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

This document contains the case definition 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.

Page last updated: 01 July 2015

Version
Status
Last reviewed
Endorsement date
Implementation date
1.2 Change name from‘Syphilis – less than 2 years duration (infectious - primary, secondary and early latent)’ to ‘Infectious Syphilis – less than two years duration (includes primary, secondary and early latent)’
Include new case definition for infectious syphilis, probable case.
Reporting
Both confirmed and probable cases should be notified.
Laboratory definitive evidence
Move details regarding treponemal tests to notes section.
May 2014 January 2015 1 July 2015
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).      
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Reporting

Confirmed and probable cases should be notified.

Confirmed case

A confirmed case requires either:

  1. Laboratory definitive evidence

OR

  1. Laboratory suggestive evidence AND clinical evidence.

Laboratory definitive evidence

  1. Seroconversion in past two years: treponemal specific testa reactive when previous treponemal specific test non-reactive within past two years and the latest result is confirmed by either a reactive non-treponemal testb or a different reactive treponemal specific test

OR

  1. A fourfold or greater rise in non-treponemal antibody titre compared with the titre within past two years, and a reactive treponemal specific test

Laboratory suggestive evidence

  1. Demonstration of Treponema pallidum by darkfield microscopy (not oral lesions), direct fluorescent antibody microscopy (direct antigen test), equivalent microscopic methods (eg silver stains), or DNA methods (eg nucleic acid testing)

OR

  1. A reactive treponemal specific test confirmed by either a reactive non-treponemal test or a different reactive treponemal specific test

OR

  1. A reactive non- treponemal test confirmed by a treponemal specific test
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Clinical evidence

  1. Presence of a primary chancre (or ulcer)

OR

  1. Clinical signs of secondary syphilis.

Probable case

A probable case requires that case does not meet the criteria for a confirmed case AND

Either:

  1. In a person with no known previous reactive serology: no history of adequate treatment of syphilis, or endemic treponemal disease, and
  1. Contact with an infectious case AND laboratory suggestive evidence.

OR

  1. Laboratory suggestive evidence AND RPR ≥16.

OR

  1. Positive syphilis IgM AND laboratory suggestive evidence.

OR

  1. In a person with previous reactive serology: a fourfold or greater rise in non-treponemal antibody titre when the previous serology was done more than two years ago.

AND

  1. Contact with an infectious case

OR

  1. Positive syphilis IgM
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Notes

  1. Treponemal specific tests are: IgG immunoassay, Treponema pallidum haemagglutination assay, Treponema pallidum particle agglutination assay, Fluorescent Treponemal Antibody Absorption, 19S-IgM antibody test, or IgM immunoassay

  2. Non-treponemal tests are; Rapid Plasma Reagin (RPR), Venereal Disease Research Laboratory (VDRL)

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