Alternative Names neurosyphilis, general paresis of the insane, paretic neurosyphilis
Definition General paresis is a chronic infection of the brain with the organism that causes syphilis, Treponema pallidum. The disease is characterised by progressive mental and physical impairment. Today, this disease is almost non-existent in Australia because treatment is widely available. Syphilis of the brain or spinal cord affects only about 5% of people with untreated syphilis.
What is going on in the body? This disease is caused by an untreated syphilis infection. It develops over 20 years or more. This condition includes a gradual mental and neurological decline.
What are the signs and symptoms of the disease? Symptoms include:
dementia, or difficulty with memory and overall thinking, along with lack of co-ordination, called ataxia
mood and personality changes, such as someone thinking they are superhuman
What are the causes and risks of the disease? This condition stems from a long untreated syphilis infection.
What can be done to prevent the disease? If syphilis is recognised early in its course, it can be cured with antibiotics. General paresis develops only in those who go for years without treatment. Preventive strategies also include:
getting prompt treatment for any signs of infection, especially genital infections
practicing safe sex
limiting sexual partners and avoiding infected partners
How is the disease diagnosed? Doctors/specialists will look for the clinical signs of the disease. These include nervous system problems accompanied by dementia. Samples of blood and cerebrospinal fluid, which is the fluid that surrounds the brain and spinal cord, will be tested for chronic syphilis infection.
What are the long-term effects of the disease? Some of the changes that occur during neurosyphilis are not reversible. The brain itself often becomes damaged. Treatment is important to stop the brain damage at the earliest possible time. Dementia from any cause increases the risk of early death. It also makes a person less able to care for himself or herself.
What are the risks to others? General paresis occurs after many years of a syphilis infection, when the person is no longer contagious.
What are the treatments for the disease? The disease is treated with high doses of penicillin for 2 or more weeks. This treatment is effective in improving the mental and physical symptoms in about 40% of the people treated early in general paresis.
What are the side effects of the treatments? Penicillin and other antibiotics may cause allergic reactions, rash, or stomach upset.
What happens after treatment for the disease? Treatment halts the progression of the disease 40% to 50 % of the time. Neurological problems improve in 30% to 40% of cases. The cerebrospinal fluid has to be rechecked to be sure that the Treponema organism is completely eliminated. Sometimes, the penicillin treatment has to be repeated.
Author: Gerald C. McIntosh, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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