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General paresis

General paresis of the insane; General paralysis of the insane; Paralytic dementia

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

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Central nervous system and peripheral nervous system

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Causes

General paresis is one form of neurosyphilis. It usually occurs in people 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.

With neurosyphilis, the syphilis bacteria attack the brain and nervous system. General paresis often begins about 10 to 30 years after the syphilis infection.

Symptoms

Syphilis infection can damage many different nerves of the brain. With general paresis, symptoms are usually those of dementia and may include:

Exams and Tests

The health care provider will perform a physical exam and ask about your medical history. During the exam, the doctor may check your nervous system function. Mental function tests will also be done.

Tests that may be ordered to detect syphilis in the body include:

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 provider 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. People with late syphilis infections are more likely to develop other infections and diseases.

Possible Complications

Complications of this condition include:

When to Contact a Medical Professional

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

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

Go to the emergency room or call 911 or the local emergency number 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 people who have secondary syphilis.

Related Information

Neurosyphilis
Tabes dorsalis

References

Ghanem KG, Hook EW. Syphilis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 303.

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. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 237.

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Review Date: 2/4/2020  

Reviewed By: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Stony Brook University School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. 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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