Tabes dorsalis is a late expression of untreated syphilis and is characterized by a triad of clinical symptoms namely gait unsteadiness, lightning pains and urinary incontinence. It occurs due to a slow and progressive degeneration of nerve cells and fibers in spinal cord. It is one of the forms of tertiary syphilis or neurosyphilis.
Treatment is aimed at curing the infection and hopefully halting the progression of neurologic damage. Treatment is unfortunately limited in reversing the damage already done and the degree of recovery depends on the extent of damage when therapy is started. Appropriate treatment however does reduce future nerve damage, reduces symptoms and normalizes the CSF abnormalities.
The CDC of the United States Department of Health and Human Services has extensive guidelines for treatment of tabes. It recommends antibiotic treatment with intravenous aqueous crystalline penicillin G for two weeks. If the patient has penicillin allergy, he should be desensitized first before treatment. Otherwise, the antibiotic Ceftriaxone can be used as an alternative but the adequacy of this has not been fully approved by the CDC. Serum VDRL titers are checked every three months till they start declining.
CSF is checked at six and twelve months and if still abnormal, rechecked at two years. Re-treatment is recommended if neurological damage progresses, if CSF white cell count does not normalize in six months, VDRL titers do not decline or show a four-fold increase and if the first course of treatment was suboptimal. Symptomatic analgesic treatment is given for pain.
This can range from simple over the counter medications like aspirin or Tylenol or more potent analgesics like narcotics. Certain anti-seizure medications like Phenytoin, Carbamazepine and Valproic acid are efficacious in treating resistant pain. If patients become demented and have behavioral issues, anti-psychotic medications can be given.
Primary and secondary prevention of syphilis is important to prevent development of tabes dorsalis. Safe sex (using a condom) is a way of primary prevention. Screening, detection and treatment of early syphilis are measures of secondary prevention. Sexually active people should consult a physician about any rash or sore in the genital area.
Those who have been treated for another sexually transmitted infection like gonorrhea, should be tested for syphilis and HIV. Persons who have been exposed sexually to another person who has syphilis of any stage should be clinically evaluated, undergo testing and even be presumptively treated in certain instances.
Image Courtesy: Getty
Read more barticles on Tabes Dorsalis.