CS Webinar Questions
Answers to Questions from "The Revised Congenital Syphilis Report Form - What's New, Why, and How to Use It"
1. Can polymerase chain reaction (PCR) be used to confirm a case of congenital syphilis?
No, the surveillance case definition for congenital syphilis (revised September 1996) does not currently include PCR evidence.
2. Should the CSF VDRL be considered diagnostic of CS?
A reactive CSF VDRL in an infant/child supports the diagnosis of CS, but does not by itself establish the diagnosis of CS. A negative CSF FTA-ABS result makes the diagnosis of neurosyphilis highly unlikely, but a reactive CSF FTA-ABS does not indicate neurosyphilis (please see STD Treatment Guidelines).
3. What is an "equivocal" test for HIV?
Infection with HIV is diagnosed in two steps.
- A sensitive screening test detects antibodies to HIV, but can yield false-positive results.
- A confirmatory test must then be performed. A Western blot can be used to confirm a positive screening test. The Western blot yields a pattern of bands; bands that match a specific standard confirm infection with HIV. If a Western blot has some, but not enough, bands that match that standard, the result can be read as "equivocal" -- neither confirming HIV infection, nor ruling out infection. In such cases, retesting is usually performed, because the patient might have early HIV infection and might be in the process of seroconverting.
The DIS should make every effort to determine the ultimate answer (positive or negative), as effective methods to prevent transmission of HIV from mother-to-child exists.
4. Can the treponemal IgM immunoblot be used to rule out infection with syphilis? If the treponemal IgM is negative, is it safe not to treat the infant?
No, a negative treponemal IgM immunoblot does not rule out infection with syphilis. In asymptomatic infants/children at risk for CS, a positive result only occurs in 4–22% of cases. All available reports on treponemal IgM immunoblots warn against using a negative IgM immunoblot to rule out CS. A negative result does not mean the patient can forego treatment. A positive treponemal IgM immunoblot supports the diagnosis of CS but more evidence is required before a diagnosis can be made.
5. Will a hospital or outside laboratory know to do a darkfield microscopy test if the physician doesn't order the test?
No, the technique uses a wet preparation on a microscope slide, so the treponemes do not survive long (e.g., not long enough for transport to a hospital or outside laboratory). The physician must know what a darkfield microscopy test is, obtain the appropriate specimen, and have the personnel (e.g., trained fluorescent microscopist) and equipment immediately on hand to perform the test.
6. One of the scenarios in the webinar stated an abnormal CSF protein after 30 days of age was >30 mg/dl, yet the footnote on the infant/child algorithm states "40 mg/dl'. Which value is it?
A CSF protein of 40 mg/dl is the correct threshold value for infant/child more than 30 days old. This typographical error has been corrected in the slide set for this webinar available at http://www.cdc.gov/std/program/partners.htm.
Thank you to the participant who noted this typographical error!
7. Can a patient have congenital syphilis if the cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test is negative?
Absolutely, please refer to the surveillance case definition for congenital syphilis in the appendices of the instructions to the revised CS report form and STD Surveillance Report at http://www.cdc.gov/std/stats11/default.htm
8. If a mother has both reactive treponemal and non-treponemal tests, should she be reported as a case of syphilis?
More data are needed to answer this question. If the mother had a chancre or signs of secondary syphilis, then she should be reported as a case of syphilis. If the mother is asymptomatic, whether or not she should be reported as a case depends upon her history of diagnosis and treatment. Please see the surveillance case definitions for syphilis at http://www.cdc.gov/std/stats11/app-casedef.htm#Syphilis
9. If a mother had serologies performed around, but not at, delivery, how should that data be reported?
If maternal serologies were performed within a week of delivery, please mark "at delivery" for Box 14c.
10. If a mother has syphilis, is inadequately treated, and has a stillbirth with defects unrelated to syphilis, should the case be reported as "syphilitic stillbirth"?
