General paresis is one form of neurosyphilis. It usually occurs in people who have had untreated syphilis for many years. Syphilis is a bacterial infection that is most often spread through sexual 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 initial syphilis infection.

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

• Memory problems
• Language problems, such as saying or writing words incorrectly
• Decreased mental function, such as problems thinking and with judgment
• Mood changes
• Personality changes, such as delusions, hallucinations, irritability, inappropriate behavior

Your health care provider will perform a physical exam and ask about your medical history. During the exam, your provider 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:

• CSF-VDRL
• FTA-ABS

Tests of the nervous system may include:

• Head CT scan and MRI
• Nerve conduction tests
• Spinal tap (lumbar puncture)

The goals of treatment are to cure the infection and slow the disorder and prevent further damage. Your 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.

Without treatment, a person can become disabled. People with late syphilis infections are more likely to develop other infections and diseases.

Complications of this condition include:

• Inability to communicate or interact with others
• Injury due to seizures or falls
• Inability to care for yourself

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

Contact 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.

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.

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

Ghanem KG, Dionne JA, Ghanem KG. Syphilis and nonsyphilitic treponematoses. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 295.

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.

Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.