Syphilis – the great pretender – is our clinical topic of the month. Its protean manifestations are seen in a case report of syphilitic periostitis,1 and two reviews explore clinical management dilemmas in HIV positive patients. The management of syphilis in HIV positive individuals has generated much heat though less light in recent years, and Blank et al's review2 sets out the inadequate state of the literature. There is a strong case for large scale randomised clinical trials, which will need firm and transparent governance in the wake of Guatemala and Tuskegee. The unreliability of non-treponemal tests in HIV infected patients with ocular syphilis is emphasised by Tucker et …