Syphilis is a sexually transmitted infection that was nearly eradicated in 2001 but is now making a resurgence. It has a wide range of clinical manifestations depending on disease stage. Neurosyphilis is an infrequently seen infectious disease with central nervous system involvement that can occur in either early- or late-stage syphilis. The diagnosis of neurosyphilis is challenging, primarily because Treponema pallidum, the infecting organism, cannot be cultured in vitro. This article describes a patient with neurosyphilis and reviews the epidemiology and clinical manifestations, diagnostics, and treatment of neurosyphilis.
In compliance with the request of the Privacy Board of our institution, the numerical age of this patient has been omitted. A sexually active teenage girl who was treated for primary syphilis 2 years earlier presented to a tertiary children's hospital with paresthesia and weakness of her right leg, left arm, and neck. Magnetic resonance imaging revealed cervical intramedullary cord edema consistent with transverse myelitis. Serum studies showed positive syphilis enzyme immunoassay, T. pallidum particle agglutination assay, and fluorescent treponemal antibody absorption. A serum rapid plasma reagin test was negative. A lumbar puncture was performed with normal cell count and protein. A cerebrospinal fluid Venereal Disease Research Laboratory test was negative. She was diagnosed with neurosyphilis and treated with intravenous steroids and penicillin G, with near complete resolution of symptoms.
Why should an Emergency Physician Be Aware of This?
The Centers for Disease Control and prevention has noted a steady rise of the incidence of syphilis since 2002. Emergency physicians should be familiar with the spectrum of the clinical manifestations of syphilis, challenges in diagnostics, and appropriate treatment course.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Syphilis - 2015 STD Surveillance.(Available at:)https://www.cdc.gov/std/stats15/STD-Surveillance-2015-print.pdfDate accessed: October 6, 2017
- Call to action: let's work together to stem the tide of rising syphilis in the United States.(Available at:)https://www.cdc.gov/std/syphilis/SyphilisCalltoActionApril2017.pdfDate accessed: April 25, 2017
- Clinical reasoning: the “great imitator.”.Neurology. 2014; 83: e188-e196
- The Oslo study of the natural course of untreated syphilis: an epidemiologic investigation based on a re-study of the Boeck-Bruusgaard material.Med Clin North Am. 1964; 48: 613
- Update on syphilis: resurgence of an old problem.JAMA. 2003; 290: 1510-1514
- Neurosyphilis.Curr Neurol Neurosci Rep. 2004; 4: 435-440
- Neurosyphilis: a current review.Curr Infect Dis Rep. 2005; 7: 277-284
- Syphilis.Pediatr Rev. 1999; 20: 160-165
- Pediatric acute transverse myelitis overview and differential diagnosis.J Child Neurol. 2012; 27: 1426-1436
- Demyelinating disorders: update on transverse myelitis.Curr Neurol Neurosci Rep. 2006; 6: 236-243
- The laboratory diagnosis or syphilis.Can J Infect Dis Med Microbiol. 2005; 16: 45-51
- The performance of cerebrospinal fluid treponemal-specific antibody tests in neurosyphilis: a systematic review.Sex Transm Dis. 2012; 39: 291-297
Published online: March 27, 2018
Accepted: January 25, 2018
Received in revised form: October 24, 2017
Received: July 26, 2017
© 2018 Elsevier Inc. All rights reserved.