The mother had inadequately treated syphilis. If the stillbirth was >500 g or >20 weeks' gestation, the case meets the case definition of "syphilitic stillbirth" and should be reported.
11. For late latent syphilis, what is “adequate” treatment for the mother?
If treatment for late latent syphilis begins 30 or more days prior to delivery, then treatment can be completed less than 30 days before delivery. If treatment is not completed before delivery, the mother would be inadequately treated.
12. If the mother's (or infant's) medical records are not available, will a care provider's oral report suffice?
No, any data reported on the revised CS report form must come from documents containing that data. Public health authorities have the authority to access medical records for public health reasons.
13. What defines an area of "high morbidity" when determining if screening pregnant women at 28–32 weeks and at delivery should be performed?
There is no one solid threshold. Local health jurisdictions should be aware of their baseline prevalence of syphilis (including congenital syphilis), and if they detect an increase in activity, should act accordingly. Analyses have shown cost effectiveness of screening for CS when prevalence of early syphilis (primary, secondary, and early latent syphilis) was as low as 5 per 100,000 females.
14. Where should IV penicillin therapy be recorded?
Use box (22.) and specify "other."
15. How does the form capture prenatal care through the mother's pregnancy — for example, if a mother only receives care during first trimester, then at delivery?
The quality of care a mother receives is captured through multiple data elements (including trimester of 1st prenatal visit, date of first non-treponemal test during pregnancy, date of treatment, and what that treatment was).
16. Is capturing the onset of stigmata (e.g., when a patient began to show symptoms) important?
No, the usefulness of that data hasn't been demonstrated, and there is no place on the form to report it. Reporting what signs are present in the infant/child is more important.
17. When will the revised CS report form be ready for use?
The revised CS report form is already available (in PDF format) at http://www.cdc.gov/std/program/partners.htm.
18. Is the revised CS report form in triplicate like the old form?
The hard (paper) copy version of the revised CS report form will be in triplicate and available beginning in June 2013. The triplicate report form can be obtained by contacting Ms. Darlene Davis at 404-639-1838 or firstname.lastname@example.org.
19. Will there be an effort to make the PDF form fillable?
There has been discussion on making the revised CS report form available in fillable PDF format. However, no decision has been made. For those reporting jurisdictions that report via hard copy, the triplicate forms are required.
20. Are slides from the webinar available for download?
Yes: both the recording of the webinar and the slide set itself are available at http://www.cdc.gov/std/program/partners.htm.
21. Into what version of STD*MIS is the new report form being entered? How will entering data from the revised CS report form into STD*MIS change?
The current STD*MIS versions, 4.1c and 5.1, are being updated to accommodate the new data elements (the updated versions being named 4.2 and 5.2, respectively). The new report can be entered into STD*MIS 4.2 and 5.2.
22. Will the revised CS report form be part of the STD data program PRISM?
PRISM, as well as other reporting systems, will be able to use the updated NETSS Implementation Plan as a guide in making the necessary modifications to local systems. The updated NETSS Implementation Plan is planned to be available in July 2013.
23. If the revised CS report form is available, how should cases that have already been reported this year on the old form be handled?
Cases that have already been reported should remain in the format in which they were reported (e.g., old CS report form). Project areas that currently report CS by paper form can immediately begin use of the revised CS report form. Triplicate forms should be requested from Ms. Darlene Davis at 404-639-1838 or email@example.com. Project areas that currently report electronically should begin reporting the new data elements contained in the revised CS report form as soon as they have the necessary system updates.
24. Do the fields in the revised CS report form correspond to fields in STD*MIS 4.1c?
Some fields in the revised CS report form do not correspond to fields in STD*MIS 4.1c. However, STD*MIS 4.1c is being updated to accommodate the new data elements (the updated version will be called "STD*MIS 4.2"). Data elements for the revised CS report form will be enterable in STD*MIS 4.2, which will be released soon.
25. Are continuing education (CEU) credits available for this webinar?
Sorry, no CEU credits are available for this webinar.