Proper staging of syphilis is critical to the treatment of syphilis because it is a function of treatment drug selection, treatment course, and post-treatment evaluation. However, it is very difficult to assess the clinical staging of syphilis, and there is no syphilis test that can be used directly for staging syphilis, so how to properly stage syphilis often tests the STD’s knowledge of syphilis. So how is staging done? Clinicians need to obtain the following important information and make a comprehensive judgment through detailed examination and physical examination, as well as combining different laboratory results: 1. 3. syphilis infection of sexual partners, parents and children: to distinguish whether the syphilis is congenital (transmitted from mother) or acquired (transmitted from sexual partners); 4. syphilis laboratory test results: high (often suggesting early infection) or low (often suggesting late infection) titers of non-specific antibodies to syphilis, etc. This is because: a) the patient lacks clinical manifestations: for example, latent syphilis, also called occult syphilis, this type of syphilis does not show any clinical symptoms and is only discovered through blood tests; b) the site of syphilis is hidden: for example, it occurs in the vagina, the cervical opening, the rectum, the hard chancre, and the rectum. (c) Early syphilis symptoms can disappear on their own: such as hard chancre and second-stage syphilis rash, which often do not cause any discomfort to patients and can disappear on their own after some time, so they are often ignored by patients. nephritis, blindness, deafness, stroke, dementia, paralysis, etc. as the first symptoms, but finally they are found to be caused by syphilis infection; 3. Unclear whether sexual partners, parents, or children are infected with syphilis: Because most people are ashamed to tell their family members that they are infected with syphilis, and therefore more reluctant to bring them for syphilis examination and treatment, clinicians are often unable to obtain the syphilis infection status of their family members. I once treated a middle-aged female syphilis patient, her husband concealed her for 20 years and finally told her when she was paralyzed in the lower body due to syphilis, but by then the best time for treatment had passed and she regretted her life; 4. Lack of laboratory tests that can be used directly for syphilis staging: so far there is still no syphilis test that can be used for syphilis staging, so a variety of syphilis The results of multiple syphilis tests need to be evaluated in order to finally obtain a correct diagnosis. However, due to the limitations of the sensitivity and specificity of syphilis test results, I have encountered cases of early syphilis infection (highly infectious) who did not take preventive treatment because of negative test results and eventually infected their partners; I have also encountered cases of pregnant women who were not infected with syphilis but were treated as infected with syphilis because of positive blood test for syphilis (this is called biological false positive, not really infected with syphilis); and We have encountered cases where patients with serum fixation for syphilis have been treated with anti-syphilis treatment because their syphilis antibody titers do not drop …… The more information the patient provides, the more helpful it is for staging syphilis, but clinicians often do not have access to all of the above information, so they are required to act like Sherlock Holmes, staging syphilis through the clues provided by the patient, combined with their own strong clinical experience and research background in syphilis diagnosis and treatment.