Neurosyphilis (General Paresis of the Insane)

Infections of the central nervous system caused by TREPONEMA PALLIDUM which present with a variety of clinical syndromes. The initial phase of infection usually causes a mild or asymptomatic meningeal reaction. The meningovascular form may present acutely as BRAIN INFARCTION. The infection may also remain subclinical for several years. Late syndromes include general paresis; TABES DORSALIS; meningeal syphilis; syphilitic OPTIC ATROPHY; and spinal syphilis. General paresis is characterized by progressive DEMENTIA; DYSARTHRIA; TREMOR; MYOCLONUS; SEIZURES; and Argyll-Robertson pupils. (Adams et al., Principles of Neurology, 6th ed, pp722-8)

Also Known As:

Networked: 602 relevant articles (28 outcomes, 37 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Syphilis
2.	Infection
3.	Neurosyphilis (General Paresis of the Insane)
4.	Urethritis
5.	Lymphogranuloma Venereum

Experts

1.	Marra, Christina M: 7 articles (12/2015 - 04/2004)
2.	Zhou, Pingyu: 5 articles (06/2015 - 08/2012)
3.	Guan, Zhifang: 5 articles (06/2015 - 08/2012)
4.	Ghanem, Khalil G: 4 articles (12/2015 - 06/2008)
5.	Lu, Haikong: 4 articles (06/2015 - 08/2012)
6.	Wang, Cuini: 4 articles (06/2015 - 11/2013)
7.	Sahi, Sharon K: 4 articles (07/2014 - 10/2008)
8.	Tantalo, Lauren C: 4 articles (07/2014 - 10/2008)
9.	Tong, Man-Li: 4 articles (04/2013 - 06/2012)
10.	Yang, Tian-Ci: 4 articles (04/2013 - 06/2012)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Neurosyphilis:

