Against the backdrop of a decrease in the incidence of syphilis in recent years, emerging trends in the Rostov Region show an increase in the incidence of neurosyphilis (NS) cases, which can lead to a high risk of disability. The development of effective measures to prevent the incidence of NS requires an improvement in the system of periodic monitoring and the study of the epidemiological features of syphilis and NS. Objective — to provide a breakdown of the prevalence and incidence of NS in the population of the Rostov region with projections of future cases in order to assess the effectiveness of implemented preventive public health measures. Material and methods. The object of study — a breakdown of the number of registered cases in the Rostov region from 1999 to 2017 (46,321 cases of syphilis, of which 1157 were cases of NS). Results. For the period 2008—2017, among all cases of syphilis, the proportion of NS cases increased by 18.2%, to an average annual rate of 2.38 per 100 thousand of population (o/ooo). The incidence of NS in urban areas (2.66 o/ooo) exceeded the corresponding figure in rural areas (1.99 o/ooo). An upward trend in the number of reported cases of neurosyphilis with an average annual growth rate of +27.98% was revealed, which was formed within the context of a decrease in the incidence of syphilis, with an average annual growth rate of –10.28%. The constructed models for the long-term trends and extrapolated projections in the incidence of NA form the basis for evaluating the effectiveness of optimization measures. Conclusion. The features of the incidence of NA in the population of the Rostov region were studied. An increase in the later stages of syphilis, including NA, was noted against the background of a decrease in the incidence of primary syphilis. Statistically contrasting geographical variances were found in the average annual growth rates (AAGR) of reported cases of NA in different parts of the region, which indicate insufficient detection of the disease in some cities. Medium-range forecasts for the incidence of syphilis and NA were calculated.