Acquired Syphilis v1

Query purpose: 

Acquired syphilis is an infection caused by the bacterium Treponema pallidum that is most commonly transmitted via sexual contact. Syphilitic infections progress through multiple stages, alternating between symptomatic periods and periods of latency when no clinical signs or symptoms or infection are present. This definition was created by the CDC National Syndromic Surveillance Program (NSSP) for use with emergency department data to develop queries for acquired syphilis (i.e., non-congenital syphilis) in patients 10 years and older. Please note that the queries are developed using syphilis-related free text terms from chief complaint fields; International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) discharge diagnosis codes; and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) as the basis for identifying patient visits of interest and not the Council of State and Territorial Epidemiologists (CSTE) syphilis surveillance case definition. The queried patient visits may or may not represent data for a case patient included in National Notifiable Diseases Surveillance System (NNDSS) case data and further public health investigation may be required. This query is intended to be a version 1 and may be further improved upon by the NSSP community of practice in the future. This query is intended to be narrow and capture visits with specific terms to support greater monitoring and actionable public health data. More complex and/or extensive queries may exist that more broadly capture symptoms or other terms.

How it works:

To ensure that only patients with acquired syphilis are captured, include an age restricting the dataset to patients ages 10 and over. This can be done by:

• Selecting the “Age Range” age group filter.
• Using the drop down box and selecting the operator “greater than or equal to”.
• Typing “10” into the input box for Age Range.

The Chief Complaint Discharge Diagnosis (CCDD) parsed field is used to query both the discharge diagnosis codes and chief complaint free text, and exclusions are incorporated as necessary.

