TABLE 3:

Surveillance case definition for congenital syphilis

A confirmed case of congenital syphilis is an infant in whom Treponema pallidum is identified by darkfield microscopy, fluorescent antibody, or other specific stains in specimens from lesions, placenta, umbilical cord or autopsy material.

A presumptive case of congenital syphilis is when either of the following conditions are present: any infant whose mother had untreated or inadequately treated* syphilis at delivery, regardless of findings in the infant; or any infant or child who has a reactive treponemal test for syphilis and any one of the following: any evidence of congenital syphilis on physical examination†; any evidence of congenital syphilis on long bone x-ray; reactive cerebrospinal fluid Venereal Disease Research Laboratory‡; elevated cerebrospinal fluid cell count or protein (without other cause)‡; quantitative nontreponemal serological titres which are fourfold higher than the mother’s (both drawn at birth); or reactive test for IgM antibody by an approved method‡.

A syphilitic stillbirth is defined as a fetal death in which the mother had untreated or inadequately treated syphilis* at delivery of a fetus after a 20-week gestation or of 500 g.

^*Inadequate treatment consists of any nonpenicillin therapy or penicillin given less than 30 days before delivery.

^†See Table 1.

^‡It may be difficult to distinguish between congenital and acquired syphilis in a seropositive child after infancy. Signs may not be obvious and stigmata may not yet have developed. Abnormal values for cerebrospinal fluid Venereal Disease Research Laboratory, cell count, and protein, as well as immunoglobulin M antibodies, may be found in either congenital or acquired syphilis. Findings on long bone x-rays may help because these will indicate congenital syphilis. The decision may ultimately be based on maternal history and clinical judgment; the possibility of sexual abuse also needs to be considered. Reproduced from reference 20