Syphilis has increased in recent years, causing difficulties for clinicians and public health practitioners alike. While one issue with the current management of syphilis is that it has both a myriad of presentations and complicated laboratory results, another issue relates to the current case definitions used to define and track syphilis in public health surveillance. One item that is missing is a "probable" case definition, which could help capture the number of likely cases of syphilis that were appropriately treated clinically, but which failed to reach public health case definition based on serologic markers. This approach could produce a more accurate picture of the breadth of syphilis transmission in North America and help better appreciate the groups most affected by syphilis change. We put forward and argue this position herein.