United States Centers for Disease Control and Prevention surveillance case definition for congenital syphilis

Laboratory criteria for diagnosis

Demonstration of Treponema pallidum by any of the following:

Darkfield microscopy of lesions, body fluids, or neonatal nasal discharge, or
PCR or other equivalent direct molecular methods of lesions, neonatal nasal discharge, umbilical cord, or autopsy material, or
Immunohistochemistry or special staining (eg, silver staining) of lesions, neonatal nasal discharge, umbilical cord, or autopsy material

Case classification

Probable

An infant whose mother had untreated or inadequately treated* syphilis at delivery, regardless of signs in the infant, or

An infant or child who has a reactive non-treponemal test for syphilis (VDRL, RPR, or equivalent methods) and any of the following:

Evidence of congenital syphilis on physical examination^¶
Evidence of congenital syphilis on radiographs of long bones
Reactive CSF VDRL
Elevated CSF WBC count or CSF protein (in a nontraumatic LP and without any other cause)^Δ

Confirmed

Any case that is laboratory confirmed according to the laboratory criteria above

PCR: polymerase chain reaction; VDRL: venereal disease research laboratory; RPR: rapid plasma reagin; CSF: cerebrospinal fluid; WBC: white blood cell; LP: lumbar puncture; CDC: United States Centers for Disease Control and Prevention.

* Adequate treatment is defined as completion of a penicillin-based regimen, in accordance with CDC treatment guidelines, appropriate for stage of infection and initiated 30 or more days before delivery.

¶ Physical examination findings of congenital syphilis in an infant or child <2 years old may include hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, pallor (anemia), or edema (nephrotic syndrome and/or malnutrition). Findings in older children may include interstitial keratitis, hearing loss, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints. Refer to UpToDate topic on congenital syphilis for additional details.

Δ Suggested parameters for abnormal CSF WBC and protein values:

During the first 30 days after birth – CSF WBC count >15 WBC/mm³ or CSF protein >120 mg/dL is abnormal
For infants and children >30 days old – CSF WBC count >5 WBC/mm³ or CSF protein >40 mg/dL is abnormal

Adapted from: Centers for Disease Control and Prevention. Syphilis (Treponema pallidum) 2018 Case Definition. https://ndc.services.cdc.gov/case-definitions/syphilis-2018/ (Accessed on June 17, 2021).

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United States Centers for Disease Control and Prevention surveillance case definition for congenital syphilis