1.	Penicillins (Penicillin)FDA Link 03/15/2012 - "Since the introduction of penicillin in 1943, however, the prevalence of neurosyphilis has declined dramatically and the prognosis of the few still affected has been greatly improved. " 03/01/2004 - "A case of neurosyphilis showing a marked improvement of clinical symptoms and cerebral blood flow on single photon emission computed tomography with quantitative penicillin treatment." 03/01/2004 - "A 31-year-old woman manifested significant emotional symptoms and personality change due to neurosyphilis; her clinical symptoms were improved with quantitative penicillin treatment. " 12/01/1994 - "The regimen of high-dose penicillin recommended for neurosyphilis is not consistently effective in patients infected with HIV." 03/01/2013 - "Penicillin is an effective treatment for neurosyphilis to stop progression of neurologic damage, but it does not cure the previously developed tabetic arthropathy. "
2.	AntibodiesIBA 04/01/1961 - "[Immunological studies on antibodies in neurosyphilis]." 05/01/2015 - "Immunohistochemistry using polyclonal antibodies against Treponema pallidum revealed the presence of spirochetes, associated with the paretic form of parenchymal neurosyphilis. " 04/01/2004 - "She was diagnosed as meningovascular neurosyphilis because syphilitic antibodies reactions in both serum and cerebrospinal fluid were highly positive. " 01/01/2001 - "The diagnosis of neurosyphilis was made in 10 out of 14 cases with progressive neurological disease and reactive serum rapid plasma reagin, luorescent treponemal absorbent-absorbent antibodies and treponemal pallidum hemagglutination. " 01/01/2001 - "The diagnosis of neurosyphilis was made if the patient had reactive serum fluorescent treponemal absorbent antibodies or treponemal pallidum hemagglutination, history of progressive neurological disease and increased cerebrospinal fluid cells or protein. "
3.	Penicillin G (Benzylpenicillin)FDA LinkGeneric 01/01/2013 - "All three patients responded well to a neurosyphilis regimen of intravenous penicillin G. " 09/01/2014 - "The patient refused prolonged inpatient treatment with penicillin G i.v., as recommended as first-line therapy in the national guidelines for asymptomatic neurosyphilis. " 02/01/2014 - "Standard treatment of neurosyphilis was given to each patient, including 4 million units of penicillin G administered intravenously every 4 hours for 14 days. " 01/01/2014 - "The patient received standard treatment for neurosyphilis with intravenous penicillin G. " 04/01/2013 - "Intravenously infusion of penicillin G is the only treatment recommended for neurosyphilis."
4.	Azithromycin (Zithromax)FDA LinkGeneric 05/01/2012 - "These changes include new diagnostic tests for bacterial vaginosis, Neisseria gonorrhoeae, and human papillomavirus; new treatment recommendations for bacterial vaginosis, gonorrhea, and genital warts; the increasing prevalence of antimicrobial-resistant N gonorrhoeae; new criteria for spinal fluid examination to evaluate for neurosyphilis; and the emergence of azithromycin-resistant Treponema pallidum." 08/04/2006 - "Included in these updated guidelines are an expanded diagnostic evaluation for cervicitis and trichomoniasis; new antimicrobial recommendations for trichomoniasis; additional data on the clinical efficacy of azithromycin for chlamydial infections in pregnancy; discussion of the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; emergence of lymphogranuloma venereum protocolitis among men who have sex with men (MSM); expanded discussion of the criteria for spinal fluid examination to evaluate for neurosyphilis; the emergence of azithromycin- resistant Treponema pallidum; increasing prevalence of quinolone-resistant Neisseria gonorrhoeae in MSM; revised discussion concerning the sexual transmission of hepatitis C; postexposure prophylaxis after sexual assault; and an expanded discussion of STD prevention approaches." 12/17/2010 - "Included in these updated guidelines is new information regarding 1) the expanded diagnostic evaluation for cervicitis and trichomoniasis; 2) new treatment recommendations for bacterial vaginosis and genital warts; 3) the clinical efficacy of azithromycin for chlamydial infections in pregnancy; 4) the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; 5) lymphogranuloma venereum proctocolitis among men who have sex with men; 6) the criteria for spinal fluid examination to evaluate for neurosyphilis; 7) the emergence of azithromycin-resistant Treponema pallidum; 8) the increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae; 9) the sexual transmission of hepatitis C; 10) diagnostic evaluation after sexual assault; and 11) STD prevention approaches." 05/01/2006 - "Newer drugs that penetrate CSF, such as ceftriaxone or azithromycin, have not yet been adequately tested for neurosyphilis. " 01/01/2002 - "Penicillin was first introduced for the treatment of syphilis in 1943, and despite interest in the use of amoxicillin, erythromycin, tetracycline, doxycycline, ceftriaxone and azithromycin, penicillin remains the only recommended antibacterial agent for neurosyphilis."
5.	Immunoglobulin M (IgM)IBA 01/01/1992 - "These data show that the VDRL is not sensitive enough to diagnose congenital neurosyphilis, and that FTA-ABS or, at least, TPHA are convenient, sometimes with false-positive results, when a sophisticated method of detecting specific IgM in CSF is not available." 10/01/1993 - "burgdorferi-specific IgM could be detected by any assay in patients with neurosyphilis.(ABSTRACT TRUNCATED AT 250 WORDS)" 12/01/1988 - "Local IgM production in meningoradiculitis Bannwarth and neurosyphilis." 11/01/1986 - "The IgM ELISA in CSF should prove to be useful for confirmation of symptomatic neurosyphilis." 12/01/1983 - "In 10 out of 16 CSF samples taken from patients with untreated neurosyphilis, a treponemal IgM antibody could be proved by TP-IgM-ELISA. "
6.	Penicillin G Benzathine (LPG)FDA Link 03/01/1982 - "Although few well-controlled studies exist to document conclusively the efficacy of benzathine penicillin in the treatment of neurosyphilis, its use is recommended in selected situations." 03/01/1982 - "Controlled trials of benzathine penicillin in the treatment of neurosyphilis are reviewed, as are recent case reports of benzathine penicillin failures. " 01/01/2002 - "There has been concern that benzathine penicillin may not prevent the development of neurosyphilis but that is a rare outcome with this therapy. " 01/01/2002 - "Neurosyphilis has been reported in HIV-infected patients previously treated with penicillin G benzathine, which does not achieve treponemicidal levels in cerebrospinal fluid. " 03/01/1982 - "Benzathine penicillin G in the treatment of neurosyphilis."
7.	Ceftriaxone (Ceftriaxon)FDA LinkGeneric 05/01/2011 - "A late form of neurosyphilis manifesting with psychotic symptoms in old age and good response to ceftriaxone therapy." 12/01/2005 - "Although ceftriaxone benefits from its once-daily administration (and can be easily delivered on outpatient basis), it is not the firstline treatment of neurosyphilis. " 10/01/2003 - "We report a case of successful treatment of symptomatic neurosyphilis with parenteral ceftriaxone." 10/01/2003 - "Treatment of neurosyphilis with ceftriaxone." 07/01/1986 - "Ceftriaxone therapy for asymptomatic neurosyphilis. "
8.	Immunoglobulins (Immunoglobulin)IBA 12/01/1990 - "Our data indicate that determinations of immunoglobulin indices performed on consecutive specimens from individual patients with neurosyphilis may be helpful in the evaluation of treatment." 11/01/1965 - "[Contribution to the study of immunoglobulins of the cerebrospinal fluid in the course of human neurosyphilis by the technics of immunoelectrophoretic and immunofluorescence analysis]." 12/01/2013 - "Criteria for the diagnosis of neurosyphilis in cerebrospinal fluid: relationships with intrathecal immunoglobulin synthesis and blood-cerebrospinal fluid barrier dysfunction." 01/01/1995 - "The diagnosis of neurosyphilis was established when specific CNS-derived immunoglobulin was detected. " 04/01/1982 - "Specificity of immunoglobulins synthesized within the central nervous system in neurosyphilis."
9.	Penicillin G Procaine (Procaine, Benzylpenicillin)FDA Link 02/01/1985 - "Treatment with crystalline penicillin is mandatory in patients with concomitant neurosyphilis, whereas procaine penicillin is seemingly sufficient in those with a normal cerebral spinal fluid examination." 12/01/1984 - "This dose of procaine penicillin alone or with probenecid is therefore not recommended for treating neurosyphilis." 04/21/1975 - "A 60-year-old man with symptomatic neurosyphilis was treated with penicillin G procaine in the dosages recommended by the Public Health Service, and a less than spirocheticidal level of penicillin G was found in the cerebrospinal fluid." 11/01/1992 - "Studies comparing ceftriaxone with 10 to 14 doses of procaine penicillin are needed to determine the most cost-effective treatment for asymptomatic neurosyphilis or presumed latent syphilis in this group of patients." 03/01/1993 - "For the treatment of neurosyphilis, treponemicidal levels of penicillin can be achieved in the CSF using 2.4 million units procaine penicillin daily with concurrent probenecid 500 mg 4 times a day, or an intravenous infusion of benzyl penicillin 12-24 million units daily. "
10.	Doxycycline (Vibramycin)FDA LinkGeneric 04/01/2010 - "Prospective trials are needed to assess the long-term efficacy oral doxycycline for neurosyphilis." 04/01/2010 - "We describe two HIV-infected patients with asymptomatic neurosyphilis who were successfully treated with oral doxycycline. " 04/01/2010 - "Oral doxycycline for treatment of neurosyphilis in two patients infected with human immunodeficiency virus." 10/01/2003 - "Other than doxycycline, which penetrates the CNS, there are few alternatives for the treatment of neurosyphilis. " 08/01/1985 - "Five patients with laboratory evidence of latent or neurosyphilis were treated orally with doxycycline (200 mg) twice a day for 21 days. "

