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.
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The characteristic lesion of primary syphilis is the chancre, but atypical primary lesions may occur.
Demonstration of Treponema pallidum in clinical specimens by darkfield, fluorescent antibody, or equivalent microscopic methods
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
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.
Demonstration of T. pallidum in clinical specimens by darkfield, fluorescent antibody, or equivalent microscopic methods
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
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.
Presumptive: no clinical signs or symptoms of syphilis and the presence of one of the following:
A subcategory of latent syphilis. When initial infection has occurred within the previous 12 months, latent syphilis is classified as early.
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 subcategory of latent syphilis. When initial infection has occurred greater than 1 year previously, latent syphilis is classified as late.
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
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.
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
Evidence of CNS infection with Treponema pallidum
A reactive serologic test for syphilis and reactive VDRL in cerebrospinal fluid (CSF)
Presumptive: syphilis of any stage, a negative VDRL in CSF, and both of the following:
Confirmed: syphilis, of any stage, that meets the laboratory criteria for neurosyphilis
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
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