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Tabes dorsalis

Locomotor ataxia; Syphilitic myelopathy; Syphilitic myeloneuropathy; Myelopathy - syphilitic; Tabetic neurosyphilis

Tabes dorsalis is a complication of untreated syphilis that involves muscle weakness and abnormal sensations.

Causes

Tabes dorsalis is a form of neurosyphilis, which is a complication of late stage syphilis infection. Syphilis is a bacterial infection that is spread sexually.

When syphilis is untreated, the bacteria damages the spinal cord and peripheral nervous tissue. This leads to the symptoms of tabes dorsalis.

Tabes dorsalis is now very rare because syphilis is usually treated early in the disease.

Symptoms

Symptoms of tabes dorsalis are caused by damage to the nervous system. Symptoms include any of the following:

  • Abnormal sensations (paresthesia), often called "lightning pains"
  • Problems walking such as with the legs far apart
  • Loss of coordination and reflexes
  • Joint damage, especially of the knees
  • Muscle weakness
  • Vision changes
  • Bladder control problems
  • Sexual function problems

Exams and Tests

The health care provider will perform a physical exam, focusing on the nervous system.

If syphilis infection is suspected, tests may include the following:

If the serum VDRL or serum RPR test is positive, one of the following tests will be needed to confirm the diagnosis:

Treatment

The goals of treatment are to cure the infection and slow the disease. Treating the infection helps prevent new nerve damage and may reduce symptoms. Treatment does not reverse existing nerve damage.

Medicines likely to be given include:

  • Penicillin or other antibiotics for a long time to make sure the infection goes away
  • Painkillers to control pain

Symptoms of existing nervous system damage need to be treated. People who are unable to eat, dress themselves, or take care of themselves may need help. Rehabilitation, physical therapy, and occupational therapy may help with muscle weakness.

Outlook (Prognosis)

Left untreated, tabes dorsalis may lead to disability.

Possible Complications

Complications may include:

  • Blindness
  • Paralysis

When to Contact a Medical Professional

Call your provider if you have:

Prevention

Proper treatment and follow-up of syphilis infections reduces the risk of developing tabes dorsalis.

If you are sexually active, practice safer sex and always use a condom.

All pregnant women should be screened for syphilis.

References

Hook EW. Syphilis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 319.

Radolf JD,Tramont EC, Salazar JC. Syphilis (Treponema pallidum). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 239.

  • Superficial anterior muscles

    Superficial anterior muscles - illustration

    Superficial muscles are close to the surface of the skin. Muscles which lie closer to bone or internal organs are called deep muscles.

    Superficial anterior muscles

    illustration

  • Primary syphilis

    Primary syphilis - illustration

    Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. Primary syphilis presents as a small painless open sore 3 to 6 weeks after exposure. Although the lesion heals within 6 to 8 weeks, the untreated organism will continue to multiply unchecked, causing many complications. Infection may last for 30 years or more and result in severe neurological complications.

    Primary syphilis

    illustration

  • Late-stage syphilis

    Late-stage syphilis - illustration

    Tertiary syphilis is a late stage of the disease which can follow the initial infection, primary syphilis, by several years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive.

    Late-stage syphilis

    illustration

    • Superficial anterior muscles

      Superficial anterior muscles - illustration

      Superficial muscles are close to the surface of the skin. Muscles which lie closer to bone or internal organs are called deep muscles.

      Superficial anterior muscles

      illustration

    • Primary syphilis

      Primary syphilis - illustration

      Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. Primary syphilis presents as a small painless open sore 3 to 6 weeks after exposure. Although the lesion heals within 6 to 8 weeks, the untreated organism will continue to multiply unchecked, causing many complications. Infection may last for 30 years or more and result in severe neurological complications.

      Primary syphilis

      illustration

    • Late-stage syphilis

      Late-stage syphilis - illustration

      Tertiary syphilis is a late stage of the disease which can follow the initial infection, primary syphilis, by several years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive.

      Late-stage syphilis

      illustration


     

    Review Date: 9/22/2018

    Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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