September 4, 2017 

Dear Colleague, 

In June 2017, the Council of State and Territorial Epidemiologists (CSTE) approved the Update 

to Public Health Reporting and National Notification for Syphilis. This new position statement 

for syphilis (17-ID-11) includes revisions to the surveillance case definition for syphilis.

These changes will take effect January 1, 2018. By ensuring that cases of syphilis are reported in

accordance with this revised surveillance case definition, we can obtain the most accurate 

surveillance for this disease and its clinical manifestations, and we can better address syphilitic 

infection and transmission. 

Changes related to reporting syphilis stages

• “Secondary syphilis” still requires BOTH a reactive treponemal test and a reactive

nontreponemal test, but no longer requires a titer ≥1:4.

• For surveillance purposes, the nomenclature for “Early latent syphilis” has been changed

to “Early non-primary non-secondary syphilis.” The rationale for this change was to

remove the term “latent” from the names of the surveillance stages, in order to clarify that

certain clinical manifestations (e.g., neurosyphilis, ocular syphilis, and otic syphilis) may

occur during any stage of syphilis.

• For surveillance purposes, the nomenclature for “Late latent syphilis” has been changed

to “Unknown duration or late syphilis.” The rationale for this change was to remove the

term “latent” from the names of surveillance stages, as described above. In addition, this

change was made to emphasize that this stage includes cases with unknown duration of

infection (i.e., cases that potentially acquired syphilis within the past 12 months, but do

not meet the surveillance case definition for “Early non-primary non-secondary

syphilis”). Programs are encouraged to prioritize these cases for follow-up and partner

services based on sex, age, and titer.

• “Late syphilis with clinical manifestations” has been omitted. These cases should now be

reported as “Unknown duration or late syphilis,” and the late clinical manifestations

should be noted in the case report data with the new variables described below.

• No changes were made to the congenital syphilis or syphilitic stillbirth case definitions.

Changes related to reporting clinical manifestations of syphilis

• In order to improve surveillance for important clinical manifestations of syphilis, several

new variables have been added to the case report data. The previous variable for

“Neurological involvement” has been renamed “Neurologic Manifestations,” and

variables for “Ocular Manifestations,” “Otic Manifestations,” and “Late Clinical

Manifestations” have been added. The guidance for reporting these manifestations and
the definitions for the appropriate response codes are fully described here in the CSTE 

position statement.

• For the “Neurologic Manifestations” variable (as well as the clinical manifestations 

variables), the nomenclature of “Confirmed” and “Probable” has been changed to 

“Verified” and “Likely.” In addition, a new response code, “Possible,” has been added.

• The criteria for “Verified Neurologic Manifestations” (previously “Confirmed 

Neurologic Manifestations”) now requires BOTH (1) clinical symptoms or signs that are 

consistent with neurosyphilis and (2) a reactive CSF VDRL.

In addition, CSTE and CDC will be hosting two webinars to explain these revisions: 

• The first webinar will be held on September 28, 2017 at 2 pm EDT and will focus on the 

changes related to the reporting of syphilis stages. Please register for this webinar here. 

• The second webinar will be held on November 7, 2017 at 2 pm EST and will focus on the 

clinical manifestations of syphilis and how to report them. Please register for this webinar 

here. 

• Both webinars will be recorded and links to these recordings will be posted on the CSTE 

and CDC websites. 

Best Regards,

Gail Bolan, MD

Director, Division of STD Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD and

TB Prevention

Centers for Disease Control and Prevention