What should you know about CNS syphilis?

Nervous-system involvement can occur at different stages and may cause headache, vision or hearing changes, numbness, weakness, balance difficulty, memory or personality changes, or pain. Some people have few obvious symptoms, which is why a history of syphilis, neurological findings, or eye symptoms should be discussed openly. These features are not specific to syphilis, so diagnosis relies on clinical assessment and appropriate blood or spinal-fluid testing rather than symptoms alone.

Arrange medical review promptly if you have a positive syphilis test, symptoms affecting vision or hearing, or new neurological symptoms. A clinician may review sexual and treatment history, examine the nervous system, and arrange STI screening or other tests. If CNS involvement is diagnosed, antibiotic treatment is selected and given under medical supervision. Do not self-treat, share antibiotics, or stop a prescribed course without contacting the treating team. Partners may also need confidential evaluation.

Go to emergency care for sudden vision loss, sudden weakness or numbness, a new severe headache, seizure, confusion, fainting, or difficulty speaking. Contact a clinician urgently for rapidly worsening balance, hearing, memory, or eye symptoms. Prompt assessment can help protect neurological function and identify other emergencies with similar features.

Which tests can show whether syphilis has affected my nervous system? Do I need an eye or hearing assessment? What treatment will I receive, how will symptoms be monitored, and should partners be tested?