Australian national notifiable diseases case definitions

Syphilis - infectious (primary, secondary and early latent), less than 2 years duration case definition

This document contains the case definitions for syphilis - infectious (primary, secondary and early latent), less than 2 years duration which is nationally notifiable within Australia. This definition should be used to determine whether a case should be notified.

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Surveillance case definition

Version	Status	Last reviewed	Endorsement date	Implementation date
1.1	Lab Definitive evidence: Point 1: “… and the latest result is confirmed by either a reactive non specific treponemal test or a different specific treponemal test result.” Added. Lab Suggestive Evidence: Point 1: “microscopy” added to the “direct fluorescent antibody [microscopy]” Significant rework of the remainder of this section including addition of: “A reactive specific treponemal test (e.g. IgG enzyme immunoassay, Treponema pallidum haemagglutination assay, Treponema pallidum particle agglutination, Treponema pallidum immobilisation assay, or fluorescent treponemal antibody absorption), confirmed either by a different specific test or a non-specific treponemal test; OR A reactive non-specific treponemal test (e.g. Venereal Diseases Research Laboratory, Rapid Plasma Reagin) confirmed by a specific treponemal test (e.g. IgG enzyme immunoassay, Treponema pallidum haemagglutination assay, Treponema pallidum particle agglutination, Treponema pallidum immobilisation assay, or fluorescent treponemal antibody absorption).”	CDWG O-O-S January 2010	CDNA 29 September 2010	1 January 2011
1.0	Initial case definition (2004).

Reporting

Only confirmed cases should be notified.

Confirmed case

A confirmed case requires either:

1.         Laboratory definitive evidence

OR

2.         Laboratory suggestive evidence AND clinical evidence.

Laboratory definitive evidence

1. Seroconversion in past two years: specific treponemal test (e.g. IgG enzyme immunoassay, Treponema pallidum haemagglutination assay, Treponema pallidum particle agglutination, Treponema pallidum immobilisation assay, or fluorescent treponemal antibody absorption) reactive when previous treponemal test non-reactive within past two years and the latest result is confirmed by either a reactive non specific treponemal test or a different specific treponemal test result

OR

2. A fourfold or greater rise in non-specific treponemal antibody titre (e.g. Venereal Diseases Research Laboratory, Rapid Plasma Reagin) in the past two years, and a reactive specific treponemal test (e.g. IgG enzyme immunoassay, Treponema pallidum haemagglutination assay, Treponema pallidum particle agglutination, Treponema pallidum immobilisation assay, or fluorescent treponemal antibody absorption).

Laboratory suggestive evidence

1. Demonstration of Treponema pallidum by darkfield microscopy (not oral lesions), direct fluorescent antibody microscopy tests, equivalent microscopic methods (e.g. silver stains), or nucleic acid testing

OR

2. A reactive specific treponemal test (e.g. IgG enzyme immunoassay, Treponema pallidum haemagglutination assay, Treponema pallidum particle agglutination, Treponema pallidum immobilisation assay, or fluorescent treponemal antibody absorption), confirmed either by a different specific test or a non-specific treponemal test

OR

3. A reactive non-specific treponemal test (e.g. Venereal Diseases Research Laboratory, Rapid Plasma Reagin) confirmed by a specific treponemal test (e.g. IgG enzyme immunoassay, Treponema pallidum haemagglutination assay, Treponema pallidum particle agglutination, Treponema pallidum immobilisation assay, or fluorescent treponemal antibody absorption).

Clinical evidence

1.         Presence of a primary chancre (or ulcer)

OR

2.         Clinical signs of secondary syphilis.