Testing for syphilis

Syphilis is no longer a disease headed for the history books but a disease on the resurgence. Its rising prevalence in populations of all sexualities has moved it from an unlikely differential diagnosis to an important one not to miss. With a latency to symptoms of sometimes many years, syphilis is a key disease to consider and does not need the clinician to attempt to risk assess the patient. This article seeks to equip the jobbing neurologist to recognise the manifestations of syphilis, and to understand the tests available, the interpretation of results and the limitations of testing. We provide an overview approach to assessing and managing these cases, what to expect and where to seek expert opinion and advice.