Higoumenakis' sign in the diagnosis of congenital syphilis in anthropological specimens

Abstract

Higoumenakis' sign (HS) is a diagnostic criterion referring to the enlargement of the sternal end of the (right) clavicle, frequently observed in patients with late congenital syphilis. Although indexed for several years in clinical medicine textbooks, it has not been extensively applied for the diagnosis of congenital syphilis among anthropological specimens. This is highly significant, since the other major palaeopathology findings refer almost exclusively to the skull and diagnosis thus becomes difficult if only peripheral skeletal remains are available for evaluation. The potential effectiveness of the proposed use of HS as a marker of syphilis in anthropology appears adequate, since descriptions very similar to that of HS have been reported for certain findings, although no attempt has been made to correlate them with the presence of the disease. Higoumenakis himself originally observed this sign in 86% of his patients with congenital syphilis, and this report was subsequently verified by other independent researchers. His attempt to explain the pathophysiology of the sign and its localisation, on the basis of anatomical, biological, and mechanical reasons, however, has been questioned. On the other hand, the application of the remaining markers of congenital syphilis is also problematic, due to sensitivity and/or specificity limitations, and other signs may not be detected due to inability to retain soft tissue samples in anthropological populations and a lack of reliable techniques for treponematous DNA amplification in such old samples. Thus, the fact that the onset of any of the signs of syphilis is not a constant finding justifies the authors' suggestion that HS should be checked for in any available anthropological specimen, because it is highly indicative of possible infection by Treponema pallidum.