Progress in the Fight Against Neurosyphilis

A skull damaged by Neurosyphilis, specifically the bacterium Treponema Pallidum

One of the contenders for "Who Killed Friedrich Nietzsche" was tertiary syphilis causing necrosis around the spleen and the brain stem. This condition is known in the present as neurosyphilis, and while it may have caused the slow death of the unfortunate man, developed nations today have minimized the presence of tertiary syphilis in its various forms, and great strides are being made towards the diagnosis of this diseases in less developed nations. Right now, in fact, the biggest challenge to overcome is that caused by the rarity of neurosyphilis in the developed world, which is making it difficult to be recognized in the less developed world.

This statement is affirmed by a study assessing the presence of neurosyphilis in South Africa conducted in 2004 and published in the Journal of Neurology, Neurosurgery & Psychiatry. In this study, 324 subjects who tested positive for FTA-abs were categorized according to presentation of symptoms associated with syphilis. The FTA-abs is a test for fluorescent treponema antibody absorption in the cerebrospinal fluid (CSF), which, when positive, is a common indicator for syphilis. Of these 324 subjects, the majority had limited access to healthcare, and were generally poor and unhealthy, with many suffering from alcoholism, malnourishment, and HIV.

The subjects were then examined according to six categories of diagnosis for neurosyphilis.

Category 1-- Neuropsychiatric disorders
Category 2-- Cerebrovascular trauma (i.e. evidence of stroke or aneurysm)
Category 3-- visual loss or optic nerve dysfunction
Category 4-- Myelopathy: especially for tabes dorsalis, the demyelination of nerves in the spinal cord
Category 5-- Seizure
Category 6-- Brain stem/cranial nerve distress

If some or all of these categories were satisfied and patients were shown to have either
a)high CSF cell count
b)high CSF protein
or c) a high IgG index
then the subject was considered to have neurosyphilis.

While 324 subjects were examined, 161 subjects were deemed to have actual neurosyphilis, and not symptoms caused by any other diseases or conditions. In these 161 individuals, many statistics such as age of onset were recorded, and the subjects were then treated in a hospital setting with the most common treatment being 20 million units of penicillin G per day. With an average treatment of 14.9 days, all but six o the patients survived, albeit most suffering from permanent cognitive loss, residual seizures, or psychiatric disorders.

This, however, was not in experiment in the treatment of neurosyphilis, but rather in the accuracy of diagnosis. By examining a large variety of categories and criteria for diagnosis, the experimenters hoped to refine the process of diagnosis for the disease, which, if left unchecked, is often lethal. In this regard, they experienced some success as they concluded this process, although arduous, showed accurate results. Ultimately, the diagnosis of neurosyphilis is still difficult, but this study certainly contributed to an awareness of this difficulty, and will continue to push forward efforts to increase the quality of diagnosis.

If there has been a drastic change in the fight against neurosyphilis since the late nineteenth century, it has been due to a combination of the more aggressive diagnostic techniques, movements to stop the spread of the disease and finally, the advent of penicillin. Before penicillin, tabes dorsalis was the main mode of presentation for neurosyphilis. Tabes Dorsalis would very likely have been expressed in Nietzsche if in fact he were a victim of syphilis, but tabes alone proves particularly susceptible to antibiotics.

There are those who might view such small improvements in our ability to diagnose and treat symptoms as insignificant, considering the span of time, but for me, this is unarguably good. The fact is that in developed nations, health care has improved such that progressive and tertiary cases of syphilis are almost never seen, so while the ability to treat highly progressed syphilis has not improved dramatically, the need to do so has decreased sharply.

Works Consulted:
Timmermans, M., and J. Carr. "Neurosyphilis in the Modern Era." Journal of Neurology, Neurosurgery and Psychiatry (2004). Times cited: 64