Quaternary Syphilis: An Overview

Introduction

Syphilis is a sexually transmitted disease caused due to Treponema pallidum and has human beings as the host. Syphilitic nervous system infection is the chronic and meningeal inflammatory process. Invasion of the central nervous system occurs early in untreated syphilis and causes an exponential increase in the incidence of syphilis in urban areas. Neurosyphilis is defined as a condition with cerebrospinal fluid, white blood cells count of 20 cells/µL or greater, or a reactive Venereal Disease Research Laboratory (VDRL) test.

What Is Neurosyphilis or Quaternary Syphilis?

Syphilis is a sexually transmitted infection (STI) that spreads due to direct contact with syphilitic sores. This disease has been prevalent since the early 16th century, is treatable, and is simple to prevent. However, there was an increase in syphilis emergence in the 2000s among women between 20 and 24 and men between 35 and 39. If syphilis is not treated, the affected person can develop neurosyphilis. Neurosyphilis is an infection of the nervous system, the brain, and the spinal cord. Neurosyphilis is a life-threatening disease.

What Are the Causes and Risk Factors of Neurosyphilis?

Treponema pallidum is the bacterium causing syphilis, followed by neurosyphilis. Neurosyphilis develops 10 to 20 years after the initial infection with the bacterium. HIV and untreated syphilis are major risk factors for the development of neurosyphilis.

What Are the Types of Neurosyphilis?

Neurosyphilis occurs with the invasion of the cerebrospinal fluid (CSF) after acquiring the T. pallidum infection. The organism is identified in the CSF from around one-third of untreated patients having symptoms of early syphilis. Specific strains of T. pallidum have a higher chance of causing neurosyphilis. Other bacteria can also infect the cerebrospinal fluid; however, invasion of CSF with T. pallidum not always can cause persistent infection, as the spontaneous resolution occurs in a few cases without any inflammatory response. In some cases, spontaneous resolution happens after transient meningitis.

There are five different forms of neurosyphilis.

Asymptomatic Neurosyphilis is a prevalent type of neurosyphilis. It occurs before the symptoms of syphilis are visible. In this neurosyphilis, there is no feeling of sickness or any signs of neurologic disease.

Meningeal Neurosyphilis appears a few weeks to a few years after the contraction of syphilis. Symptoms include the following.

• Nausea.

• Vomiting.

• A stiff neck.

• A headache.

• Loss of hearing.

• Loss of vision.

Meningovascular Neurosyphilis is a severe form of meningeal neurosyphilis. This occurs along with the history of at least one stroke. Around 10 to 12 percent of people with neurosyphilis develop meningovascular neurosyphilis. There is a risk of stroke in the first few months after the syphilis infection or a few years after the infection.

General Paresis can appear decades after the infection with syphilis, leading to long-term problems. However, it is rare because of advances in the screening, treatment, and prevention of sexually transmitted diseases. Nevertheless, general paresis can cause several health problems, as follows::

• Paranoia.

• Mood swings.

• Emotional troubles.

• Personality changes.

• Weakened muscles.

• A loss of the ability to use language.

• Dementia.

Tabes Dorsalis is a form of neurosyphilis that is rare in occurrence. It can affect the spinal cord 20 years after the initial syphilis infection. The symptoms include

• Balancing disturbance.

• A loss of coordination.

• Incontinence.

• Altered walking.

• Vision problems.

• Pains in the abdomen, arms, and legs.

Other symptoms of syphilis include the following.:

• Swollen lymph glands,

• A headache.

• Hair loss.

• Weight loss.

• Fatigue.

• Muscle ache.

How to Diagnose Neurosyphilis?

There are several test options to diagnose neurosyphilis.

• A physical exam to evaluate neurosyphilis is done by checking normal muscle reflexes and looking for atrophied muscles.

• A blood test can detect middle-stage neurosyphilis. A variety of blood tests will see the current presence of syphilis or an infection in the past.

• A spinal tap or a lumbar puncture provides a sample of the fluid around the brain and spinal cord. This sample is used to determine the infection's extent and treatment plan.

• Imaging tests like computed tomography CT scan is a series of X-rays that allows the body to be visualized in cross sections and angles.

• A magnetic resonance imaging MRI scan is a test in which a tube with a strong magnet sends radio waves through the body to view detailed images of the internal organs.

What Is the Treatment for Quaternary or Neurosyphilis?

• The antibiotic penicillin is used to treat syphilis and neurosyphilis. It is either injected or consumed orally. The usual regimen is for 10 to 14 days.

• The antibiotics Probenecid and Ceftriaxone are used with penicillin.

• Blood tests are conducted at three and six-month intervals during recovery, followed by blood tests every year for three years post-treatment.

• Monitoring cerebrospinal fluid levels with spinal taps is done every six months.

• Neurosyphilis is common in people with HIV. Syphilitic sores quickly become infected with HIV. In addition, Treponema pallidum interacts with HIV and makes it difficult to treat the syphilis infection. Neurosyphilis and HIV combined need more Penicillin injections and have less chance of complete recovery.

How to Prevent Quaternary Syphilis?

• The first step in neurosyphilis treatment is preventing syphilis itself.

• As syphilis is an STI, the best option is to have safe sex.

• Condoms reduce the chance of contracting syphilis. Syphilis is also contracted by touching genitals externally covered by a condom.

• People do not know about syphilis infection as symptoms remain hidden for years.

• An initial sore or sores at the site of infection appears weeks or months after the contraction of the disease. Although these sores heal on their own, the condition persists.

• A rough but not itchy rash with reddish-brown spots appears at the injection site or another part of the body.

• Sexually active individuals should get tested for sexually transmitted diseases regularly.

• Syphilis is contagious and can be passed to others, including the unborn baby.

Conclusion

Long-term outlook depends on the type of neurosyphilis, early detection, and diagnosis. Penicillin treats the infection and prevents any further damage. However, medicines cannot repair the damage that has occurred. In mild cases, antibiotics may help. The other three types improve after treatment but may not help return to perfect health.