If you have cardiovascular syphilis is it possible not to exhibit any symptoms before heart failure? I know an aortic aneurysm is one of the symptoms, would a physical from your doctor be able to detect that particular symptom? or an ecg?
I would be very surprised if cardiovascular syphilis is a reastlic possibility in you or anyone you know, especially if you are in the US or other industrialized country. It is extremely rare these days -- in my 30+ years in the STD business, I have never seen a case. Further, the identical problems -- aortic aneurysm, aortic valve insufficiency, and heart failure as a result -- are far more commonly due to other things than syphilis. As a guess, for every 100,000 such cases I'll bet no more than one is due to syphilis.
With that as introduction the answer is yes: whether due to syphilis or other causes, these abnormalities would usually be easily detected by a routine cardiac examination, chest Xray, ECG, or even routine blood pressure check before overt heart failure develops. Not universally -- it is possible heart failure would appear as the first manifestation -- but unlikely.
If you or someone you know has heart disease of unknown cause, and if there has been a past diagnosis of syphilis or risks for it, having a syphilis blood test would make sense. If you have specific reasons to suspect the person in question in fact has cardiovascular syphilis, I would be happy to comment further.
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