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General paresis

General paresis is a problem with mental function due to damage to the brain from untreated syphilis.

Causes

General paresis is one form of neurosyphilis, an infection of the brain or spinal cord. It usually occurs in persons who have had untreated syphilis for many years. Syphilis is bacterial infection that is most often spread through sexual or nonsexual contact. Today, neurosyphilis is very rare.

Syphilis infection can appear in many different ways, and damages many different nerves of the brain. This damage can cause:

  • Abnormal mental function including hallucinations and false ideas (delusions)
  • Brief, sharp, "lightning" pains that occur with tabes dorsalis
  • Decreased mental function
  • Eye changes and abnormal pupil response
  • Mood changes
  • Overactive reflexes
  • Personality changes
  • Speech changes

General paresis usually begins about 15 to 20 years after the syphilis infection. Risks include syphilis infection and infection with other sexually transmitted diseases, such as gonorrhea (which may hide symptoms of syphilis infection).

Symptoms

Symptoms of neurosyphilis may include any of the following:

  • Decreased language ability (aphasia)
  • Decreased motivation
  • Impaired judgment
  • Loss of ability to calculate
  • Loss of long-term memory (long-past events)
  • Loss of short-term memory (recent events)
  • Muscle weakness (difficulty using legs, arms, or other parts of the body)
  • Personality changes, such as delusions, hallucinations, irritability, inappropriate behavior
  • Seizures

Exams and Tests

The doctor will perform a physical exam and ask about your medical history. During the exam, the doctor may check your nervous system function. For example, your muscles may be tested for weakness. Or you may be asked to stand while your eyes are closed.

Blood and urine tests may be ordered to detect syphilis in the body.

Tests of the nervous system may include:

Treatment

The goals of treatment are to cure the infection and slow the disorder from getting worse. The doctor will prescribe penicillin or other antibiotics to treat the infection. Treatment will likely continue until the infection has completely cleared.

Treating the infection will reduce new nerve damage. But it will not cure damage that has already occurred.

Treatment of symptoms is needed for existing nervous system damage.

Outlook (Prognosis)

Without treatment, a person can become disabled. Persons with late syphilis infections are more likely to get other infections and diseases.

Possible Complications


  • Inability to care for yourself
  • Inability to communicate or interact with others
  • Injury due to seizures or falls

When to Contact a Medical Professional

Call your health care provider if you know you have been exposed to syphilis or other sexually transmitted infection in the past, and have not been treated.

Call your health care provider if you have nervous system problems (such as walking or trouble thinking), especially if you know you have been infected with syphilis.

Go to the emergency room or call the local emergency number (such as 911) if you have seizures.

Prevention

Treating primary syphilis and secondary syphilis infections will prevent general paresis.

Practicing safer sex, such as limiting partners and using protection, may reduce the risk of getting infected with syphilis. Avoid direct skin contact with persons who have secondary syphilis.

References

Beck BJ. Mental disorders due to a general medical condition. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 21.

Koshy A, Roos K. Infections of the nervous system. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 53C.

Update Date: 2/24/2014

Updated by: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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