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PART 1. CASE DEFINITIONS1 FOR NATIONALLY NOTIFIABLE INFECTIOUS DISEASESChancroid (Revised 9/96) Clinical description A sexually transmitted disease characterized by painful genital ulceration and inflammatory inguinal adenopathy. The disease is caused by infection with Haemophilus ducreyi. Laboratory criteria for diagnosis
Case classification Probable: a clinically compatible case with both a) no evidence of Treponema pallidum infection by darkfield microscopic examination of ulcer exudate or by a serologic test for syphilis performed 7 days after onset of ulcers and b) either a clinical presentation of the ulcer(s) not typical of disease caused by herpes simplex virus (HSV) or a culture negative for HSV. Confirmed: a clinically compatible case that is laboratory confirmed Chlamydia trachomatis, Genital Infections (Revised 9/96) Clinical description Infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, acute salpingitis, or other syndromes when sexually transmitted; however, the infection is often asymptomatic in women. Perinatal infections may result in inclusion conjunctivitis and pneumonia in newborns. Other syndromes caused by C. trachomatis include lymphogranuloma venereum (see Lymphogranuloma Venereum) and trachoma. Laboratory criteria for diagnosis
Case classification Confirmed: a case that is laboratory confirmed Gonorrhea (Revised 9/96) Clinical description A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis. Infection may be asymptomatic. Laboratory criteria for diagnosis
Case classification Probable: a) demonstration of gram-negative intracellular diplococci in an endocervical smear obtained from a female or b) a written morbidity report of gonorrhea submitted by a physician Confirmed: a case that is laboratory confirmed Syphilis (All Definitions Revised 9/96) 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
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
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
Case classification Probable: a clinically compatible case with a nontreponemal (VDRL or RPR) titer 4 Confirmed: a clinically compatible case that is laboratory confirmed 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:
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 (see Syphilis, latent) 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:
Syphilis, late latent Clinical description A subcategory of latent syphilis. When initial infection has occurred 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 ≥ 32 Neurosyphilis Clinical description Evidence of central nervous system infection with T. pallidum Laboratory criteria for diagnosis
Case classification Probable: syphilis of any stage, a negative VDRL in CSF, and both the following:
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 description A fetal death that occurs after a 20-week gestation or in which the fetus weighs 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. Syphilis, Congenital (Revised 9/96) Clinical description A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth. An infant or child (aged 2 years) may have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints). Laboratory criteria for diagnosis Demonstration of T. pallidum by darkfield microscopy, fluorescent antibody, or other specific stains in specimens from lesions, placenta, umbilical cord, or autopsy material Case classification Probable: a condition affecting an infant whose mother had untreated or inadequately treated* syphilis at delivery, regardless of signs in the infant, or an infant or child who has a reactive treponemal test for syphilis and any one of the following:
Confirmed: a case that is laboratory confirmed Comment Congenital and acquired syphilis may be difficult to distinguish when a child is seropositive after infancy. Signs of congenital syphilis may not be obvious, and stigmata may not yet have developed. Abnormal values for CSF VDRL, cell count, and protein, as well as IgM antibodies, may be found in either congenital or acquired syphilis. Findings on radiographs of long bones may help because radiographic changes in the metaphysis and epiphysis are considered classic signs of congenitally acquired syphilis. The decision may ultimately be based on maternal history and clinical judgment. In a young child, the possibility of sexual abuse should be considered as a cause of acquired rather than congenital syphilis, depending on the clinical picture. For reporting purposes, congenital syphilis includes cases of congenitally acquired syphilis among infants and children as well as syphilitic stillbirths. *Inadequate treatment consists of any nonpenicillin therapy or penicillin administered 30 days before delivery. 1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 1997;46(No. RR-10;1).
Page last modified: December 13, 2006 Page last reviewed: December 13, 2006 Historical Document Content Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention |
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