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Ask the Mental Health Expert Archives 2001-2004

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Syphilis--The Great Imitator

Q. I'm doing a project on the mental disorders that can come from syphilis in the late stages. What other sexually transmitted diseases can cause mental symptoms? Any information you have would be great.

A. As you know, neurosyphilis is sometimes called the great imitator, owing to the wide and puzzling array of psychiatric symptoms it may produce. More recently, the human immunodeficiency virus (HIV)--the cause of AIDS--has been recognized as a frequent cause of neuropsychiatric problems [see, e.g., Alciati et al, J Psychiatry Neurosci 2001 May;26(3):229-234]. These problems may present as a subcortical dementia, or as a mood or psychotic disorder. The Herpes Simplex Virus (HSV) may also be transmitted sexually, and may also cause central nervous system infection (e.g., meningitis).

Less commonly, other sexually-transmitted microbes may invade the central nervous system, and cause neuropsychiatric problems. Oro-genital sex is implicated as a route of transmission for gonorrhea, Chlamydia trachomatis, chancroid, and Neisseria meningitides [Edwards & Carne, Sex Transm Infect 1998 Apr;74(2):95-100]. Gonorrhea--which had something of a resurgence in the 1990s-may lead to meningitis.

Chlamydia trachomatis may (rarely) cause meningitis or meningoencephalitis. Neisseria meningitides (an organism related to that which causes gonorrhea) can also cause meningitis, characterized by severe headache, confusion, lethargy, and coma. In short, the great imitator is not the only sexually-transmitted disease that can affect the brain, and hence, cause mental symptoms.

November 2001

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