The 81st Annual Meeting of the American Association of Physical Anthropologists (2012)


Overall health and the pathophysiology of tertiary syphilis

MOLLY K. ZUCKERMAN1 and GEORGE J. ARMELAGOS2.

1Department of Anthropology and Middle Eastern Cultures, Mississippi State University, 2Department of Anthropology, Emory University

Friday 8:45-9:00, Parlors Add to calendar

While many of the long-standing historico-scientific questions about syphilis approach resolution, several of the disease’s compelling mysteries remain, including that of why its manifestations, particularly the destructive, dangerous (and skeletally identifiable) ones associated with tertiary stage disease vary so greatly between individuals. Investigations largely ground to a halt with the antibiotic era and due to the pathogen’s resistance to being cultured, much about its pathogenesis and virulence mechanisms remains unknown. As several pre-antibiotic era studies suggested a destructive synergistic relationship between syphilis and other sources of morbidity, this study assesses potential associations between skeletal indicators of overall health, specifically linear enamel hypoplasias (LEH), periodontal disease, and caries, and the presence of tertiary infection, and, in individuals with tertiary infection, the extent of tertiary manifestations and the type of syphilitic lesions expressed. Results from an analysis of syphilitic (N=24) and non-syphilitic, control skeletons (N=160) from multiple late medieval English samples suggest that the pathophysiology of syphilis varies in relation to overall health. Specifically, significant co-variation between the presence of LEH and syphilis aligns with other studies demonstrating that early life experiences may play a critical role in creating differential susceptibility to chronic disease in later life, though the causal mechanism here remains ambiguous. In addition to informing paleoepidemiological studies on the heterogeneity of frailty, given the increased global incidence of syphilis, these findings are potentially germane to contemporary public health; even with modern diagnostic capabilities, variation in the presentation of syphilis can greatly impede diagnosis and treatment.

At the time of this work, the first author was a National Science Foundation Pre-doctoral fellow. Support was also provided by the Laney Graduate School of Arts and Sciences, Emory University.

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