An Iron Age (megalithic) skull recovered from a cist burial complex at Agripalle, Andhra Pradesh, India, exhibits extensive erosion of the calvarium, areas of sclerotic diploe, irregular osteitic and periosteitic lesions, and deep ulcerations with a granulomatous appearance of nodular foci due to bone remodeling. These lesions are found over the entire surface, but are less severe in the temporal region and in the occipital region below lambda. There is extensive ulceration and destruction of the orbital roof and the nasopalatine region. A thick bony mass representing a healed lesion is present on the nasal margin. Comparison with the pathologic skeletal series of Ortner and Putschar ([1981] Smithson. Contrib. Anthropol. 28:180–218), Steinbock ([1976] Paleopathology: Diagnosis and Interpretation, pp. 86–169), and Calvin ([1964] Bones and Disease: Evidence of Disease and Abnormality in Early Man) indicates that these findings warrant a diagnosis of an advanced stage of treponematosis. The material from Agripalle, together with similar specimens recovered from the sites of Bhimbetka (Iron Age) and Inamgaon (Chalcolithic), furnish additional evidence supporting the hypothesis of the prehistoric antiquity of treponemal disease in both the New and Old Worlds.