Unique forms of syphilis that do not fit neatly into one of the categories already described include neurosyphilis, congenital syphilis, and late syphilis. Involvement of the CNS by T. pallidum is termed neurosyphilis. Neurosyphilis can occur during any of the numerous forms and stages of syphilis. It is caused by direct infection of the CNS by the spirochete. Most patients with syphilis exhibit no signs of CNS involvement, even when the bacteria can be isolated from the CNS. However, almost all of these cases of asymptomatic neurosyphilis eventually progress to symptomatic clinical illness. Some of the common symptoms of neurosyphilis are headache, hearing difficulty, neck stiffness, and muscle weakness. As the disease progresses untreated, patients develop seizures, delirium, and tabes dorsalis. Tabes dorsalis results from degeneration of the posterior columns of the spinal cord. The posterior columns are critical for proper sensation, and patients with tabes dorsalis develop gait disorders, diminished reflexes, proprioception abnormalities, pain, paresthesias, and a host of other neurological symptoms. If neurosyphilis remains untreated, the patient dies of the disease. Therefore, any patient who exhibits signs or symptoms of neurosyphilis should undergo a spinal tap to evaluate the cerebrospinal fluid for involvement with T. pallidum.
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