Treponemal disease revisited: skeletal discriminators for yaws, bejel, and venereal syphilis

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.