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]

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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

Early

This is a subset of cases of congenital syphilis. Newborns may be asymptomatic and are only identified on routine prenatal screening. If not identified and treated, these newborns develop poor feeding and rhinorrhea. By definition, early congenital syphilis occurs in children between 0 and 2 years old. After, they can develop late congenital syphilis.

Late

Late congenital syphilis is a subset of cases of congenital syphilis. By definition, it occurs in children at or greater than 2 years of age who acquired the infection trans-placentally.

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.