Syphilis is a bacterial infection spread sexually. When it is left untreated, the bacteria responsible for syphilis damage the spinal cord and peripheral nervous tissue, which can lead to tabes dorsalis.
Tabes dorsalis is a progressive disease of the nerve cells that can cause permanent damage. Like syphilis, it is treatable, and the sooner it is treated the less risk there is of permanent damage.
What Is Tabes Dorsalis?
Tabes dorsalis is a gradual degeneration of the nerve cells and fibers responsible for carrying sensory information to the brain. This condition results as a complication of syphilis left untreated.
The nerves affected by tabes dorsalis are located in the dorsal column of the spine, which is the area closest to the back of the body. These nerves are responsible for carrying information that helps someone maintain their sense of position.
Tabes dorsalis typically appears in late-stage syphilis infection, and it is a progressive disease with symptoms that worsen as time goes by.
Tabes Dorsalis Symptoms
Symptoms for tabes dorsalis may not appear until decades after the initial syphilis infection.
Tabes dorsalis symptoms include:
- diminished reflexes
- progressive degeneration of the joints
- unsteady gait
- moments of intense pain
- loss of coordination
- personality changes
- diminished response to light
- visual impairment
- bladder control problems
The first symptom of tabes dorsalis is typically “lightning pain,” which is a transient, stabbing pain that affects the legs.
The lightning pain is then followed by a loss of tendon reflexes and a loss of muscular coordination that causes someone to have an erratic and uneven walk.
As tabes dorsalis progresses, those infected often struggle to sense limb position, pain, and temperature, which can cause someone to lose control over their bladder and potentially their bowel. These struggles in sensation can also cause severe foot ulcerations and osteoarthritis affecting the hips and knees.
As neurologic deterioration continues, someone’s pupils can lose the ability to react to changes in light.
Diagnosing Tabes Dorsalis
When diagnosing tabes dorsalis, your healthcare provider will perform a physical exam that focuses on the nervous system.
If they suspect a syphilis infection, they may then send for the following exams:
- Cerebrospinal fluid (CSF) examination
- Serum RPR or Serum VDRL
- Spine CT, head CT, or MRI scans (brain and spinal cord)
If the serum VDRL or serum RPR test, which screens for syphilis infection, comes back positive, your doctor will then need to use another test to confirm the diagnosis (e.g., MHA-TP, FTA-ABS, TP-PA, TP-EIA)
How Is Tabes Dorsalis Treated?
Treatment for tabes dorsalis typically involves penicillin administered intravenously. The ultimate goal of treatment is to cure the infection and slow down the disease’s progression.
The associated pain accompanying tabes dorsalis can be treated with valproate, opiates, or carbamazepine.
In patients who have muscle weakness, physical or rehabilitative therapy can help.
Outlook And Possible Complications
If tabes dorsalis is left untreated, it can lead to dementia, paralysis, or blindness. Additionally, nerve damage that already exists cannot be reversed, so the longer it is left untreated, the more permanent damage it can cause.
Since nerve damage caused by the syphilis infection cannot be reversed, those with nervous symptom damage may need physical therapy, rehabilitation, or occupational therapy. Some signs of these needs include being unable to eat, dress, or care for themselves.
Tabes dorsalis is rarely fatal, and treating the infection can help to relieve pain and prevent the disease from progressing further.
In some cases, tabes dorsalis may be accompanied by meningitis or meningomyelitis, which is the inflammation of the lining of the brain (meninges) or the inflammation of the meninges and the spinal cord, respectively.
How To Prevent Tabes Dorsalis
Since tabes dorsalis results as a complication of a syphilis infection, the best way to prevent its progression is to protect yourself against syphilis.
Syphilis is a sexually transmitted disease (STD) that can be spread through oral, vaginal, or anal sex. Because of this, the best way to prevent its infection is to abstain from oral, vaginal, or anal sex.
For those who do have sex, safe sex is a priority. This includes using a barrier protection method, such as a condom, every time you have sex, especially if you have multiple partners.
Yet another component of preventing tabes dorsalis is undergoing regular STD screenings if you are sexually active. Doing so ensures that, if you do have syphilis, you can receive treatment before it progresses to tabes dorsalis.
Treatment for syphilis involves antibiotics, typically penicillin, and it is crucial to take the complete course of antibiotics. Additionally, be sure to receive follow-ups concerning your syphilis infection to ensure that you are completely cured.
When To See a Doctor
It is important to see a doctor if the following symptoms are present:
- loss of muscle strength
- loss of coordination
- loss of sensation
These symptoms may be signs of tabes dorsalis, and getting an early diagnosis means you can begin treatment sooner.
Get Help from An Online Doctor
If you think that you have tabes dorsalis, talking to an online doctor can help you determine if tabes dorsalis is a possibility and what your next steps should be. With DrHouse, you can meet with a doctor in just 15 minutes to quickly discuss any symptoms you may have and their connection to prior syphilis infection.
An additional benefit of an online doctor is that you are able to meet with your doctor from the comfort of your home. For those with tabes dorsalis who are experiencing unpleasant symptoms that make movement difficult, this allows you to stay in your home while you gain medical advice.
Tabes dorsalis is a complication of late-stage syphilis infection. It can appear decades after the initial syphilis infection and can occur from untreated syphilis or not completing the entire course of antibiotics for syphilis infection.
Tabes dorsalis is a progressive neurodegenerative disease impacting the nerves in the dorsal column of the spine, which are responsible for carrying information that allows someone to maintain their sense of position. As tabes dorsalis progresses, those infected may experience symptoms such as lightning pains, uneven gait, and loss of bladder control.
Tabes dorsalis is a treatable condition, but any nerve damage that has already been caused cannot be reversed. Because of this, it is crucial to receive treatment for tabes dorsalis as soon as possible. Meeting with an online doctor can help you seek early treatment, preventing the progression of the disease.
- Tabes Dorsalis | National Institute of Neurological Disorders and Stroke. (2022). Retrieved 26 July 2022, from https://www.ninds.nih.gov/health-information/disorders/tabes-dorsalis
- Osman, C., Clark, T., Ghosh, B., & Halfpenny, C. (2015). TABES DORSALIS IN THE POST ANTIBIOTIC ERA: NEVER SAY NEVER. Journal Of Neurology, Neurosurgery &Amp; Psychiatry, 86(11), e4.123-e4. doi: https://www.doi.org/10.1136/jnnp-2015-312379.34
- Where Can I Get Treated For Syphilis? | Treatment Info. (2022). Retrieved 26 July 2022, from https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/syphilis/how-do-i-get-treated-for-syphilis
- Bhandari J, Thada PK, Ratzan RM. Tabes Dorsalis. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557891/
- Tabes dorsalis: MedlinePlus Medical Encyclopedia. (2022). Retrieved 26 July 2022, from https://medlineplus.gov/ency/article/000729.htm
- Tatu, L., & Bogousslavsky, J. (2021). Tabes dorsalis in the 19th century. The golden age of progressive locomotor ataxia. Revue Neurologique, 177(4), 376-384. Doi: https://www.doi.org/10.1016/j.neurol.2020.10.006
DrHouse articles are written by MDs, NPs, nutritionists and other healthcare professionals. The contents of the DrHouse site are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. If you are experiencing high fever (>103F/39.4C), shortness of breath, difficulty breathing, chest pain, heart palpitations, abnormal bruising, abnormal bleeding, extreme fatigue, dizziness, new weakness or paralysis, difficulty with speech, confusion, extreme pain in any body part, or inability to remain hydrated or keep down fluids or feel you may have any other life-threatening condition, please go to the emergency department or call 911 immediately.