The Puzzle of Syphilis: A Literature Review on Putting the Pieces Together

As culture changes, so does disease. This change has been seen in a variety of diseases, but none are so hotly debated and researched as the treponematoses, the four diseases related to and including venereal syphilis. There have been decades of debate on every aspect of syphilis: where it came from, who gave it to whom, how it evolved, and what the distribution was at various points in time. Herein, the four types of treponematoses will be examined along with the clinical pathology of each. The skeletal evidence will be examined carefully, taking into account the distribution of lesions for each of the treponematoses in order to discern whether they can be distinguished. The debate over the Columbian/pre-Columbian origin of venereal syphilis will be discussed, along with the equally rampant debate over the unitarian/nonunitarian hypotheses for the evolution of the disease. In order to draw conclusions on the origin of the treponematoses, the area of first contact between Spanish explorers and the New World inhabitants will be examined. Next, the problem of differential diagnoses will be discussed, followed by the examination of DNA techniques being employed to trace the origins and distribution of the treponematoses. From the beginning of its recognition as a disease of humans, debate has surrounded syphilis and its cousins, making it one of the most argued over diseases in human history. Syphilis has long held a place in the forefront of researchers‟ minds in various disciplines: medical anthropology, paleopathology, epidemiology, virology, and DNA research. Because of the mysterious beginnings and often virulent pathology, decades of debate and ideas about the disease have gained more and less popularity in scientific fields. Unfortunately, there is still no clear winner to any of the debates. For all the research that has been done, more questions arise. What is the ultimate origin of the treponematoses? Is it a single disease manifesting itself in different ways based on location and social standards? Is it a quartet of closely related syndromes that evolved their virulence in their respective environments? These and other questions will be examined through many different aspects of research