Neurosyphilis: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats neurosyphilis?
An infectious disease doctor and a neurologist (brain and nerve doctor) usually manage neurosyphilis together, a condition where a syphilis infection has spread to the brain or spinal cord. Treatment uses antibiotics, medicine that fights the infection. See a doctor urgently if you have had syphilis and develop signs of nervous system problems, such as vision changes or trouble thinking.
What is neurosyphilis?
Neurosyphilis is a rare bacterial infection of the brain or spinal cord. It can develop when syphilis goes untreated for many years. Not everyone with syphilis gets it. Syphilis is an infection spread by sex. Bacteria cause it. In neurosyphilis, the germ attacks the brain and nerves.
Symptoms
Symptoms depend on the type of neurosyphilis. The most common type causes no symptoms.
- Meningeal neurosyphilis can cause headache, stiff neck, nausea, and vomiting. Some people are sensitive to light or have vision or hearing loss.
- Meningovascular neurosyphilis has the same symptoms. It also causes vertigo (a spinning feeling) and weak legs. It can lead to stroke.
- General paresis can cause mood changes and memory problems. It can also cause trouble with thinking, judgment, and language. Some people have delusions (false beliefs) or seizures.
- Tabes dorsalis can cause pain in the arms, legs, or belly. It can cause poor coordination and burning or tingling feelings. Other signs are bladder and sex problems, vision loss, and trouble walking.
Causes and who gets it
Treponema pallidum bacteria cause neurosyphilis. They also cause syphilis. It can affect anyone who has syphilis, especially people who do not get treatment for months or years. You usually get syphilis from sex with someone who has it. It can also pass from mother to baby during pregnancy. People with HIV are also at higher risk of having neurosyphilis.
How doctors diagnose it
A provider will do a physical exam. They will ask about your health history. They will also check your nerves with a neurological exam. Blood tests can detect signs of syphilis. With neurosyphilis, it is important to test the spinal fluid for signs of syphilis. This is done with a lumbar puncture, also called a spinal tap. Scans, such as a head CT, spine CT, or MRI, look for nervous system problems. They also help rule out other diseases.
Treatment
The standard treatment for neurosyphilis is penicillin, an antibiotic, given through a vein (IV) for 10 to 14 days. If a person can be counted on to follow the plan, daily penicillin shots plus a pill can be used instead. Ceftriaxone, another antibiotic, is an alternative. Everyone with neurosyphilis should also be tested for HIV. Antibiotics may stop it from getting worse. But nerve damage may not be reversible. After treatment, you need spinal taps every six months and periodic blood tests to make sure the infection is gone.
People with the silent type or meningeal type usually return to normal health. People with the other types usually do not return to normal health. They may still get much better. Without treatment, it can cause lasting paralysis, dementia, and death.
When to see a doctor
Neurosyphilis is a life-threatening complication of syphilis. If you had syphilis and now have nerve problems, get medical care right away. Call 911 or go to the emergency room if you faint, lose consciousness, cannot speak, or have sudden weakness.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A direct primary care doctor can order tests for syphilis and explain the results. They can also help set up visits with an infectious disease doctor and a neurologist.
Common questions
What are the symptoms of neurosyphilis?
Neurosyphilis can cause headaches, confusion, trouble with balance, vision changes and memory problems, though some people have no symptoms at all. Symptoms depend on the type of neurosyphilis. Tests, including a spinal fluid test, help diagnose it.
Can a direct primary care doctor manage neurosyphilis?
A direct primary care doctor can order testing if syphilis is suspected and refer you to an infectious disease doctor and neurologist for treatment. Neurosyphilis is treated with antibiotics and needs follow-up spinal fluid and blood tests, so a direct primary care doctor can help coordinate that care with specialists.
Is neurosyphilis curable?
Neurosyphilis can be treated with antibiotics, and treatment may stop the infection from getting worse. Some nerve damage that has already happened may not fully go away, which is why early diagnosis and treatment matter. Regular follow-up testing checks that treatment worked.
Sources
- National Institute of Neurological Disorders and Stroke - Neurosyphilis
- Centers for Disease Control and Prevention - Neurosyphilis, Ocular Syphilis, and Otosyphilis: STI Treatment Guidelines
- MedlinePlus - Syphilis
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
