Neurosyphilis remains an important and highly morbid neurologic infection. Recent years have seen a dramatic increase in the incidence of syphilis across a variety of populations, making recognition of the many neurologic complications of this infection still relevant for modern clinicians. As manifestations of neurosyphilis are famously varied, a high index of suspicion is essential, especially in the face of atypical presentations. In this review, we discuss updates to the epidemiology, range of clinical presentations, diagnosis, and management of neurosyphilis. ANN NEUROL 2025;98:1070–1076