In 2015, Cuba became the first country to eliminate mother-to-child transmission of syphilis. History Paleopatholgists have known for decades that syphilis was present in the Americas before European contact. The situation in Europe and Afro-Eurasia has been murkier and caused considerable debate. According to the Columbian theory, syphilis was brought to Spain by the men who sailed with Christopher Columbus in 1492 and spread from there, with a serious epidemic in Naples beginning as early as 1495. Contemporaries believed the disease sprang from American roots, and in the sixteenth century physicians wrote extensively about the new disease inflicted on them by the returning explorers. Most historians and paleopathologists initially accepted the Columbian theory, but over several decades beginning in the 1960s examples of probable treponematosis—the parent disease of syphilis, bejel, and yaws—in skeletal remains have shifted opinion. As a result the pre-Columbian hypothesis is now more widely accepted. It argues that treponemal disease in the form of bejel and yaws was a common childhood ailment in Europe and Afro-Eurasia beginning in ancient times. Largely benign if still unpleasant, infections occurred among the young, transmitted via shared drinking vessels or bedding with only a small bacterial load. In adulthood, people infected as children had a certain degree of immunity that prevented serious symptoms upon reinfection. Once living conditions began to change with urbanization, however, and certain more elite social groups separated themselves from their inferiors and regularly practiced better hygiene, treponematosis was driven out of the age group in which it had become endemic. It then began to appear in adults as syphilis. Because they had never been exposed as children, they were not able to fend off serious illness. Spreading the disease via sexual contact also led to victims being infected with a massive bacterial load from open sores on the genitalia. Adults in higher socioeconomic groups then became very sick with painful and debilitating symptoms lasting for decades. Often they died of the disease, as did their children who were infected with congenital syphilis. The difference between rural and urban populations was first noted by Ellis Herndon Hudson, a clinician who published extensively about the prevalence of treponematosis, including syphilis, in times past. The importance of bacterial load was first noted by the physician Ernest Grin in 1952 in his study of syphilis in Bosnia. The most compelling evidence for the validity of the pre-Columbian hypothesis is the presence