Syphilis (Treponema pallidum)

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1990 Case Definition

Syphilis is a complex, sexually transmitted disease with 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.

Primary Syphilis

Clinical description

The characteristic lesion of primary syphilis is the chancre, but atypical primary lesions may occur.

Laboratory criteria for diagnosis

• Demonstration of Treponema pallidum in clinical specimens by darkfield, fluorescent antibody, or equivalent microscopic methods

Case classification

Probable: a clinically compatible case with one or more ulcers (chancres) consistent with primary syphilis and a reactive serologic test

Confirmed: a clinically compatible case that is laboratory confirmed

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Secondary Syphilis

Clinical description

A stage of infection due to Treponema pallidum, characterized by localized or diffuse mucocutaneous lesions and generalized lymphadenopathy. Constitutional symptoms are common, and clinical manifestations are protean. The primary chancre may still be present.

Laboratory criteria for diagnosis

• Demonstration of T. pallidum in clinical specimens by darkfield, fluorescent antibody, or equivalent microscopic methods

Case classification

Probable: a clinically compatible case with a reactive nontreponemal (VDRL, RPR) test titer of greater than or equal to 4

Confirmed: a clinically compatible case that is laboratory confirmed

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Latent Syphilis

Clinical description

A stage of infection due to Treponema 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 syphilis categories based upon the length of elapsed time from initial infection.

Case classification

Presumptive: no clinical signs or symptoms of syphilis and the presence of one of the following:

• No past diagnosis of syphilis and a reactive nontreponemal test, and a reactive treponemal (fluorescent treponemal antibody-absorbed [FTA-ABS], microhemagglutination assay for antibody to Treponema pallidum [MHA-TP]) test
• A past history of syphilis therapy and a current nontreponemal test titer demonstrating fourfold or greater increase from the last nontreponemal test titer

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Early Latent Syphilis

Clinical description

A subcategory of latent syphilis. When initial infection has occurred within the previous 12 months, latent syphilis is classified as early.

Case classification

Presumptive: latent syphilis (see above) of a person who has evidence of having acquired the infection within the previous 12 months based on one or more of the following criteria:

• A nonreactive serologic test for syphilis or a nontreponemal titer that has dropped fourfold within the past 12 months
• A history of symptoms consistent with primary or secondary syphilis without a history of subsequent treatment in the past 12 months
• A history of sexual exposure to a partner with confirmed or presumptive primary or secondary syphilis, or presumptive early latent syphilis, and no history of treatment in the past 12 months
• Reactive nontreponemal and treponemal tests from an individual whose only possible exposure occurred within the preceding 12 months

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Late Latent Syphilis

Clinical description

A subcategory of latent syphilis. When initial infection has occurred greater than 1 year previously, latent syphilis is classified as late.

Case classification

Presumptive: latent syphilis (see above) of a patient who shows no evidence of having acquired the disease within the past 12 months (see Early Latent Syphilis) and whose age and titer do not meet the criteria specified for unknown latent syphilis

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Unknown Latent Syphilis

Clinical description

A subcategory of latent syphilis. When the date of initial infection cannot be established as occurring within the previous year, and the patient's age and titer meet criteria described below, latent syphilis is classified as unknown latent.

Case classification

Presumptive: latent syphilis (see above) that does not meet the criteria for early latent syphilis, and the patient is 13-35 years of age with a nontreponemal test serologic titer of greater than or equal to 32

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Neurosyphilis

Clinical description

Evidence of CNS infection with Treponema pallidum

Laboratory criteria for diagnosis

• A reactive serologic test for syphilis and reactive VDRL in cerebrospinal fluid (CSF)

Case classification

Presumptive: syphilis of any stage, a negative VDRL in CSF, and both of 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

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Syphilitic Stillbirth

Clinical case definition

A fetal death that occurs after a 20-week gestation or in which the fetus weighs greater than 500g, 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. return

See also:

• 1996 Case Definition

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This page last updated January 9, 2008

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