Sir,Although recent data suggest very low prevalence rates of syphilis, are we moving toward elimination, or is there a resurgence and change in the pattern of presentation? In addition, the emergence of HIV infection has increased the importance of measures aimed at the control of sexually transmitted infections (STIs) such as syphilis.A 28-year-old female, with 12 weeks of amenorrhea (G2P1A0L1), was found to be venereal disease research laboratory (VDRL) positive during routine antenatal checkup. The pregnancy was terminated considering the risk of congenital syphilis. A detailed history and thorough clinical examination revealed no signs of syphilis. The patient refused any premarital or post/extramarital sexual contact. Repeat VDRL of the patient and her husband was positive (1:16 and 1:32, respectively). Her husband was also asymptomatic, and clinical examination was normal. He gave history of unprotected premarital sexual exposure with multiple partners 14 years back but no extramarital sexual contact. Subsequently, both cases were subjected to the treponema pallidum hemagglutination assay, which also came out to be positive. Both patients were diagnosed as cases of syphilis incognito (possibly late latent) and treated with three doses of injection benzathine penicillin G.Syphilis incognito is a subtype of latent syphilis (early or late) which runs a subclinical course from the time of infection until its diagnosis by routine serologic screening. These patients are completely unaware of when, where, how, or by whom they had been infected, report no signs or symptoms consistent with primary or secondary syphilis, and are diagnosed as having syphilis accidentally during routine serologic screening.A literature search revealed two retrospective, epidemiological studies reporting the patterns of STIs in India. Narayanan (1990–2000)[1] found syphilis to be the most common (57.3%) genital ulcer disease; however, a later time frame in Sasidharanpillai et al.'s study[2](2003–2012), syphilis accounted for only 5.6% of the total STI cases. Although statistically insignificant, the latter also witnessed a rise in the number of syphilis cases during the second half of the study period. Moreover, greater than 90% belonged to the category of syphilis of unknown duration. However, the former reported only 8.3% of latent syphilis. A similar study from Puducherry[3] also found latent syphilis as the most common presentation (78.6%) among the total diagnosed cases of syphilis. Therefore, this exponential decline in the number of cases of syphilis was coupled with dominance of incognito or latent cases toward the latter half of the past 20 years.These findings have been corroborated in other parts of the world where screening programs have found a high percentage of asymptomatic cases.[4] An increased incidence of syphilis from 2.40 to 8.19 cases/100,000, people was seen in Shandong province of China between 2004 and 2012.[5] However, latent cases did not show dominance over other forms, and the increase in incidence of all forms of syphilis was equivocal. Reports from the USA suggest that the prevalence of syphilis in heterosexuals continue to decline, and resurgence has only been seen in men who have sex with men.[6]A rampant inadvertent use of prescription and nonprescription antibiotics is prevalent in our country. The resurgence of syphilis incognito or latent syphilis may root from partial cure of the disease due to the widespread use of penicillins and cephalosporins for common infections.[1] HIV infection and homosexual behavior are also cited as major risk factors. These patients may remain as late latent syphilis cases. Many years after infection, VDRL can become nonreactive even in untreated or inadequately treated patients. An immunodeficiency state-like HIV infection can place these inadequately treated patients at risk for reactivation.The cases discussed in this report coupled with the recent changing epidemiological patterns of syphilis raise some concerns. In the years to come, will there be a rise in the number of tertiary syphilis cases as a consequence of rise in the proportion of latent syphilis? Has the historical “great imitator” changed into a “covert devil”? The need of the hour is a large-scale screening program to discern the prevalence in other parts of the country and curtail the risk of an epidemic.