According to the British Association for Sexual Health and HIV (BASHH) guidelines, a chest X-ray is recommended as part of the assessment of patients with late latent syphilis to exclude cardiovascular complications. The aims of this study were firstly to audit all cases of late latent syphilis seen at our centre since 1994 and to see whether a chest X-ray was requested and secondly to assess whether performing a chest X-ray was clinically useful. Of the 456 case notes audited, 298 chest X-rays were requested; 182 (61%) were reported as normal. Results were not available for 64 (21%) and 32 (11%) patients either declined or did not attend for follow-up. There were 20 (7%) chest X-rays that were reported as abnormal, yet none of these radiological findings were consistent with the cardiovascular complications of syphilis. In view of the lack of significant chest X-ray findings in asymptomatic patients with late latent syphilis, a chest X-ray should not be requested.