Syphilis 2001 a palaeopathological reappraisal

The origin and subsequent spread of the treponematoses, especially that of venereal syphilis, has been the subject of considerable scientific attention. Various theories were put forth and palaeopathological specimens were used for their validation in recent times. One influential contribution was the paper by Baker & Armelagos in 1988. Numerous new findings and results on both sides of the Atlantic call for a new evaluation of the available osseous material. A review of the recent literature leads to the suggestion of a worldwide distribution of non-venereal treponemal disease since the emergence of Homo and to a first epidemic outbreak of venereal syphilis in Europe of the late 15th and the early 16th century, which was a time of change and enormous sexual liberty. Old World specimens with pathological alterations attributed to venereal syphilis and dated to precolumbian times seem to invalidate the Columbian theory and call for a more differentiated analysis of the phenomenon of syphilis than a theory based on a single factor can provide. With the help of molecular methods which now allow a positive identification of Treponema pallidum pallidum, causative agent of venereal syphilis, in palaeopathological material, it seems possible to elucidate the matter of origin and spread of syphilis further and to evaluate previous diagnoses of treponemal disease.     

Syphilis as a chronic systemic infection

During the last STDs'epidemic in Russia (1994 - 2004) over 2.7 min people have been infected with syphilis. At present the structure of syphilis morbidity is characterized by 37% of latent forms, including 1.5% late latency. The increased level of late latency may result from: an ever-growing number of those with asymptomatic syphilis; disorderly and self-dependent usage of antibacterial preparations; spread of the virus chronic infections (herpes, hepatitis B, C) altering the macroorganism immune response; alcohol and drug abuse which decreases the efficacy of specific therapy. In general, chronization of the syphilitic infection may be caused by antigenically inert treponemal cell surface; paucity of outer membrane protein; residence of treponemas within an immunoprotective niche; uncompleted phagocytosis of treponemes with macrophages. Syphilis remains an "infectio magna" and demands thorough attention to all diagnostic and therapeutic procedures on every stage of the disease.