In this study, the skeleton of an approximately 15-year-old child, dating back to the Late Byzantine period (13th century AD) is examined with the aim of determining where this specimen fits in the continuing arguments on the origins of syphilis. It was unearthed during an excavation at an amphitheatre in Nicaea dating to the Roman period. The Nicaea specimen displays common symptoms found in the majority of people with congenital syphilis such as Hutchinson's incisor, mulberry molar, darkened enamel, radial scar on frontal bone, sabre tibia, syphilitic dactylitis, and gummatous and non-gummatous osteomyelitis on almost every post-cranial bone. Because of the sub-periosteal new bone formation, the medullary spaces in some long bones are narrowed or completely obliterated. These lesions, which were observed via macroscopic and radiological examination, reflect the late stages of congenital syphilis. The specimen, when examined together with increasing numbers of other finds from the Old World, contributes to the argument that venereal syphilis did exist in the Old World before 1493, and brings forward the need to revise the Columbian hypothesis, which maintains that syphilis is a new disease carried to the Old World from the New World by Columbus' crew. Copyright © 2005 John Wiley & Sons, Ltd.