Positive serology in a patient without symptoms or signs of disease is referred to as latent syphilis and is the commonest presentation of syphilis in Australia today. Possibly because of the widespread use of antibiotics, the infection often proceeds to the latent stage without a recognised primary or secondary stage. An attempt should be made to determine the duration of latency (by asking about previous syphilis serology at the time of blood transfusion, STD or pregnancy, by identifying the occurrence of a primary lesion etc.) because specific treatments for early and late latent syphilis are different

Tertiary manifestations of syphilis may be ‘benign’ with development of gummas (granulomatous lesions) in almost any organ, or more serious with cardiovascular or central nervous system involvement. Benign gummatous disease is rare but cardiovascular disease and neurosyphilis occasionally occur. Careful management and follow up of patients with early or latent disease is essential to prevent late sequelae.

Late syphilis should be excluded in any patient with aortic incompetence or dilatation of the ascending arch of the aorta. Syphilis should be excluded as the cause of dementia, personality change, multifocal neurological disorders, nerve deafness, pupillary abnormalities, retinal disease or uveitis.
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