Gastric syphilis is sometimes difficult to distinguish from gastric cancer and gastric ulcers. However, gastric syphilis mostly occurs in young patients who have not been treated with anti-syphilis, and has a longer duration and slower weight loss than gastric cancer. Sometimes the diagnosis can be confirmed by biopsy or post-surgical pathology. Symptoms develop slowly, but progressively worsen, and become apparent with the reduction of gastric volume and concurrent ulcers. It starts with pain or discomfort in the upper abdomen after meals. It is accompanied by epigastric distention, nausea, vomiting and wasting and weakness. The abdominal pain and vomiting are aggravated by gastric scar formation and obstruction of pyloric passage. Some patients have symptoms similar to peptic ulcer. In a few cases, a mass may be palpable on physical examination of the abdomen. The diagnosis of gastric syphilis is difficult because there are no specific symptoms, but the diagnosis can be confirmed based on the history of previous diseases, history of initial syphilis chancre and gastric X-ray and serum antigen reaction. Gastroscopic findings and biopsy are consistent with the pathological changes of syphilis and can confirm the diagnosis. After anti-syphilis treatment, barium meal X-ray of the stomach showing improvement or disappearance of the lesion is also helpful for diagnosis.