Table 1.

Council of State and Territorial Epidemiologists (CSTE) case definitions for neurologic, ocular, and otic manifestations of syphilis

Classification	Neurologic manifestations	Ocular manifestations	Otic manifestations
Verified	Reactive nontreponemal test and a reactive treponemal test with both of the following: Clinical symptoms or signs consistent with neurosyphilis without other known causes for these clinical abnormalities, AND A reactive Venereal Disease Research Laboratory (VDRL) test result in cerebrospinal fluid (CSF) in the absence of grossly bloody contamination of the CSF.	Reactive nontreponemal test and a reactive treponemal test with both of the following: Clinical symptoms or signs consistent with ocular syphilis without other known causes for these clinical abnormalities, AND Demonstration of T. pallidum in aqueous or vitreous fluid by darkfield microscopy, or by polymerase chain reaction (PCR) or equivalent direct molecular methods.	Reactive nontreponemal test and a reactive treponemal test with both of the following: Clinical symptoms or signs consistent with otosyphilis without other known causes for these clinical abnormalities, AND Demonstration of T. pallidum in inner ear fluid by darkfield microscopy, or by PCR or equivalent direct molecular detection methods.
Likely	Reactive nontreponemal test and a reactive treponemal test with both of the following: Clinical symptoms or signs consistent with neurosyphilis without other known causes for these clinical abnormalities, AND Elevated CSF protein (>50 mg/dL) or leukocyte count (>5 white blood cells/cubic millimeter CSF) in the absence of other known causes for these abnormalities.	Reactive nontreponemal test and a reactive treponemal test with both of the following: Clinical symptoms or signs consistent with ocular syphilis without other known causes for these clinical abnormalities, AND Findings on exam by an ophthalmologist that are consistent with ocular syphilis in the absence of other known causes for these abnormalities.	Reactive nontreponemal test and a reactive treponemal test with both of the following: Clinical symptoms or signs consistent with otosyphilis without other known causes for these clinical abnormalities, AND Findings on exam by an otolaryngologist that are consistent with otosyphilis in the absence of other known causes for these abnormalities.
Possible	Reactive nontreponemal test and a reactive treponemal test and clinical symptoms or signs consistent with neurosyphilis without other known causes for these abnormalities.	Reactive nontreponemal test and a reactive treponemal test and clinical symptoms or signs consistent with ocular syphilis without other known causes for these abnormalities.	Reactive nontreponemal test and a reactive treponemal test and clinical symptoms or signs consistent with otosyphilis without other known causes for these abnormalities.