Syphilis is a venereal (sexually transmitted) disease. It has a few stages and involves unpleasant phenomena such as lesions and skin eruptions. Syphilis can go dormant (latent) for years or even decades before it affects the brain in a condition known as general paresis. Brain tissue is gradually destroyed by the tiny organisms that cause syphilis, the spirochetes. This progressive devastation causes mania, dementia, megalomania (delusions of grandeur), and paranoia.

Even when its existence is suspected, syphilis is difficult to diagnose. Most mental health clinicians are unlikely to try to rule it out. Syphilis in its tertiary (brain consuming) phase produces symptoms that are easily misdiagnosed as Bipolar Disorder combined with the Narcissistic and the Paranoid Personality Disorders.