CS Webinar Questions

No, the surveillance case definition for congenital syphilis (revised September 1996) does not currently include PCR evidence.

A reactive CSF VDRL in an infant/child supports the diagnosis of CS, but does not by itself establish the diagnosis of CS. A negative CSF FTA-ABS result makes the diagnosis of neurosyphilis highly unlikely, but a reactive CSF FTA-ABS does not indicate neurosyphilis (please see STD Treatment Guidelines).

Infection with HIV is diagnosed in two steps.

1. A sensitive screening test detects antibodies to HIV, but can yield false-positive results.
2. A confirmatory test must then be performed. A Western blot can be used to confirm a positive screening test. The Western blot yields a pattern of bands; bands that match a specific standard confirm infection with HIV. If a Western blot has some, but not enough, bands that match that standard, the result can be read as "equivocal" -- neither confirming HIV infection, nor ruling out infection. In such cases, retesting is usually performed, because the patient might have early HIV infection and might be in the process of seroconverting.

The DIS should make every effort to determine the ultimate answer (positive or negative), as effective methods to prevent transmission of HIV from mother-to-child exists.

No, a negative treponemal IgM immunoblot does not rule out infection with syphilis. In asymptomatic infants/children at risk for CS, a positive result only occurs in 4–22% of cases. All available reports on treponemal IgM immunoblots warn against using a negative IgM immunoblot to rule out CS. A negative result does not mean the patient can forego treatment. A positive treponemal IgM immunoblot supports the diagnosis of CS but more evidence is required before a diagnosis can be made.

No, the technique uses a wet preparation on a microscope slide, so the treponemes do not survive long (e.g., not long enough for transport to a hospital or outside laboratory). The physician must know what a darkfield microscopy test is, obtain the appropriate specimen, and have the personnel (e.g., trained fluorescent microscopist) and equipment immediately on hand to perform the test.

A CSF protein of 40 mg/dl  is the correct threshold value for infant/child more than 30 days old. This typographical error has been corrected in the slide set for this webinar available at http://www.cdc.gov/std/program/partners.htm.

Thank you to the participant who noted this typographical error!

Absolutely, please refer to the surveillance case definition for congenital syphilis in the appendices of the instructions to the revised CS report form and STD Surveillance Report at http://www.cdc.gov/std/stats11/default.htm    

More data are needed to answer this question. If the mother had a chancre or signs of secondary syphilis, then she should be reported as a case of syphilis. If the mother is asymptomatic, whether or not she should be reported as a case depends upon her history of diagnosis and treatment. Please see the surveillance case definitions for syphilis at http://www.cdc.gov/std/stats11/app-casedef.htm#Syphilis  

If maternal serologies were performed within a week of delivery, please mark "at delivery" for Box 14c.

The mother had inadequately treated syphilis. If the stillbirth was >500 g or >20 weeks' gestation, the case meets the case definition of "syphilitic stillbirth" and should be reported.

If treatment for late latent syphilis begins 30 or more days prior to delivery, then treatment can be completed less than 30 days before delivery. If treatment is not completed before delivery, the mother would be inadequately treated.

No, any data reported on the revised CS report form must come from documents containing that data. Public health authorities have the authority to access medical records for public health reasons.

There is no one solid threshold. Local health jurisdictions should be aware of their baseline prevalence of syphilis (including congenital syphilis), and if they detect an increase in activity, should act accordingly. Analyses have shown cost effectiveness of screening for CS when prevalence of early syphilis (primary, secondary, and early latent syphilis) was as low as 5 per 100,000 females.

Use box (22.) and specify "other."

The quality of care a mother receives is captured through multiple data elements (including trimester of 1st prenatal visit, date of first non-treponemal test during pregnancy, date of treatment, and what that treatment was).

No, the usefulness of that data hasn't been demonstrated, and there is no place on the form to report it. Reporting what signs are present in the infant/child is more important.

The revised CS report form is already available (in PDF format) at http://www.cdc.gov/std/program/partners.htm.

The hard (paper) copy version of the revised CS report form will be in triplicate and available beginning in June 2013. The triplicate report form can be obtained by contacting Ms. Darlene Davis at 404-639-1838 or dwd1@cdc.gov.

There has been discussion on making the revised CS report form available in fillable PDF format. However, no decision has been made. For those reporting jurisdictions that report via hard copy, the triplicate forms are required.

Yes: both the recording of the webinar and the slide set itself are available at http://www.cdc.gov/std/program/partners.htm.

The current STD*MIS versions, 4.1c and 5.1, are being updated to accommodate the new data elements (the updated versions being named 4.2 and 5.2, respectively). The new report  can be entered into STD*MIS 4.2 and 5.2. 

PRISM, as well as other reporting systems, will be able to use the updated NETSS Implementation Plan as a guide in making the necessary modifications to local systems.  The updated NETSS Implementation Plan is planned to be available in July 2013.

Cases that have already been reported should remain in the format in which they were reported (e.g., old CS report form). Project areas that currently report CS by paper form can immediately begin use of the revised CS report form. Triplicate forms should be requested from Ms. Darlene Davis at 404-639-1838 or dwd1@cdc.gov.  Project areas that currently report electronically should begin reporting the new data elements contained in the revised CS report form as soon as they have the necessary system updates.

Some fields in the revised CS report form do not correspond to fields in STD*MIS 4.1c. However, STD*MIS 4.1c is being updated to accommodate the new data elements (the updated version will be called "STD*MIS 4.2").  Data elements for the revised CS report form will be enterable in STD*MIS 4.2, which will be released soon.

Sorry, no CEU credits are available for this webinar.