Editing Syphilis (section)

===Tertiary===
[[File:Tertiary syphilis head.JPG|thumb|left|upright=1.2|Model of a head of a person with tertiary (gummatous) syphilis, [[Musée de l'Homme]], Paris]]
Tertiary syphilis may occur approximately 3 to 15 years after the initial infection and may be divided into three different forms: gummatous syphilis (15%), late [[neurosyphilis]] (6.5%), and cardiovascular syphilis (10%).<ref name=Kent08/><ref name=Eye07/> Without treatment, a third of infected people develop tertiary disease.<ref name=Eye07/> People with tertiary syphilis are not infectious.<ref name=Kent08/>

Gummatous syphilis or late [[benignity|benign]] syphilis usually occurs 1 to 46 years after the initial infection, with an average of 15&nbsp;years.<ref name=Kent08/> This stage is characterized by the formation of chronic [[gumma (pathology)|gummas]], which are soft, tumor-like balls of inflammation which may vary considerably in size.<ref name=Kent08/> They typically affect the skin, bone, and liver, but can occur anywhere.<ref name=Kent08/>

Cardiovascular syphilis usually occurs 10–30&nbsp;years after the initial infection.<ref name=Kent08/> The most common complication is [[syphilitic aortitis]], which may result in [[aortic aneurysm]] formation.<ref name=Kent08/>

[[Neurosyphilis]] refers to an infection involving the [[central nervous system]]. Involvement of the central nervous system in syphilis (either asymptomatic or symptomatic) can occur at any stage of the infection.<ref name=NEJM2020/> It may occur early, being either asymptomatic or in the form of [[Meningeal syphilis|syphilitic meningitis]]; or late as meningovascular syphilis, manifesting as [[general paresis]] or [[tabes dorsalis]].<ref name=Kent08/>

Meningovascular syphilis involves inflammation of the small and medium arteries of the central nervous system. It can present between 1–10 years after the initial infection. Meningovascular syphilis is characterized by stroke, cranial nerve palsies and [[myelopathy|spinal cord inflammation]].<ref name=autogenerated1>{{cite journal |last1=Longo |first1=Dan L. |last2=Ropper |first2=Allan H. |title=Neurosyphilis |journal=New England Journal of Medicine |date=3 October 2019 |volume=381 |issue=14 |pages=1358–63 |doi=10.1056/NEJMra1906228|pmid=31577877 |s2cid=242487360 }}</ref> Late symptomatic neurosyphilis can develop decades after the original infection and includes 2 types; general paresis and tabes dorsalis. General paresis presents with dementia, personality changes, delusions, seizures, psychosis and depression.<ref name=autogenerated1 /> Tabes dorsalis is characterized by gait instability, sharp pains in the trunk and limbs, impaired positional sensation of the limbs as well as having a positive [[Romberg's sign]].<ref name=autogenerated1 /> Both tabes dorsalis and general paresis may present with [[Argyll Robertson pupil]] which are pupils that constrict when the person focuses on near objects ([[accommodation reflex]]) but do not constrict when exposed to bright light ([[Light reflex|pupillary reflex]]).