is also possible in the further course. The prerequisite for this is that no irreversible damage has occurred. If damage to the nerve tissue is found in the person affected, the prognosis worsens. In these cases, long-term consequences occur because the spinal cord and the brain can no longer regenerate. The aim of the treatment is then the regular care of the individually occurring complaints and an improvement in the quality of life.

In this course of the disease, recovery is no longer achieved despite the use of the best possible therapy methods. Nevertheless, the spread and thus the progression of the syphilis disease can be prevented. The life of the affected person is no longer endangered by the administration of the medicines. The current state of health can be emotionally distressing. Therefore, there is an increased risk of developing a mental disorder.


Neurosyphilis is a complication of syphilis infection. So the best way of prevention is to prevent syphilis infection. Since this is a sexually transmitted disease, responsible sexual behavior is required.

The use of condoms not only protects against infection with syphilis, but also against other serious diseases. However, it must be noted that syphilis – unlike HIV, for example – can also be transmitted through oral sex and other sexual contacts.

To prevent neurosyphilis, it is essential to treat an existing syphilis disease quickly and consistently. In this way, serious secondary diseases such as neurosyphilis can be avoided.


Even during follow-up, patients continue to be prescribed a drug, such as penicillin, to ensure recovery from syphilis. After the therapy, regular check-ups are important. Physical examinations, regular patient consultations and laboratory tests ensure that the disease has completely healed and that complications are identified quickly.

The liquor in particular is checked. The patient’s state of health can be precisely determined on the basis of the CSF findings and the serological examinations. If the values ​​are unremarkable after 24 months, this speaks for a cure. If neurosyphilis recurs, the necessary treatment measures can be initiated immediately. The STP working group recommends check-ups every three, six and twelve months after therapy.

A prerequisite for extending the intervals is a four-fold decrease in titer. Otherwise, treatment may need to be restarted. With successful therapy, the symptoms heal without further complications. The patient is symptom-free within nine to twelve months.

Follow-up care can be ended after two years if no abnormalities were found during the CSF examination. The aftercare measures are always based on the individual course of the disease, the constitution of the patient and a whole range of other factors.

You can do that yourself

Neurosyphilis as a serious complication of untreated or resistant syphilis does not allow for any self-help options that come close to therapy. It is not possible to treat the bacterial pathogen of syphilis with home remedies, alternative therapies or other remedies that are offered. The only possible cure is the use of strong antibiotics.

In the meantime, based on the current state of medical research, it is urgently advisable not to use unauthorized drugs and substances that are not prescribed by licensed doctors.

However, there are ways in which the sufferer can better cope with the symptoms. Massages, hot baths or cooling can help against pain that occurs as a result of nerve damage or paralysis. This differs from person to person. However, it is only a temporary relief of these symptoms. Other self-help measures, meanwhile, are based on the symptoms caused. In the case of the psychological symptoms associated with neurosyphilis in particular, there are hardly any measures for self-help.

Damage to the nervous system caused by neurosyphilis can be partially compensated for by those affected through targeted training. Those affected by neurosyphilis who are undergoing drug therapy may therefore be able to make use of various exercise therapies and cognitive training. Type and scope are to be determined with the attending physician.