- Clinical presentation of one or more ulcers or chancre;
AND
- Presence of one of the following:
- detection and confirmation of Treponema pallidum in clinical specimens (e.g., chancre, regional lymph node) by appropriate laboratory techniques, such as dark-field microscopy, direct fluorescent antibody, or nucleic acid amplification test (NAAT);
OR
- reactive treponemal serology (regardless of non-treponemal serology reactivity) in a case with no previous history of syphilis; OR
- four-fold or greater increase (e.g., 1:8 to 1:32) in titre over the last known non-treponemal test
- Clinical presentation of rash, fever, malaise, lymphadenopathy, mucous lesions, condyloma latum, alopecia, meningitis, headaches, uveitis, retinitis, or recent hearing impairment;
AND
- Presence of one of the following:
- detection and confirmation of T. pallidum in clinical specimens (e.g., chancre, regional lymph node) by appropriate laboratory techniques, such as dark-field microscopy, direct fluorescent antibody, or nucleic acid amplification test (NAAT);
OR
- reactive treponemal serology (regardless of non-treponemal serology reactivity) in a case with no previous history of syphilis; OR
- four-fold or greater increase in titre over the last known non-treponemal test
Note: The possibility of a prozone reaction should be considered in individuals who are suspected of having secondary syphilis but whose non-treponemal test is non-reactive. Neurological symptoms may be present.
- No signs or symptoms of primary or secondary syphilis
and either reactive treponemal serology (regardless of non-treponemal serology reactivity)
or four-fold or greater increase in titre over the last known non-treponemal test;
AND
- Presence of one of the following within the previous 12 months:
- non-reactive serology;
OR
- signs or symptoms suggestive of primary or secondary syphilis;
OR
- sexual exposure to a partner with primary, secondary, or early latent syphilis
- No signs or symptoms of primary or secondary syphilis
AND
- Either reactive treponemal serology (regardless of non-treponemal serology reactivity) or four-fold or greater increase in titre over the last known non-treponemal test
AND
- Last known sexual activity within the previous 12 months
AND
- Presence of one of the following within the previous 12 months:
- a titre at least or greater than 1:8 at time of diagnosis;
OR
- clinical suspicion of syphilis acquisition
- No signs or symptoms of primary or secondary syphilis; AND
- Persistently reactive treponemal serology (regardless of non-treponemal serology reactivity);
AND
- Does not meet the case definition for confirmed early latent syphilis or latent syphilis of unknown duration;
AND
- Has not been previously treated for syphilis.
- Meets the case definition for any stage of syphilis;
OR
- Reactive treponemal serology (regardless of non-treponemal serology reactivity)
AND
- Presence of one of the following:
- reactive VDRL in non-bloody cerebrospinal fluid (CSF);
OR
- clinical evidence of neurosyphilis
and either elevated CSF leukocytes
or elevated CSF protein in the absence of other known causes
- Meets the case definition for any stage of syphilis;
OR
- Reactive treponemal serology (regardless of non-treponemal serology reactivity)
AND
- Clinical diagnosis of neurosyphilis, based on compatible clinical or laboratory findings, in the absence of other known causes
-
Early (infectious) neurosyphilis – diagnosis of neurosyphilis within 12 months after infection (i.e., neurosyphilis coincides with primary, secondary or early latent syphilis)
-
Late (non-infectious) neurosyphilis – diagnosis of neurosyphilis more than 12 months after infection
- Meets the case definition for any stage of syphilis;
OR
- Reactive treponemal serology (regardless of non-treponemal serology reactivity)
AND
- Clinical presentation of uveitis, retinitis or optic neuropathy in the absence of other known causes
- Reactive treponemal serology (regardless of non-treponemal serology reactivity);
AND
- Characteristic abnormalities of the cardiovascular system, bone, skin or other tissue [4], in the absence of other known causes
- Clinical presentation [5] compatible with congenital syphilis in a stillbirth, neonate or older case
AND
- Presence of one of the following:
- titre greater than maternal titre
and reactive treponemal confirmatory test;
OR
- detection and confirmation of
T. pallidum in clinical specimens (e.g., lesions, placenta, umbilical cord, or autopsy) by appropriate laboratory techniques, such as dark-field microscopy, direct fluorescent antibody assay or polymerase chain reaction (PCR);
OR
- mother with untreated or inadequately treated syphilis (i.e., primary, secondary, early latent, or late latent syphilis) during pregnancy or at birth
Early congenital syphilis – onset less than two years of age, including stillbirth.
Late congenital syphilis – onset at two or more years of age.
An infant/child with:
- Reactive serology (non-treponemal and/or treponemal) from venous blood (not cord blood); AND
- Born to a pregnant individual who had untreated OR inadequately treated syphilis at delivery*;
AND WITHOUT
- clinical, radiographic, or laboratory evidence of congenital syphilis (other than reactive serology)
*Inadequate treatment is receipt of non-penicillin therapy or penicillin therapy administered less than 30 days before delivery.
- Meets the case definition for infectious syphilis (i.e., primary, secondary or early latent)
or late latent syphilis
AND
- Presence of one of the following:
- syphilis serology conducted as part of prenatal blood screening;
OR
- known to have given birth to an infant, live or stillborn, with congenital syphilis;
OR
- clinical presentation of infectious syphilis during pregnancy
- Reactive treponemal serology (regardless of non-treponemal serology reactivity) in an individual either with no previous history of syphilis
or four-fold or greater increase in titre over the last known non-treponemal test;
AND
- Follow-up to determine staging of syphilis is not complete
- Syphilis is a complex sexually transmitted infection that has a highly variable clinical course. Classification by a clinician with expertise in syphilis may take precedence over the above case definitions developed for surveillance purposes
- Treponemal test includes TP-PA, EIA, CIA or equivalent serologic methods
- Non-treponemal test includes VDRL, RPR or equivalent serologic methods
-
T. pallidum is rarely seen in these lesions and is diagnostic when present although not required to meet the surveillance case definition
- Clinical presentation includes any evidence of congenital syphilis on physical examination (e.g., skin lesions, lymphadenopathy, hepatosplenomegaly); on radiographs of long bones; a reactive CSF-VDRL; or an elevated CSF cell count or protein in the absence of other known causes. Note that neonates may not display clinical manifestations of congenital syphilis thus may only meet laboratory criteria
For more information on the case definition of syphilis, please refer to the
Technical Appendix of the annual STI surveillance reports.
