GENERALIZED paresis of the insane and the late manifestations of congenital syphilis were at one time relatively common clinical problems. Today the remaining handful of patients with generalized paresis inhabit the back wards of state mental hospitals, and congenital syphilis is seen infrequently in newborns and almost never as the late onset form of the disease. With the discovery of penicillin, and the subsequent relative decline in the number of cases of syphilis being seen by the private practitioner, there has been a tendency to omit the serological test for syphilis from the routine prenatal examination.
In the past few years syphilis has been on the increase, particularly in the 15- to 25-year-age group—the early reproductive years. It is by reputation "the great imitator," and unless suspected and looked for, it will be missed. The occurrence of late-onset congenital syphilis manifesting itself as generalized paresis is a rare situation. This
Greenberg PA. Generalized Paresis in a 15-Year-Old Girl. JAMA. 1965;193(1):69–70. doi:10.1001/jama.1965.03090010075028