Syphilis is a complex sexually transmitted disease that has a highly variable clinical course. Classification by a clinician with expertise in syphilis may take precedence over the following case definition developed for surveillance purposes.

CLINICAL DESCRIPTION

Clinical manifestations of late syphilis other than neurosyphilis may include inflammatory lesions of the cardiovascular system, skin, and bone. Rarely, other structures (e.g., the upper and lower respiratory tracts, mouth, eye, abdominal organs, reproductive organs, lymph nodes, and skeletal muscle) may be involved. Late syphilis usually becomes clinically manifest only after a period of 15-30 years of untreated infection.

1. CONFIRMED

   NOTE: Analysis of CSF for evidence of neurosyphilis is necessary in the evaluation of late syphilis with clinical manifestations.

   A clinically compatible case that is laboratory confirmed by:
   
   

   • Demonstration of Treponema pallidum in late lesions by fluorescent antibody or special stains (although organisms are rarely visualized in late lesions).

2. PROBABLE
   
   • Characteristic abnormalities or lesions of the cardiovascular system, skin, bone, or other structures with a reactive treponemal test, in the absence of other known causes of these abnormalities, and without CSF abnormalities and clinical symptoms or signs consistent with neurosyphilis
     
     
3. POSSIBLE
   
   

   • Not used