Syphilis is a
complex sexually transmitted disease
that has a highly variable clinical
course. Classification by a
clinician with expertise in syphilis
may take precedence over the
following case definitions developed
for surveillance purposes.
Syphilis, primary
Clinical description:
A
stage of infection with
Treponema pallidum
characterized by one or more
chancres (ulcers); chancres might
differ considerably in clinical
appearance.
Laboratory criteria
for diagnosis:
Demonstration of
T. pallidum in clinical
specimens by darkfield microscopy,
direct fluorescent antibody
(DFA-TP), or equivalent methods.
Case
classification:
-
Probable:
a clinically compatible case with
one or more ulcers (chancres)
consistent with primary syphilis
and a reactive serologic test
(nontreponemal: Venereal Disease
Research Laboratory [VDRL] or
rapid plasma reagin [RPR];
treponemal: fluorescent treponemal
antibody absorbed [FTA-ABS] or
microhemagglutination assay for
antibody to T. pallidum
[MHA-TP])
-
Confirmed:
a clinically compatible case that
is laboratory confirmed
Syphilis,
secondary
Clinical
description:
A stage of
infection caused by T. pallidum
and characterized by localized or
diffuse mucocutaneous lesions, often
with generalized lymphadenopathy.
The primary chancre may still be
present.
Laboratory
criteria for diagnosis:
Demonstration of
T. pallidum in clinical
specimens by darkfield microscopy,
DFA-TP, or equivalent methods
Case
classification:
Syphilis, latent
Clinical
description:
A stage of
infection caused by T. pallidum
in which organisms persist in
the body of the infected person
without causing symptoms or signs.
Latent syphilis is subdivided into
early, late, and unknown categories
based on the duration of infection.
Case
classification:
Probable:
no clinical signs or symptoms of
syphilis and the presence of one of
the following:
-
No past
diagnosis of syphilis, a reactive
nontreponemal test (i.e., VDRL or
RPR), and a reactive treponemal
test (i.e., FTA-ABS or MHA-TP)
-
A past history
of syphilis therapy and a current
nontreponemal test titer
demonstrating fourfold or greater
increase from the last
nontreponemal test titer
Syphilis, early
latent
Clinical
description:
A subcategory of
latent syphilis. When initial
infection has occurred within the
previous 12 months, latent syphilis
is classified as early latent.
Case
classification:
Probable:
latent syphilis in a person who has
evidence of having acquired the
infection within the previous 12
months based on one or more of the
following criteria:
-
Documented
seroconversion or fourfold or
greater increase in titer of a
nontreponemal test during the
previous 12 months
-
A history of
symptoms consistent with primary
or secondary syphilis during the
previous 12 months
-
A history of
sexual exposure to a partner who
had confirmed or probable primary
or secondary syphilis or probable
early latent syphilis (documented
independently as duration less
than 1 year)
-
Reactive
nontreponemal and treponemal tests
from a person whose only possible
exposure occurred within the
preceding 12 months
Syphilis, late
latent
Clinical
description:
A subcategory of
latent syphilis. When initial
infection has occurred greater than
1 year previously, latent syphilis
is classified as late latent.
Case
classification:
Probable:
latent syphilis (see Syphilis,
latent) in a patient who has no
evidence of having acquired the
disease within the preceding 12
months (see Syphilis, early latent)
and whose age and titer do not meet
the criteria specified for latent
syphilis of unknown duration.
Syphilis, latent,
of unknown duration
Clinical
description:
A subcategory of
latent syphilis. When the date of
initial infection cannot be
established as having occurred
within the previous year and the
patient's age and titer meet
criteria described below, latent
syphilis is classified as latent
syphilis of unknown duration.
Case
classification:
-
Probable:
latent syphilis (see Syphilis,
latent) that does not meet the
criteria for early latent
syphilis, and the patient is aged
13-35 years and has a
nontreponemal titer greater than
or equal to 32
Neurosyphilis
Clinical
description:
Evidence of
central nervous system infection
with T. pallidum
Laboratory criteria
for diagnosis:
A reactive
serologic test for syphilis and
reactive VDRL in cerebrospinal fluid
(CSF)
Case
classification:
Probable:
syphilis of any stage, a negative
VDRL in CSF, and both the following:
-
Elevated CSF
protein or leukocyte count in the
absence of other known causes of
these abnormalities
-
Clinical
symptoms or signs consistent with
neurosyphilis without other known
causes for these clinical
abnormalities
Confirmed:
syphilis of any stage that meets the
laboratory criteria for
neurosyphilis
Syphilis, late,
with clinical manifestations other
than neurosyphilis (late benign
syphilis and cardiovascular
syphilis)
Clinical
description:
Clinical
manifestations of late syphilis
other than neurosyphilis may include
inflammatory lesions of the
cardiovascular system, skin, and
bone. Rarely, other structures
(e.g., the upper and lower
respiratory tracts, mouth, eye,
abdominal organs, reproductive
organs, lymph nodes, and skeletal
muscle) may be involved. Late
syphilis usually becomes clinically
manifest only after a period of
15-30 years of untreated infection.
Laboratory
criteria for diagnosis:
Demonstration of
T. pallidum in late lesions
by fluorescent antibody or special
stains (although organisms are
rarely visualized in late lesions)
Case
classification:
-
Probable:
characteristic abnormalities or
lesions of the cardiovascular
system, skin, bone, or other
structures with a reactive
treponemal test, in the absence of
other known causes of these
abnormalities, and without CSF
abnormalities and clinical
symptoms or signs consistent with
neurosyphilis
-
Confirmed:
a clinically compatible case that
is laboratory confirmed
Comment:
Analysis of
CSF for evidence of neurosyphilis is
necessary in the evaluation of late
syphilis with clinical
manifestations.
Syphilitic
Stillbirth
Clinical case
definition:
A fetal death
that occurs after a 20-week
gestation or in which the fetus
weighs greater than 500 g and the
mother had untreated or inadequately
treated* syphilis at delivery
Comment:
For reporting
purposes, syphilitic stillbirths
should be reported as cases of
congenital syphilis.
*Inadequate
treatment consists of any
non-penicillin therapy or penicillin
given less than 30 days before
delivery.
