Syphilis in pregnancy, if left untreated, tends to have a severe impact on fetal development. The transplacental spread of the spirochete leads to congenital syphilis. Late latent syphilis and tertiary syphilis are considered to be non-infectious stages of the disease. The disease is highly infectious in patients with primary, secondary syphilis or early latent syphilis with mucocutaneous involvement. Hematogenous spread from the primary site then leads to the involvement of multiple organs, including eyes. These lesions are often associated with local lymphadenopathy, which may be tender. The infection leads to the formation of an erythematous papule at the inoculation site, and later the lesion erodes to form a painless ulcer. Its incubation period is long, about 4 weeks to three months. Its limited outer membrane polysaccharides and few surface proteins make it difficult for the immune system to identify and fight the infection quickly. Initial infection with the spirochete evokes both a humoral and cellular immune response in the body. Humans are the only hosts of the organism, and there is no animal reservoir of Treponema pallidum, so the disease only spreads via human to human transmission. The disease is often difficult to diagnose and has more serious effects in patients with AIDS (acquired immunodeficiency syndrome). Syphilis is also common in patients co-infected with human immunodeficiency virus (HIV). It was estimated that in 2018, men accounted for approximately 86% of all cases of syphilis in the U.S. In the U.S., approximately 55,400 people are infected newly each year. Since early 2000, rates of syphilis have been increasing in the U.S., Australia, and Europe, primarily among men who have sex with men. The disease, however, declined rapidly during the early and mid-20th century with the widespread use of antibiotics. Syphilis continued to spread and was rampant in Europe during the 18th and 19th centuries. The first documentation of an outbreak of syphilis occurred in the late 15th century in Italy. The origin of syphilis has been debated for centuries. There are two hypotheses: the first one hypothesizes that syphilis was carried to Europe from America by the crew of famous sailor Christopher Columbus while the second one proposes that the disease existed in Europe since the Hippocratic era but was often misdiagnosed and went unrecognized. These two theories are referred to as the "Columbian" and "pre-Columbian" hypotheses of the origin of syphilis. The disease can be treated effectively with appropriate antibiotic therapy. Diagnosis is based on clinical exam with serological tests. Ocular manifestations can be associated with neurosyphilis. Ocular syphilis, if untreated, may lead to blindness. Other common manifestations include interstitial keratitis, recurrent anterior uveitis, retinal vasculitis, and optic neuropathy. Syphilis can involve almost any ocular structure, but posterior uveitis and panuveitis are the most common presentations. Ocular manifestations can occur at any stage of the disease with varied clinical presentations because of which the disease is also known as the great imitator, as it can mimic a number of ocular diseases. Transplacental spread leads to congenital syphilis. The disease is most commonly transmitted sexually, and its clinical course is divided into primary, secondary, latent, and tertiary syphilis. The disease acquired its current name, syphilis, from the title character of a poem written by Italian physician and poet Girolamo Fracastoro, describing the havoc of the disease in his country in 1530. Syphilis was initially called the "French disease" by the people of Naples as they claimed that the disease was spread by French troops during the French invasion in the late 15th century.
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