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Misclassification of the stages of syphilis: Implications for
surveillance.
Sexually Transmitted Diseases 2005;32(3):144-149.
Peterman TA, Kahn RH, Ciesielski CA, Ortiz-Rios E, Furness BW, Blank
S, Schillinger JA, Gunn RA, Taylor M, Berman SM.
Abstract
SHORT SUMMARY: Syphilis cases were reviewed to see if reported stages met the
Centers for Disease Control and Prevention case definition. Classification
was excellent for primary and secondary and good for late latent, but half
of early latent and unknown duration were misclassified. New surveillance
definitions are suggested, comments requested. BACKGROUND: Uncertainty when
staging latent syphilis should lead clinicians to call it late latent (requires
more treatment) and disease investigators to call it early latent (priority
for partner investigation). Accurate surveillance requires consistent case
definitions. OBJECTIVE: Assess validity of reported syphilis stages. METHODS:
Record reviews in 6 jurisdictions to determine if reported cases met the
Centers for Disease Control and Prevention case definitions. RESULTS: Nine
hundred seventy-three records from 6 jurisdictions in 2002 showed excellent
agreement for reported primary (94.0%) and secondary (95.4%), good agreement
for late latent (80.2%), and poor agreement for early latent (48.4%) and
unknown duration (49.7%). Unknown duration (age < or =35 and nontreponemal
test titer > or =32) was often misinterpreted to mean "not known." Early
latent (within the past year, documented: seroconversion, fourfold titer
increase, symptoms, or contact with an independently documented early syphilis
case) was often misinterpreted to include patients with risky behavior, young
age, or high nontreponemal test titers. CONCLUSIONS: The unknown duration
stage should be dropped. Surveillance of latent syphilis would be more consistent
if cases were reported as having high or low titers on nontreponemal test.
Alternative approaches are solicited from readers.