Syphilis (Treponema pallidum) and Syphilis, congenital and neonatal (Treponema pallidum)

Clinical criteria

A case may be asymptomatic or present with:

A. Primary syphilis
Any person with one or several (usually painless) chancres in the genital, perineal, anal area, or mouth, or pharyngeal mucosa, or elsewhere

B. Secondary syphilis
Any person with at least one of the following:

• Diffuse maculo-papular rash often involving palms and soles
• Generalised lymphadenopathy
• Condyloma lata
• Enanthema
• Alopecia diffusa
• Ocular manifestations of early syphilis
• Neurological manifestations of early syphilis

C. Early latent syphilis (<1 year)
Positive syphilis serology, no symptoms or signs of early syphilis and a negative reference syphilis screening test within previous 12 months.

Laboratory criteria
For new cases, at least one of the following:

• Detection of Treponema pallidum nucleic acid in clinically appropriate sites.

• Detection of Treponema pallidum antibodies (total antibodies) using EIA and TPHA/ TPPA and additionally detection of Tp-IgM antibodies (e.g. IgM ELISA or immunoblot or 19S-IgM-FTA-abs)
• Detection of Treponema pallidum antibodies (total antibodies) using EIA and TPHA/ TPPA and additionally detection of cardiolipin non-Tp IgM with RPR titre of >=1:16
• For re-infections, detection of Treponema pallidum antibodies (total antibodies) and demonstration of four-fold increase in RPR titre by a validated method

Epidemiological criteria
NA

Case classification
A) Possible case
NA
B) Probable case
Any symptomatic person meeting the clinical criteria for early syphilis, as assessed by a specialised STI clinical service (but who does not meet the laboratory criteria)
C) Confirmed case
Any person meeting the clinical criteria for early syphilis, who also meets the laboratory criteria for case confirmation

Effective from: 1st January 2019 

Syphilis, congenital and neonatal (Treponema pallidum) 

Clinical Criteria 

Any infant <2 years of age with at least one of the following:

• Hepatospenomegaly
• Mucocutaneous lesions
• Condyloma lata
• Persistent rhinitis
• Jaundice
• Pseudoparalysis (due to periostitis and osteochondritis)
• Central nervous involvement
• Anaemia
• Nephrotic syndrome
• Malnutrition
• Bony radiological changes consistent with congenital syphilis

OR
— A still born childwith an epidemiological link*
Note, normal physical examination does not exclude the possibility of neonatal syphilis. Clinical criteria should be reviewed in conjunction with evidence of maternal history of syphilis, if available. Symptoms and signs of congenital syphilis can be present in other congenital infections, thus clinical criteria of congenital syphilis are NOT to be taken in isolation but instead should always be interpreted alongside serological and maternal epidemiological factors

Laboratory Criteria

Laboratory criteria for case confirmation
At least one of the following:

• A reactive non-treponemal test (VDRL, RPR) in the child’s serum  four-fold higher than in the mother
• Demonstration of treponemes by DFA-TP or immunohistochemistry stains in the umbilical cord, the placenta, autopsy material, a nasal discharge or skin lesion material
• Detection of Treponema pallidum nucleic acid in the umbilical cord, the placenta, autopsy material, exudate from suspicious lesions or body fluids by PCR
• Failure to demonstrate loss of maternal treponemal  antibodies(TPPA/TPHA) within the second year of life

Laboratory criteria for a probable case

• Reactive RPR/VDRL-CSF test result
• Positive serum RPR beyond the age of 6 months

Laboratory criteria for a probable case

• Reactive RPR/VDRL-CSF test result
• Positive serum RPR beyond the age of 6 months

Epidemiological Criteria
Any infant whose mother had untreated or inadequately treated syphilis at delivery

Case Classification
A. Possible case
NA
B. Probable case
Any infant or child meeting the clinical criteria and with at least one of the following two:
— An epidemiological link*
— Meeting the laboratory criteria for a probable case
C. Confirmed case
Any infant with or without clinical criteria and who meets the laboratory criteria for case confirmation

Clinical criteria for late congenital syphilis (manifests >2 years, usually near puberty)

• Hutchinson’s teeth (peg shaped incisors), mulberry molars (molars with extra cusps)
• Interstitial keratitis, chorioretinitis
• Eighth nerve deafness, cranial nerve palsies, general paresis, learning disability
• Hutchinson’s triad = Hutchinson’s teeth + Interstitial keratitis + Eighth nerve deafness
• Facial bone abnormalities; frontal bossing, saddle nose deformity secondary to nasal cartilage destruction
• Saber shins (tibial bowing)
• Clutton’s joints (sterile effusions of large joints)
• Unilateral clavicular enlargement

Effective from: 14 June 2023