• Inclusion based on Acquired Syphilis complaint free text terms:
  • The visit is included if it contains:
    1. A chief complaint related to Syphilis (“siphili” or “syphyli” or “syphylu” or “syphilu” or “siphyli” or “siphilu” or “syphili” or “siphilli” or “syphylli” or “syphyllu” or “syphillu” or “siphylli” or “siphillu” or “syphilli” or “sifili” or “syfyli” or “syfylu” or “syfilu” or “sifyli” or “sifilu” or “syfili”) OR
    2. A chief complaint related to General Paresis (“general paresis”) OR
    3. A chief complaint related to Tabes (“tabes”) OR
• Inclusion based on ICD-10-CM discharge diagnosis codes related to Acquired Syphilis:
  • The visit is included if it contains:
    1. A discharge diagnosis code related to Primary Syphilis (A51.0 or A51.1 or A51.2) OR
    2. A discharge diagnosis code related to Secondary Syphilis (A51.3 or A51.4) OR
    3. A discharge diagnosis code for Early Latent Syphilis (A51.5) OR
    4. A discharge diagnosis code for Early Syphilis, not specified as primary, secondary, or early latent syphilis (A51.9) OR
    5. A discharge diagnosis code for Cardiovascular or Cerebrovascular Syphilis (A52.0) OR
    6. A discharge diagnosis code related to Neurosyphilis, not specified as occurring during secondary syphilis (A52.1 or A52.2 or A52.3) OR
    7. A discharge diagnosis code for syphilis of other organs and tissues (A52.7) OR
    8. A discharge diagnosis code related to Late Syphilis, unspecified or specified as latent (A52.8 or A52.9) OR
    9. A discharge diagnosis code for Latent Syphilis, unspecified as early or late (A53.0) OR
    10. A discharge diagnosis code for Syphilis, unspecified (A53.9)
    11. A discharge diagnosis code for Syphilis complicating pregnancy (O98.11) OR
    12. A discharge diagnosis code for Syphilis complicating childbirth (O98.12) OR
    13. A discharge diagnosis code for Syphilis complicating the puerperium (O98.13) OR
• Inclusion based on ICD-9-CM discharge diagnosis codes related to Acquired Syphilis:
  • The visit is included if it contains:
    1. A discharge diagnosis code related to Primary Syphilis (091.0 or 091.1 or 091.2) OR
    2. A discharge diagnosis code related to Secondary Syphilis (091.3 or 091.4 or 091.5 or 091.6 or 091.7 or 091.8 or 091.9) OR
    3. A discharge diagnosis code related to Early Syphilis, Latent (092.0 or 092.9) OR
    4. A discharge diagnosis code for Aneurysm of aorta, specified as syphilitic (093.0) OR
    5. A discharge diagnosis code for Syphilitic aortitis (093.1) OR
    6. A discharge diagnosis code for Syphilitic endocarditis (093.2) OR
    7. A discharge diagnosis code related to Cardiovascular Syphilis (093.8 or 093.9) OR
    8. A discharge diagnosis code related to Neurosyphilis, not specified as occurring during secondary syphilis (094.0 or 094.1 or 094.2 or 094.3 or 094.8 or 094.9) OR
    9. A discharge diagnosis code related to Syphilis affecting other organs and tissues (095.0 or 095.1 or 095.2 or 095.3 or 095.4 or 095.5 or 095.6 or 095.7) OR
    10. A discharge diagnosis code related to Late Syphilis (095.8 or 095.9 or 096 or 097.0) OR
    11. A discharge diagnosis code for Latent Syphilis, unspecified (097.1) OR
    12. A discharge diagnosis code for Syphilis, unspecified (097.9) OR
    13. A discharge diagnosis code for Syphilis complicating pregnancy, childbirth, or the puerperium (647.0) OR
• Inclusion based on SNOMED CT discharge diagnosis codes related to Acquired Syphilis:
  • The visit is included if it contains:
    1. A discharge diagnosis code for Syphilis (76272004) OR
    2. A discharge diagnosis code for Acquired Syphilis (240555007) OR
    3. A discharge diagnosis code related to Primary Syphilis (266127002 or 28198007 or 31015008 or 10345003 or 54274001 or 27460003 or 186847001 or 237447001 or 237447001) OR
    4. A discharge diagnosis code related to Secondary Syphilis (240557004 or 402947001 or 1052322008 or 77028001 or 266128007 or 59233003 or 63751007 or 186861006 or 80770009 or 52414005 or 60528006 or 81339006 or 51960003 or 58227000 or 1142099009 or 197348008 or 402952006 or 186854007 or 1052296002 or 192647003 or 59934002 or 1052319006 or 39085002 or 15993351000119107 or 85857008 or 1052321001 or 15993311000119106 or 62861003 or 1052300001 or 402948006 or 66281009 or 15993471000119105 or 1052323003 or 186850003 or 15993391000119102 or 15677881000119106 or 15677801000119103 or 15677841000119101 or 266129004 or 866115006) OR
