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Untreated tertiary syphilis can lead to severe complications, with central nervous system damage being one of the most significant. This stage of syphilis occurs years after the initial infection and can manifest with a variety of neurological issues, including but not limited to tabes dorsalis, dementia, and general paresis. The bacteria (Treponema pallidum) can invade the central nervous system and cause changes that result in profound and often irreversible neurological damage. This highlights the importance of early diagnosis and treatment of syphilis to prevent these serious health consequences.

While skin lesions, joint pain, and fever may occur during earlier stages of syphilis or in some instances of other illnesses, they are not the hallmark complications associated with untreated tertiary syphilis. Central nervous system involvement represents the most critical risk, emphasizing the need for thorough monitoring and treatment of syphilis at all stages to mitigate these potential complications.