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CHRONIC CONFUSION: SYPHILIS
Syphilis is a venereal disease that is usually sexually transmitted. The state of the disease that can cause mental changes such as confusion occurs many years (often twenty or more) after the initial infection. The first stages may have been missed (painless lesions on the genitals and then rashes) or the infection may have been inadequately treated at the time. Any person with a chronic confusional state must have a blood test for syphilis. If it proves positive, some doctors also insist on a lumbar puncture to test the fluid in the spinal canal for syphilis as well. Sometimes the blood test is positive, indicating previous infection, but the spinal fluid (cerebrospinal fluid) is negative, showing that the infection is not causing the confusion and does not need to be treated. Some doctors do not insist on a lumbar puncture but treat according to the blood tests.
If treatment is necessary it usually consists of daily penicillin injections for about three weeks. The spouse may also have the infection and so positive cases are usually referred to the department of genito-urinary medicine so that skilled counselors can interview relatives and explain the need for further tests on them. The sooner the infection is treated the better the results. By the time the disease has caused a confusional state, complete recovery of full mental faculties is unlikely.
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