Syphilitic myelopathy

Syphilitic Myelopathy is a neurological disorder resulting from the infection of the spinal cord by the bacterium Treponema pallidum, which is the causative agent of syphilis. This condition is a manifestation of neurosyphilis, specifically affecting the spinal cord, and is considered a rare complication in the modern era due to early detection and treatment of syphilis. Syphilitic myelopathy typically occurs in the tertiary stage of syphilis, years after the initial infection if left untreated.

Symptoms

The symptoms of syphilitic myelopathy can vary widely among individuals but generally include a combination of sensory and motor deficits. Common symptoms include:

• Weakness or paralysis in the legs
• Loss of coordination and balance (ataxia)
• Numbness or tingling sensations (paresthesia)
• Bladder and bowel dysfunction
• Changes in gait, often leading to difficulty walking

Diagnosis

Diagnosis of syphilitic myelopathy involves a combination of clinical evaluation, serological tests for syphilis, and imaging studies. Serological tests include the Venereal Disease Research Laboratory (VDRL) test and the Fluorescent Treponemal Antibody Absorption (FTA-ABS) test, which can confirm the presence of syphilis infection. Magnetic Resonance Imaging (MRI) of the spinal cord may be used to visualize the extent of spinal cord involvement and to rule out other causes of myelopathy.

Treatment

Treatment for syphilitic myelopathy involves the administration of antibiotics to eradicate the Treponema pallidum bacterium. The preferred antibiotic is usually intravenous penicillin, administered over an extended period to ensure the complete elimination of the bacterium. In cases of penicillin allergy, alternative antibiotics may be used. Early treatment is crucial to prevent permanent damage to the spinal cord and to improve the prognosis.

Prognosis

The prognosis for individuals with syphilitic myelopathy varies. Early detection and treatment can lead to significant improvement in symptoms and a better overall outcome. However, if treatment is delayed, permanent neurological damage may occur, leading to chronic disability.

Prevention

Prevention of syphilitic myelopathy involves the prevention of syphilis infection through safe sexual practices, regular screening for sexually transmitted infections (STIs) in sexually active individuals, and prompt treatment of syphilis infections to prevent progression to neurosyphilis.