Clin i cal de scrip tion
A con di tion char ac ter ized by vis i ble, pain ful gen i tal or anal le sions
Lab o ra tory cri te ria for di ag no sis
• Iso la tion of her pes sim plex vi rus from cer vix, ure thra, or anogenital le sion, or • Dem on stra tion of vi rus by an ti gen de tec tion tech nique in clin i cal spec i mens from
cer vix, ure thra, or anogenital le sion, or
• Dem on stra tion of multinucleated gi ant cells on a Tzanck smear of scrap ings from an anogenital le sion
Case clas si fi ca tion
Prob a ble: a clin i cally com pat i ble case (in which pri mary and sec ond ary syph i lis have been ex -
cluded by ap pro pri ate se ro logic tests and darkfield mi cros copy, when avail able) with ei ther a di ag - no sis of gen i tal her pes based on clin i cal pre sen ta tion (with out lab o ra tory con fir ma tion) or a his tory of one or more pre vi ous ep i sodes of sim i lar gen i tal le sions
Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed Com ment
Gen i tal her pes should be re ported only once per pa tient. The first di ag no sis for a pa tient with no pre vi ous di ag no sis should be re ported.
Gen i tal Warts (Re vised 9/96)
Clin i cal de scrip tion
An in fec tion char ac ter ized by the pres ence of vis i ble, exophytic (raised) growths on the in ter nal or ex ter nal gen i ta lia, per i neum, or perianal re gion
Lab o ra tory cri te ria for di ag no sis
• Histopathologic changes char ac ter is tic of hu man papillomavirus in fec tion in spec i mens ob tained by bi opsy or exfoliative cy tol ogy or
• Dem on stra tion of vi rus by an ti gen or nu cleic acid de tec tion in a le sion bi opsy
Case clas si fi ca tion
Prob a ble: a clin i cally com pat i ble case with out histopathologic di ag no sis and with out mi cro scopic or
se ro logic ev i dence that the growth is the re sult of sec ond ary syph i lis
Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed Com ment
Gen i tal warts should be re ported only once per pa tient. The first di ag no sis for a pa tient with no pre vi ous di ag no sis should be re ported.
Granuloma Inguinale
Clin i cal de scrip tion
A slowly pro gres sive ul cer ative dis ease of the skin and lymphatics of the gen i tal and perianal area caused by in fec tion with Calymmatobacterium granulomatis. A clin i cally com pat i ble case would have one or more pain less or min i mally pain ful granulomatous le sions in the anogenital area.
Lab o ra tory cri te ria for di ag no sis
• Dem on stra tion of intracytoplasmic Don o van bod ies in Wright or Giemsa-stained smears or bi op sies of gran u la tion tis sue
Case clas si fi ca tion
Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed
Lymphogranuloma Venereum
Clin i cal de scrip tion
In fec tion with L1, L2, or, L3 serovars of Chlamydia trachomatis may re sult in a dis ease char ac ter - ized by gen i tal le sions, sup pu ra tive re gional lymphadenopathy, or hem or rhagic proctitis. The in fec - tion is usu ally sex u ally trans mit ted.
Lab o ra tory cri te ria for di ag no sis
• Iso la tion of C. trachomatis, serotype L1, L2, or L3 from clin i cal spec i men, or
• Dem on stra tion by immunofluorescence of in clu sion bod ies in leu ko cytes of an in gui nal lymph node (bubo) as pi rate, or
• Pos i tive microimmunofluorescent se ro logic test for a lymphogranuloma venereum strain of C. trachomatis
Case clas si fi ca tion
Prob a ble: a clin i cally com pat i ble case with one or more ten der fluctuant in gui nal lymph nodes or
char ac ter is tic proctogenital le sions with sup port ive lab o ra tory find ings of a sin gle C. trachomatis com ple ment fix a tion ti ter of > 64
Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed
Mucopurulent Cervicitis (Re vised 9/96)
Clin i cal de scrip tion
Cer vi cal in flam ma tion that is not the re sult of in fec tion with Neisseria gonorrhoeae or
Trichomonas vaginalis. Cer vi cal in flam ma tion is de fined by the pres ence of one of the fol low ing
cri te ria:
• Mucopurulent se cre tion (from the endocervix) that is yel low or green when viewed on a white, cot ton-tipped swab (pos i tive swab test)
• In duced endocervical bleed ing (bleed ing when the first swab is placed in the endocervix)
Lab o ra tory cri te ria for di ag no sis
• No ev i dence of N. gonorrhoeae by cul ture, Gram stain, or an ti gen or nu cleic acid de tec tion, and no ev i dence of T. vaginalis on wet mount
Case clas si fi ca tion
Con firmed: a clin i cally com pat i ble case in a fe male who does not have ei ther gon or rhea or
trichomoniasis
Com ment
Mucopurulent cervicitis (MPC) is a clin i cal di ag no sis of ex clu sion. The syn drome may re sult from in fec tion with any of sev eral agents (see Chlamydia trachomatis, Gen i tal In fec tions). If gon or rhea, trichomoniasis, and chlamydia are ex cluded, a clin i cally com pat i ble ill ness should be clas si fied as
MPC. An ill ness in a fe male that meets the case def i ni tion of MPC and C. trachomatis in fec tion should be clas si fied as chlamydia.
