A 28-year-old African American woman pregnant with her first child presented for her initial prenatal visit at 16 weeks' gestation. Her routine prenatal labs were within normal limits, except for a reactive venereal research laboratory test (VDRL) with a titer of 1:16. A fluorescent treponemal antibody-absorption (FTA-ABS) was requested and found to be positive. She did not have any history of syphilis and had never been tested for syphilis. She was asymptomatic, and her physical exam was within normal limits with no signs of syphilis. Tests for HIV, chlamydia, gonorrhea, and hepatitis B were all negative. A wet mount was negative for trichomonas. Based on her history, physical exam, and laboratory results, her diagnosis was syphilis of unknown duration because she had no documented VDRL in the preceding year, no history of the disease, and no symptoms. The midwife prescribed a course of benzathine penicillin 2.4 million units intramuscularly every week for 3 weeks, instructed her to refer her partner for testing and treatment, and counseled her about the potential effects of syphilis on her body and her baby. She was advised that she needed repeat serology at 6, 12, and 24 months post-treatment. After treatment, she had a level two ultrasound, which was not suspicious for congenital syphilis. Her VDRL was repeated at 28 weeks' gestation and was nonreactive. At 40 2/7 weeks' gestation, she gave birth to a healthy baby boy with Apgar scores of 9 and 9. Initial exam of the newborn was grossly within normal limits, and his serology was nonreactive for syphilis.