Syphilis is listed as a cause of ortic regurgitation in every medical textbook. However, in reality, it rarely occurs, especially in the United States and especially over the past several decades. Cardiologists hardly ever test for it. There are blood tests to detect syphilis infection but even if they are positive, it is not necessarily the case that syphilis caused the aortic problem. At the time of valve surgery, if the tissue is examined by a skilled pathologist, the diagnosis of syphilitic aortitis can be made.