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Recent studies suggest that acquired syphilis evolved in the Old World from a non-sexually transmitted treponeme originating in the New World during early European expansion and colonization. However, when and via which route the bacteria were introduced into Asia remains uncertain. This study examined the first paleopathological evidence of syphilitic infection in an individual from the 19th century AD in South Korea. The individuals from a site identified as the middle and late Joseon period were examined for the presence of the skeletal lesions that are indicative of an acquired syphilitic infection. Direct macroscopic observation of the skeletal remains was conducted alongside radiological analysis. One individual displayed extensive pathologies throughout the cranial and postcranial skeleton. Treponematosis is the only disease that best explains the pattern of lytic cranial lesions and widespread bilateral symmetrical periosteal new bone of the postcranial elements. To date, paleopathological evidence of treponemal disease in Asia is severely limited. In this regard, this study provides meaningful data for studying the history of infectious disease in Asia. This study represents the only known archaeological case in South Korea.

Syphilitic infection in a pre-modern population from South Korea (19th century AD)