Therapies and Procedures

1.	Aftercare (After-Treatment) 02/01/2014 - "Vision improved and these abnormalities reversed after treatment of neurosyphilis in most of the patients. " 08/01/2013 - "Clinical improvement occurred after treatment of neurosyphilis. " 05/01/2010 - "CSF concentrations of CXCL13 declined after treatment for neurosyphilis. " 10/01/2008 - "Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis." 01/01/2008 - "A case of neurosyphilis involving the cerebellum on magnetic resonance imaging (MRI) with resolution of the abnormality after treatment."
2.	Induced Hyperthermia (Thermotherapy) 07/01/2013 - "Julius Wagner-Jauregg (1857-1940): Introducing fever therapy in the treatment of neurosyphilis." 08/01/1999 - "Fever therapy for general paresis." 05/01/1995 - "Patients with neurosyphilis voluntarily sought admission specifically for fever therapy, seeing the asylum as a place of cure rather than as an institution of confinement. " 01/01/1956 - "Late results of fever therapy in neurosyphilis." 05/01/1995 - "The purpose of this study was to examine the effect of therapeutic innovation on the interpersonal style of physicians by using the historical example of the treatment of general paralysis of the insane by malaria fever therapy. "
3.	Drug Therapy (Chemotherapy) 01/01/2014 - "The Jarisch-Herxheimer reaction, a febrile inflammatory reaction that often occurs after the first dose of chemotherapy in spirochetal diseases, may result in deleterious effects to patients with neurosyphilis and to pregnant women. " 06/01/1943 - "THE TREATMENT OF NEUROSYPHILIS BY INDUCTOPYREXIA AND CHEMOTHERAPY." 02/01/1941 - "Combined Artificial Fever, Chemotherapy and Vaccinotherapy in Neurosyphilis." 03/01/1948 - "Penicillin treatment of neurosyphilis; a study of 45 cases that had previously received chemotherapy." 04/29/1955 - "[Treatment of neurosyphilis; classical chemotherapy or antibiotics?]."
4.	Highly Active Antiretroviral Therapy (HAART) 12/01/2010 - "HAART seemed to be associated with the low prevalence of neurosyphilis." 12/01/2010 - "The patients treated with HAART had a lower prevalence of neurosyphilis compared with the non-treated group (P = 0.018). " 06/19/2008 - "Use of any highly active antiretroviral therapy before syphilis infection reduced the odds of neurosyphilis by 65% (0.35; 0.14-0.91). " 04/20/2010 - "In the post-HAART era, it seems that clinical presentation and serological response after treatment is similar in HIV infected patients in comparison to HIV uninfected patients and that patients with early syphilis shoud be treated with one dose of benzathine penicillin G while the unique treatment for neurosyphilis is intravenous penicilline G."
5.	Transplants (Transplant) 01/01/2013 - "Neurosyphilis in a renal transplant patient." 03/01/2006 - "We describe a case of cutaneous secondary syphilis, neurosyphilis and luetic hepatitis in a cardiac transplant patient."