There have been several media reports about the “95-year-old man who had surgery to detect syphilis in a fracture”. The non-medical public has a wrong “common sense medical view” that the elderly cannot get syphilis. In fact, the elderly can still get neurosyphilis. Most syphilis patients are seen in dermatology. I am a senior neurologist with a background in domestic and international work, and I work in neurology wards and outpatient clinics. As a rule, I should not see patients with syphilis very often. Last week, three patients with neurosyphilis were discharged from our ward after treatment. All three patients were unaware that they had syphilis before they were admitted to the hospital. One of these three patients was an elderly couple who was 78 years old. The first patient this time was an elderly gentleman whose family found that he had been markedly unresponsive and somewhat demented for the past six months, and had been sleeping significantly more in the week prior to admission, so he came to our hospital. After detailed neurological examination, head MRI, EEG, blood and cerebrospinal fluid including syphilis screening test, syphilis confirmatory test and other tests, as well as finding positive syphilis, we followed up the medical history to clarify that there was indeed a history of extramarital sex thirty years ago, so after symptomatic and etiological treatment, the patient improved significantly, and we will also follow up the patient to further observe the effect of his treatment. Subsequently, we suggested that the old man’s wife also undergo relevant blood and cerebrospinal fluid tests, which also revealed a clear diagnosis of mild neurosyphilis and was treated accordingly. In addition to patients who admit to having a history of extramarital sex, there are also patients with neurosyphilis who do not admit (or whose families do not know) that they have a history of extramarital sex. Let me cite a case from last year. The patient, a 65-year-old male, was admitted to my neurology department on a certain date in June 2010 with 17 days of dizziness. I examined and followed up the medical history and found that the patient had significant memory and behavioral abnormalities for 5-6 years, which the family thought was Alzheimer’s disease without formal diagnosis and treatment. During hospitalization, detailed imaging, EEG, blood and cerebrospinal fluid examinations clarified neurosyphilis (paralytic dementia) as the primary diagnosis, and after etiologic and symptomatic treatment, the patient improved significantly. Although the family did not admit that the patient had a history of extramarital sex and was not willing to accept the diagnosis of neurosyphilis, they were satisfied with the hospital when they saw that the treatment was very effective. Neurosyphilis belongs to the late stage (stage III) syphilis, which is caused by the infection of the human body with the paleomicron spirochete. There can be a variety of manifestations, and even asymptomatic neurosyphilis also exists. Neurosyphilis can appear 1-2 years after the primary syphilis infection, or it can be latent for decades before the onset of neurological symptoms. Syphilis was almost eliminated in China in the 1950s and 1960s, but after the 1980s, with the change in sexual attitudes and the international epidemic of AIDS (often combined with syphilis), the number of syphilis patients gradually increased. After years of incubation of syphilis spirochetes, it is not surprising that the number of neurosyphilis cases is now gradually increasing. The best way to prevent the disease is to promote a healthy and safe sex life and to stop having sex outside of marriage.