Nongonococcal Ure thri tis (Re vised 9/96)
Clin i cal de scrip tion
Ure thral in flam ma tion that is not the re sult of in fec tion with Neisseria gonorrhoeae. Ure thral in - flam ma tion may be di ag nosed by the pres ence of one of the fol low ing cri te ria:
• A vis i ble ab nor mal ure thral dis charge, or
• A pos i tive leu ko cyte esterase test from a male aged < 60 years who does not have a his tory of kid ney dis ease or blad der in fec tion, pros tate en large ment, uro gen i tal an a tomic anom aly, or re cent uri nary tract in stru men ta tion, or
• Mi cro scopic ev i dence of ure thri tis (³ 5 white blood cells per high-power field) on a Gram stain of a ure thral smear
Lab o ra tory cri te ria for di ag no sis
• No ev i dence of N. gonorrhoeae in fec tion by cul ture, Gram stain, or an ti gen or nu cleic acid de tec tion
Case clas si fi ca tion
Con firmed: a clin i cally com pat i ble case in a male in whom gon or rhea is not found, ei ther by cul ture,
Gram stain, or an ti gen or nu cleic acid de tec tion
Com ment
Nongonococcal ure thri tis (NGU) is a clin i cal di ag no sis of ex clu sion. The syn drome may re sult from in fec tion with any of sev eral agents (see Chlamydia trachomatis, Gen i tal In fec tion). If gon or - rhea and chlamydia are ex cluded, a clin i cally com pat i ble ill ness should be clas si fied as NGU. An ill - ness in a male that meets the case def i ni tion of NGU and C. trachomatis in fec tion should be clas si fied as chlamydia.
Pel vic In flam ma tory Dis ease (Re vised 9/96)
Clin i cal case def i ni tion
A clin i cal syn drome re sult ing from the as cend ing spread of mi cro or gan isms from the va gina and endocervix to the endometrium, fal lo pian tubes, and/or con tig u ous struc tures. In a fe male who has lower ab dom i nal pain and who has not been di ag nosed as hav ing an es tab lished cause other than pel vic in flam ma tory dis ease (PID) (e.g., ectopic preg nancy, acute ap pen di ci tis, and func tional pain), all the fol low ing clin i cal cri te ria must be pres ent:
• Lower ab dom i nal ten der ness, and
• Ten der ness with mo tion of the cer vix, and • Adnexal ten der ness
In ad di tion to the pre ced ing cri te ria, at least one of the fol low ing find ings must also be pres ent: • Meets the sur veil lance case def i ni tion of C. trachomatis in fec tion or gon or rhea
• Tem per a ture > 100.4 F (> 38.0 C)
• Leukocytosis > 10,000 white blood cells/mm3
• Pu ru lent ma te rial in the peritoneal cav ity ob tained by culdocentesis or lap a ros copy
• Pel vic ab scess or in flam ma tory com plex de tected by bimanual ex am i na tion or by sonography
• Pa tient is a sex ual con tact of a per son known to have gon or rhea, chlamydia, or nongonococcal ure thri tis
Case clas si fi ca tion
Con firmed: a case that meets the clin i cal case def i ni tion Com ment
For re port ing pur poses, a cli ni cian’s re port of PID should be counted as a case.
STD Sur veil lance 2007 Appendix STD Sur veil lance Case Def i ni tions 167
1
Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 1997;46(No. RR-10;1).
STD Project Directors, STD Program Managers, State and Territorial Epidemiologists and Laboratory Directors
We grate fully ac knowl edge the con tri bu tions of state STD pro ject di rec tors, STD pro gram man ag ers, state and ter ri to rial epidemiologists and laboratory directors. The per sons listed were in the po si tions shown as of November 4, 2008.