    5. A discharge diagnosis code related to Oral Syphilis (235062007 or 713251003) OR
    6. A discharge diagnosis code related to Early Syphilis (186867005 or 186846005 or 266130009 or 186868000 or 1107004 or 31137003) OR
    7. A discharge diagnosis code related to Late Syphilis (72083004 or 186903006 or 788998009 or 1010615002 or 788975001 or 197757004 or 197347003 or 838317007 or 266136003 or 789121002 or 860894002 or 870319003 or 870273007 or 870347004 or 66887000 or 405635002 or 402951004 or 1142043006) OR
    8. A discharge diagnosis code related to Latent Syphilis (444150000 or 67125004) OR
    9. A discharge diagnosis code for Tertiary Syphilis (127058009) OR
    10. A discharge diagnosis code related to Quaternary Syphilis (278481001 or 240568004) OR
    11. A discharge diagnosis code for Neurosyphilis (26039008) OR
    12. A discharge diagnosis code related to Cardiovascular Syphilis (83883001 or 58056005 or 45058001 or 42770003) OR
    13. A discharge diagnosis code related to Ocular Syphilis (410478005 or 193786000) OR
    14. A discharge diagnosis code for Endocochlear Syphilis (232313005) OR
    15. A discharge diagnosis code related to Renal manifestations of Syphilis (59530001 or 29500006) OR
    16. A discharge diagnosis code related to Skeletomuscular manifestations of Syphilis (104471000119105 or 201738001 or 3743000450528008 or 49923008 or 88943008) OR
    17. A discharge diagnosis code related to Syphilis affecting specific organs (8555001 or 86028001 or 237446005) OR
    18. A discharge diagnosis code for Syphilitic prostatitis (197966009) OR
    19. A discharge diagnosis code related to Syphilitic gumma (64102008 or 235064008 or 21523006) OR
    20. A discharge diagnosis code related to Syphilides (240558009 or 240560006 or 402949003 or 240562003) OR
    21. A discharge diagnosis code related to Syphilitic iritis (711617002 or 15679561000119100 or 15679481000119100 or 15679681000119100) OR
    22. A discharge diagnosis code related to Syphilitic chancres (736686006 or 402941000 or 402940004 or 402942007) OR
    23. A discharge diagnosis code for Syphilitic aneurysm (234017002) OR
    24. A discharge diagnosis code for Syphilitic aortic aneurysm (12232008) OR
    25. A discharge diagnosis code for Syphilitic aortitis (20735004) OR
    26. A discharge diagnosis code for Syphilitic alopecia (59307008) OR
    27. A discharge diagnosis code related to Syphilitic bursitis (202933002 or 838317007) OR
    28. A discharge diagnosis code for Syphilitic myelitis (870293004) OR
    29. A discharge diagnosis code related to Syphilitic retinitis (410470003 or 15685521000119100 or 15685481000119100 or 15685441000119100) OR
    30. A discharge diagnosis code for Syphilitic balanitis (402943002) OR
    31. A discharge diagnosis code related to Syphilitic cirrhosis (16070004 or 197305002) OR
    32. A discharge diagnosis code related to Syphilitic meningitis (301086002 or 68863007 or 186863009) OR
    33. A discharge diagnosis code for Syphilitic leukoderma (55768006) OR
    34. A discharge diagnosis code for Syphilitic panuveitis (870331001) OR
    35. A discharge diagnosis code related to Syphilitic myocarditis (4082005 or 194947001) OR
    36. A discharge diagnosis code for Syphilitic choroiditis (331151000119109) OR
    37. A discharge diagnosis code for Syphilis in childbirth (10759921000119100) OR
    38. A discharge diagnosis code for Syphilitic peritonitis (34964002) OR
    39. A discharge diagnosis code related to Syphilitic endocarditis (67391006 or 94851000119107 or 186875004 or 278480000 or 186878002 or 186877007) OR
    40. A discharge diagnosis code for Syphilitic episcleritis (11338007) OR
    41. A discharge diagnosis code for Syphilitic parkinsonism (38523005) OR
    42. A discharge diagnosis code related to Syphilitic pericarditis (3589003 or 194907008) OR
    43. A discharge diagnosis code related to Syphilitic encephalitis (26135000 or 230182006) OR
    44. A discharge diagnosis code related to Syphilitic optic atrophy (22386003 or 870319003) OR
    45. A discharge diagnosis code for Syphilitic valve disease (233849007) OR
    46. A discharge diagnosis code for Syphilitic skin disorder (371237000) OR
