Syphilitic myelopathy

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Superficial anterior muscles

Tabes dorsalis

The goals of treatment are to cure the infection and to reduce progression of the disorder. Treatment of the infection reduces new nerve damage and may reduce symptoms but does not cure existing nerve damage.

For neurosyphilis, aqueous penicillin G (by injection) is the drug of choice. Some patients with penicillin allergies may undergo desensitization to penicillin so that they can be safely treated with it.

Treatment of symptoms is required for existing neurologic damage. Assistance or supervision may be needed if the person is unable to perform self-care activities (eating, dressing, etc.). Rehabilitation, physical therapy, occupational therapy, or other interventions may be appropriate for people with muscle weakness.

Analgesics may be required to control pain. These may include over-the-counter medications such as aspirin (oral salicylates) or acetaminophen for mild pain but narcotics may be required. Anti-epilepsy drugs such as carbamazepine may have a role in the treatment of lightning pains.

Progressive disability is possible if the disorder is left untreated.

• Difficulty with walking and balance
• Complications of neurosyphilis, including dementia, strokes, eye disease
• Complications of late-stage syphilis infection, which may include:
  • Inflammation of the aorta (aortitis) with aortic aneurysm
  • Disease of the heart valves
  • Destructive changes in bones, skin, and other organs

Call your health care provider if loss of coordination, loss of muscle strength, or loss of sensation occurs.

Review Date: 08/08/2006
Reviewed By: D. Scott Smith, M.D., MSc, DTM&H, Chief of Infectious Disease & Geographic Medicine, Kaiser Redwood City, CA & Adjunct Assistant Professor, Stanford University. Review provided by VeriMed Healthcare Network.