State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Directors
Al a bama Charles Woernle Sandra Langston Charles Woernle William Callan Alaska Mollie Rosier Donna Cecere Joe McLaughlin Bernard Jilly Arizona Judy Norton Alfonso Urquidi Kenneth Komatsu Victor Waddell Arkansas Kellye McCartney Mark Barnes Jim Phillips Glen Baker California Gail Bolan Romni Neiman Gilberto Chavez Paul Kimsey Los Angeles Peter Kerndt Mary Hayes Gilberto Chavez Sue Sabat San Francisco Jeffrey Klausner Wendy Wolf Gilberto Chavez Sally Liska Colorado Maureen Bush Ralph Wilmoth Ken Gershman David Butcher Connecticut James Hadler Heidi Jenkins Matthew Cartter John Fontana Delaware James Welch Catherine Mosley Ashley Love Jane Getchell District of Columbia John Heath John Heath John Davies-Cole Maurice Knuckles Florida Russell Eggert Karla Schmitt Richard Hopkins Max Salfinger Georgia Vacant Russ Cantrell John Horan Elizabeth Franko Hawaii Peter Whiticar Roy Ohye Sarah Park A. Christian Whelen Idaho Richard Armstrong Kathy Cohen Christine G. Hahn Richard Hudson Illinois Charlie Rabins Ed Renier Craig Conover (Acting) Tom Johnson Chicago Will Wong John Paffel Craig Conover (Acting) Susan Gerber Indiana Jerry Burkman Dawne Rekas James Howell Judith Lovchik Iowa Mary Jones Karen Thompson Patricia Quinlisk Christopher Atchison Kansas Brenda Walker Derek Coppedge Charles Hunt Patrick Williams Kentucky Robert Brawley Sheri White Kraig Humbaugh Stephanie Gibson Louisiana Lisa Ann Longfellow Lisa Ann Longfellow Raoult Ratard Stephen Martin Maine Bob Woods Jennah Godo Kathleen Gensheimer John Krueger Maryland Barbara Conrad Glen Oltoff David Blythe Jack DeBoy Baltimore Laura Herrera Victoria Stovall David Blythe Jack DeBoy Massachusetts Thomas Bertrand Thomas Bertrand Alfred DeMaria Mary Gilchrist Michigan Mark Miller Mark Miller Corrine Miller Frances Downes Minnesota Julia Ashley Julia Ashley Ruth Lynfield Joanne Bartkus Mississippi Craig Thompson Craig Thompson Mary Currier K. Mills McNeill Missouri Michael Herbert Michael Herbert Sarah Patrick Eric Blank Montana Laurie Kops Lisa Underwood Steve Helgerson Anne Weber Nebraska Phil Medina Phil Medina Thomas Safranek Steve Hinrichs Nevada Richard Whitley Julia Spaulding Ishan Azzam L. Dee Brown New Hampshire Denise Rondeau Drew Thomits Jose Montero Christine Bean New Jersey Janet DeGraaf Patricia Masou Christina Tan Dennis Flynn New Mexico Daryl Smith Daryl Smith C. Mack Sewell David Mills New York F. Bruce Coles Dennis Murphy Perry Smith Lawrence Sturman New York City Susan Blank Steve Rubin Perry Smith Sara Beatrice North Carolina Evelyn Foust Evelyn Foust Jeffrey Engel Leslie Wolf North Dakota Kimberly Weis Julie Goplin Kirby Kruger Myra Kosse Ohio Bill Tiedemann Amy LaGesse Forrest Smith Tammy Bannerman Oklahoma Michael Harmon Chang Lee Kristy Bradley Garry McKee Oregon Vada Latin Doug Harger Melvin Kohn Michael Skeels Pennsylvania Weston Ruhrig Steve Kowalewski Veronica Urdaneta S.I. Shahied Philadelphia Caroline Johnson Melinda Salmon Veronica Urdaneta Kerry Buchs Rhode Island Utpala Bandy Michael Gosciminski Utpala Bandy Ewa King South Carolina Dorothy Waln (Acting) Vickie Boazman-Holmes (Acting) James Gibson Arthur Wozniak South Dakota Laurie Gill David Morgan Lon Kightlinger Michael Smith Tennessee Jeanece Seals Jane Russell Tim Jones David Smalley
Texas Felipe Rocha Jim Lee Vincent Fonseca Susan Neill
Utah Jennifer Brown Tim Lane Robert Rolfs Patrick Luedtke
Vermont Daniel Daltry Daniel Daltry Patsy Kelso Mary Celotti
Virginia Kathryn Hafford Kathryn Hafford (Acting) Carl Armstrong James Pearson
Washington Mark Aubin Mark Aubin Marcia Goldoft Romesh Gautom
West Virginia Caroline Williams Caroline Williams Loretta Haddy Andrea Labik
Wisconsin Sandra Breitborde Anthony Wade Jeffrey Davis Charles Brokopp
Wyoming Brownen Anderson Canyon Hardesty Tracy Murphy Richard Harris
American Samoa Utoofili Maga Sarona Maae Sharmain Edwards Utoofili Mago
Federated States of Micronesia Vita Skilling Johnny Hebel Nena Nena
Government of the Marshall Islands Justina Langidrik Zachraias Zachraias Paul Lalita
Northern Marianas (CNMI) Joseph Villagomz John Moreno James Hosfschneider Stephanie Hart-Gouleau Guam Josie O'Mallan Bernadette Schumann Robert Haddock Josie O'Mallan Puerto Rico Greduvel Duran-Guzman Trinidad Garcia Enid Garcia Francisco Toro Republic of Palau Victor Yano Johana Ngiruchelbad Julie Erb-Alvarez Francis Permeteet Virgin Islands Darlene Carty Taetia Phillips-Dorsett Darlene Carty Joseph Mark