Congenital syphilis classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]; Kalsang Dolma, M.B.B.S.[3]; Aravind Kuchkuntla, M.B.B.S[4]

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Overview

Congenital syphilis can be classified into early (presenting 0-2 years) and late (greater 2 years) based upon on time of presentation. There is also a diagnostic classification of syphilis used for surveillance purpose.

Classification

Based upon Time of Presentation

Congenital syphilis is classified based on the timing of appearance of signs and symptoms into:

• Early congenital syphilis: If the signs and symptoms are identified in children aged less than 2 years. It is usually diagnosed in new born or in the first few weeks after birth.
• Late congenital syphilis: If the signs and symptoms of the disease are identified in children aged more than 2 years. The signs are usually non-specific and more than half the children are asymptomatic. They can present with interstitial keratitis, sensorineural deafness or clutton's joints.
• Stigmata: These are the scars resulting from early or late congenital syphilis. The features of stigmata in early congenital syphilis include saddle nose deformity, Hutchinson's teeth, rhagades (linear scars at the angles of the mouth and nose result from bacterial infection of skin lesions), choriod scarring and onychia. Stigmata secondary to late congenital syphilis include perforation of the palate, corneal opacities, optic atrophy and periosteal changes of tibia.

Diagnostic Classification

The provisional case definition includes every infant (person <12 months of age) with one of the following:

• A reactive nontreponemal serologic test for syphilis confirmed by a reactive treponemal test.

• A positive darkfield microscopic examination on a non oral mucous membrane or

• A positive fluorescent antibody examination for Treponema pallidum on any lesion.

All cases that are classified as confirmed or compatible or that require additional information to be classified should be reported to the state public health authority.

Confirmed Case

• Identification of T. pallidum by darkfield microscopy, fluorescent antibody, or other specific stains in specimens from lesions, autopsy material, placenta, or umbilical cord.

Compatible (formerly, probable or possible) Case

• A reactive STS (serologic test for syphilis) in a stillborn.

OR

• A reactive STS in an infant whose mother had syphilis during pregnancy and was not adequately treated, regardless of symptoms in the infant.

OR

• A reactive Venereal Disease Research Laboratory (VDRL) test of cerebrospinal fluid.

OR

• A reactive STS in an infant with any of the following signs: snuffles, condyloma lata, osteitis, periostitis or osteochondritis, ascites, skin and mucous membrane lesions, hepatitis, hepatomegaly, splenomegaly, nephrosis, nephritis, or hemolytic anemia.

OR

• Fourfold or greater rise in titers or nontreponemal tests (VDRL or rapid plasma reagin (RPR) and a confirmed fluorescent treponemal antibody absorption (FTA-ABS) or microhemagglutination assay for antibody to T. pallidum (MHA-TP) over a 3-month period.

OR

• A reactive treponemal test or nontreponemal test that does not revert to nonreactive in 6 months.

Unlikely Case

• No reactive STS.

OR

• Treponemal tests revert to nonreactive within 6 months.

OR

• No symptoms in live-born infant whose mother, treated for syphilis during pregnancy, had a fourfold or greater fall in titer and the infant's STS is also fourfold or lower than the maternal titer was at the time of treatment.