    47. A discharge diagnosis code for Syphilitic polyneuropathy (240569007) OR
    48. A discharge diagnosis code related to Syphilitic oral leukoplakia (235032001 or 402950003) OR
    49. A discharge diagnosis code for Syphilitic punched out ulcer (4483005) OR
    50. A discharge diagnosis code related to Syphilitic neuritis (19206003 or 36276008 or 302813001) OR
    51. A discharge diagnosis code for Syphilitic cerebral arteritis (230735006) OR
    52. A discharge diagnosis code for Syphilitic mucosal ulceration (240563008) OR
    53. A discharge diagnosis code for Secondary syphilitic gastritis (1052296002) OR
    54. A discharge diagnosis code for Syphilitic aortic incompetence (61612001) OR
    55. A discharge diagnosis code for Secondary syphilitic periostitis (69595007) OR
    56. A discharge diagnosis code for Syphilitic interstitial keratitis (44568006) OR
    57. A discharge diagnosis code for Syphilitic oral snail track ulcer (235065009) OR
    58. A discharge diagnosis code for Syphilitic coronary artery disease (240567009) OR
    59. A discharge diagnosis code for Secondary syphilitic iridocyclitis (30080002) OR
    60. A discharge diagnosis code for Syphilitic ostial coronary disease (62207008) OR
    61. A discharge diagnosis code for Tertiary syphilitic chorioretinitis (312955002) OR
    62. A discharge diagnosis code for Spastic spinal syphilitic paralysis (75299005) OR
    63. A discharge diagnosis code for Syphilitic posterior spinal sclerosis (315826004) OR
    64. A discharge diagnosis code for Rupture of syphilitic cerebral aneurysm (186893003) OR
    65. A discharge diagnosis code for Syphilitic disseminated retinochoroiditis (77939001) OR
    66. A discharge diagnosis code for Syphilitic infectious intermediate uveitis (1177029002) OR
    67. A discharge diagnosis code for Female syphilitic pelvic inflammatory disease (198175009) OR
    68. A discharge diagnosis code related to Maternal syphilis during pregnancy, childbirth and the puerperium (10759921000119107 or 199154009) ANDNOT
• All of the above must exclude:
  • A chief complaint related to Congenital Syphilis (“congenital siphilis” or “congenital syphylis” or “congenital syphylus” or “congenital syphilus” or “congenital siphylis” or “congenital siphilus” or “congenital syphilis”or “congenital siphillis” or “congenital syphyllis” or “congenital syphyllus” or “congenital syphillus” or “congenital siphyllis” or “congenital siphillus” or “congenital syphillis” or “congenital sifilis” or “congenital syfylis” or “congenital syfylus” or “congenital syfilus” or “congenital sifylis” or “congenital sifilus” or “congenital syfilis”) OR
  • An ICD-10-CM discharge diagnosis code for Congenital Syphilis (A50) OR
  • An ICD-10-CM discharge diagnosis code for Nonvenereal Syphilis (A65) OR
  • An ICD-9-CM discharge diagnosis code related to Congenital Syphilis (090.0 or 090.1 or 090.2 or 090.3 or 090.4 or 090.5 or 090.6 or 090.7 or 090.9) OR
  • An ICD-9-CM discharge diagnosis code for Nonvenereal Syphilis (104.0) OR
  • A SNOMED CT discharge diagnosis code related to Congenital Syphilis (35742006 or 87318008 or 9941009 or 192008 or 27648007 or 4359001 or 86443005 or 266126006 or 82323002 or 109436001 or 1177081002 or 827006 or 186833000 or 735515000 or 6267005 or 266125005 or 721583004 or 1142095003 or 235898000 or 1142031005 or 703134008 or 866106004 or 1142112002 or 46235002 or 722118005) OR
  • A SNOMED CT discharge diagnosis code for non-venereal endemic syphilis (271426000) OR
  • A discharge diagnosis code for Nasal Syphilis (232367004)

Plain language description:

The definition uses discharge diagnosis codes and free-text chief complaint terms. The definition requires that an emergency department visit contains a reference to the condition by its discharge diagnosis code (in at least one of the following: ICD-9-CM, ICD-10-CM, SNOMED CT diagnostic codes), or by the condition name listed in the chief complaint text. Therefore, the acquired syphilis v1 syndromic surveillance definition includes ICD-10-CM, and SNOMED CT diagnostic codes for acquired syphilis, along with direct mentions of acquired syphilis (including misspellings of syphilis) in chief complaint text. To ensure that only acquired syphilis was captured, we excluded records with chief complaint text and discharge diagnosis codes for congenital syphilis.