The Origin and Antiquity of Syphilis: Paleopathological Diagnosis and Interpretation

A review of the literature strongly suggests a New World origin of the treponemal infections. The alleged epidemic resulted from the recognition of syphilis as a separate disease in the 1490s. Urbanization, beginning in Mesopotamia and Egypt by 4000 b.c., was accompanied by an improvement in personal and community hygiene. Venereal syphilis has an incubation period of 10-90 days before the primary lesion appears in the anogenital region. Since asymptomatic bone lesions often go undetected in early syphilis, skeletal involvement may be underestimated. Skeletal involvement in venereal syphilis most often affects the cranial vault, the nasal area, and the tibia. Postcranially, formation of subperiosteal bone begins in the metaphyses of the long bones, with the tibiae being most often involved. Inflammation of the entire periosteum initiates a subperiosteal response resulting in thickening and possible bone deformation. Skeletal series in areas in which either endemic syphilis or yaws occurs are expected to reveal bone lesions in approximately 1-5% of entire series.