Treponemal Disease Revisited: Skeletal Discriminators for Yaws, Bejel, and Venereal Syphilis

Abstract

Assigning responsibility for the origins of treponemal disease has been complicated because of the (diagnostic) impreciseness of the historical written record and the inability to microbiologically distinguish among the treponematoses. Bedouin skeletal remains of individuals from the Negev area of Israel who had bejel, skeletons from the Todd human skeleton collection of individuals in whom syphilis was diagnosed, and skeletal remains from Guam of individuals who had yaws were analyzed to quantitatively assess their skeletal damage. The osseous reactions, although reproducible for each variety of treponemal disease, are not uniform among these skeletons. Examination of population frequency, demographics, character, and skeletal distribution of osseous treponemal damage in these skeletal sites provides clear, reproducible clues to the identity of the underlying treponematosis: bejel and yaws are common (> 20% according to skeletal findings) in the population. Syphilis and bejel usually spare the hands and feet. Yaws tends to be more polyostotic. Analysis of these parameters as population phenomena in pre-Columbian archeological sites should afford the opportunity to define the origins of the various treponemal disorders.

Yaws Osteoperiostitis Treated with Single-Dose Azithromycin

“…4 To explain those findings it was hypothesized that infection of the bone in yaws could be due to direct extension from skin lesions, whereas the spread of syphilis is predominantly hematogenous. 5 However, contemporary cases of yaws including the case presented here show that *Address correspondence to Oriol Mitjà, Department of Community Health, Lihir Medical Center, P.O. Box 34, Lihir Island, New Ireland Province, Papua New Guinea.…”

Is Bony Evidence of Enthesial Reaction Sufficient for Differential Diagnosis?

“…Diagnosis of Diffuse idiopathic skeletal hyperostosis (DISH) was based on ligamentous bridging of at least four contiguous thoracic vertebra in the absence of zygapophyseal joint erosions or fusion [4,46]. Diagnoses of renal disease and syphilis were based on the medical records component of the Hamman-Todd Collection [42,44]. Diagnosis of hypertrophic osteoarthritis was based on classic distal diaphyseal periosteal reaction in individution.…”

“…The healthy individual sample was selected on the basis of order of incorporation (date of death) into the collection, contemporaneous to that of the examined individuals with documented rheumatoid arthritis, spondyloarthropathy, calcium pyrophosphate deposition disease, diffuse idiopathic and skeletal hyperostosis. Given the association of enthesial reaction with renal bone disease (hyperparathyroidism and osteomalacia) [41,42], hypertrophic osteoarthropathy [43], and syphilis [4,14,44], individuals with those diagnoses were excluded from the comparative sample designated as healthy. The health of the individuals studied was not distinguishable from that of contemporary living populations [31,45].…”

First European Exposure to Syphilis: The Dominican Republic at the Time of Columbian Contact

“…Treponemal disease was specifically recognized on the basis of the periosteal reaction and osteitis [14,[20][21][22][23][24][25][26][27]. The technique for distinguishing the periosteal reaction from taphonomic changes was validated through entropy studies [28], which allowed it to be clearly distinguished from postmortem damage.…”

“…Demonstration that the macroscopically recognizable skeletal manifestations of syphilis, yaws, and bejel are also quite disparate as population phenomena [14], and reproducible across population lines [4,15,16], allows a unique approach to assessment of the role of Columbus in syphilis transmission.…”