The Centenary Series - STIs Through the Ages: The dawn of the syphilis pandemic in the Old World: history and geography of syphilis in the early sixteenth century.

Objective: To describe the first wave of the syphilis pandemic in the Old World.

Methods: Summary and discussion of early and recent literary and documentary data describing the spread of syphilis in Europe at the end of the fifteenth and during the first decades of the sixteenth century.

Results: From the second half of 1493, the spread of a disease that was clearly perceived as being sexually transmitted was the cause of considerable scandal and so much concern as to force Emperor Maximilian I to proclaim that it was the punishment for the sins of the affected as early as August 1495. Considered as new and unprecedented by most contemporaries and appearing just after the return of Columbus' first expedition, a heated controversy concerning the origin of the disease began almost immediately and, despite the findings of phylogenetic studies of Treponema sequences taken from modern specimens and early remains, still continues today. Called by many often nationalistic names (particularly French morbus or Neapolitan disease), syphilis affected millions of people in the early sixteenth century, limiting their reproductive capacity and life expectancy, and greatly reducing their quality of life.

Conclusions: Regardless of its geographical and temporal origins, the characteristics of this true pandemic were typical of those induced by a new pathogen in a virgin population.