Syphilis was perceived to be a new disease in Europe in the late 15th century, igniting a debate about its origin that continues today in anthropological, historical, and medical circles. We move beyond this age-old debate using an interdisciplinary approach that tackles broader questions to advance the understanding of treponemal infection (syphilis, yaws, bejel, and pinta). How did the causative organism(s) and humans co-evolve? How did the related diseases caused by Treponema pallidum emerge in different parts of the world and affect people across both time and space? How are T. pallidum subspecies related to the treponeme causing pinta? The current state of scholarship in specific areas is reviewed with recommendations made to stimulate future work. Understanding treponemal biology, genetic relationships, epidemiology, and clinical manifestations is crucial for vaccine development today and for investigating the distribution of infection in both modern and past populations.Paleopathologists must improve diagnostic criteria and use a standard approach for recording skeletal lesions on archaeological human remains. Adequate contextualization of cultural and environmental conditions is necessary, including site dating and justification for any corrections made for marine or freshwater reservoir effects. Biogeochemical analyses may assess aquatic contributions to diet, physiological changes arising from treponemal disease and its treatments (e.g., mercury), or residential mobility of those affected. Shifting the focus from point of origin to investigating who is affected (e.g., by age/sex or socioeconomic status) and disease distribution (e.g., coastal/ inland, rural/urban) will advance our understanding of the treponemal disease and its impact on people through time. K E Y W O R D S archaeological biogeochemistry,

The frequency and age distribution of linear enamel hypoplasia (LEH) in the dentition of 293 individuals from Latte Period sites (AD 800-1521) on Guam, Mariana Islands, are examined in this study. Individuals dying as subadults (before age 16) and as young adults (ages 16-21) have more frequent LEHs than those who survived to middle or late adulthood, documenting a relationship between LEH-causing stress events and reduced life expectancy. The age distributions of cribra orbitalia and skeletal infection in children who died by age 10 exhibit striking similarities to the etiological age patterns of LEH in children, and those with skeletal infection have more frequent hypoplasias than children without infection. The comorbidity of systemic stress and infection in children, and their impact on life expectancy, are interpreted in the biocultural context of high population density in the large coastal villages of the late prehistoric period in the Marianas.

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