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We move beyond this age\u2010old 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\u2010evolve? How did the related diseases caused by <jats:italic>Treponema pallidum<\/jats:italic> emerge in different parts of the world and affect people across both time and space? How are <jats:italic>T. pallidum<\/jats:italic> 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.<\/jats:p>","DOI":"10.1002\/ajpa.23988","type":"journal-article","created":{"date-parts":[[2020,1,20]],"date-time":"2020-01-20T05:32:09Z","timestamp":1579498329000},"page":"5-41","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Advancing the understanding of treponemal disease in the past and present"],"prefix":"10.1002","volume":"171","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9277-7815","authenticated-orcid":false,"given":"Brenda J.","family":"Baker","sequence":"first","affiliation":[{"name":"School of Human Evolution and Social Change Arizona State University  Tempe Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian","family":"Crane\u2010Kramer","sequence":"additional","affiliation":[{"name":"Department of Anthropology State University of New York at Plattsburgh  Plattsburgh New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3116-453X","authenticated-orcid":false,"given":"Michael W.","family":"Dee","sequence":"additional","affiliation":[{"name":"Centre for Isotope Research University of Groningen  Groningen Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6608-7709","authenticated-orcid":false,"given":"Lesley A.","family":"Gregoricka","sequence":"additional","affiliation":[{"name":"Department of Sociology, Anthropology, and Social Work University of South Alabama  Mobile Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1941-2286","authenticated-orcid":false,"given":"Maciej","family":"Henneberg","sequence":"additional","affiliation":[{"name":"Biological Anthropology and Comparative Anatomy Unit, Adelaide Medical School University of Adelaide  Adelaide Australia"},{"name":"Institute of Evolutionary Medicine University of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anthropology California State University Los Angeles  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9778-3301","authenticated-orcid":false,"given":"Sheila A.","family":"Lukehart","sequence":"additional","affiliation":[{"name":"Department of Medicine\/Infectious Diseases and Global Health University of Washington  Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0031-8276","authenticated-orcid":false,"given":"David C.","family":"Mabey","sequence":"additional","affiliation":[{"name":"Communicable Diseases London School of Hygiene &amp; Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2259-807X","authenticated-orcid":false,"given":"Charlotte A.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Archaeology Durham University  Durham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann L. 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