SYPHILIS (Blood Sample)
Tests performed elsewhere, or prior to the civil surgeon’s examination of the applicant, are not acceptable.
Syphilis is a sexually transmitted disease caused by Treponema Palliudm
- All applicants aged 18-44 years must be tested for evidence of syphilis.
- Applicants aged less than 18 years or greater than 44 years must be tested if there is reason to suspect infection with syphilis.
False-positive nontreponemal test results can be associated with multiple medical conditions and factors unrelated to syphilis, including other infections (e.g., HIV, tuberculosis, hepatitis, malaria), autoimmune conditions (e.g., systemic lupus, rheumatoid arthritis), vaccinations (e.g., smallpox, MMR), injection drug use, pregnancy, and older age.
Treponemal tests might be positive (or reactive) with serum from patients with other infectious and noninfectious diseases, conditions, YAWS (T. pallidum subspecies pertenue), Pinta (/t. carateum), Bejel (T. pallidum subspecies endemicum) or other treponemal diseases.
Civil Surgeons must treat syphilis according to CDC’s STI Treatment Guidelines which are periodically updated before the medical report is completed and signed.
Benzathine penicillin G (BPG) is the preferred treatment regimen for syphilis.
GONORRHEA (NAAT - Urine Sample)
Tests performed elsewhere, or prior to the civil surgeon’s examination of the applicant, are not acceptable.
Gonorrhea is a sexually transmitted disease caused by Neisseria gonorrhoeae.
- All applicants aged 18 to 44 years must be tested for evidence of syphilis
- Applicants ages less than 18 years or greater than 24 must be tested if there is a reason to suspect infection with gonorrhea.
The gonorrhea nucleic acid amplification test (NAAT) must be ordered by the civil surgeon at the time of the immigration medical examination.
Civil Surgeon’s must treat gonorrhea according to CDC’s STI Treatment Guidelines, which periodically update before the medical report is completed and signed.
TUBERCULOSIS
CDC Tuberculosis (TB) Transmission and Pathogenesis Video
Pulmonary tuberculosis is a disease that involves the lungs and is often infectious.
All applicants 2 years old or older must have an interferon gamma release assay (IGRA). Children less than 2 years of age will be tested should there be evidence of contact with TB known or suspected. All applicants with a positive IGRA, known Human immunodeficiency virus (HIV) infection, or signs or symptoms of tuberculosis disease, must have a chest radiograph (chest x-ray).
Women who are pregnant and have a positive IGRA are required to have a chest x-ray to adjust status.
Applicants with a positive IGRA result and chest x-ray not suggestive of tuberculosis disease, no known HIV infection, and no signs or symptoms of tuberculosis disease have LTBI ( latent tuberculosis infection ) .The civil surgeon can treat these applicants for LTBI or refer them for treatment elsewhere, but the applicants do not have to complete treatment before they are medically cleared and their I-693 forms are completed, because LTBI is not a Class A condition.
Applicants who have documentation of being diagnosed and completing treatment for LTBI prior to the civil surgeon examination must have a chest x-ray as part of the civil surgeon evaluation. If the chest x-ray is negative , the applicant does not have to be diagnosed with LTBI or reported to the health department and can be classified as “No Class A or Class B TB “. Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria. Other people may get sick years later, with their immune system becoming weak for another reason. Overall, about 5-10 % of infected persons who do not receive treatment for latent TB infection will develop TB disease at some time in their lives. For people whose immune systems are weak, especially those with HIV infection, the risk for developing TB disease is much higher than for people with normal immune systems.
Tuberculosis Classifications
The following are the tuberculosis classification options:
No Class A or Class B TB
Applicants without clinical findings of tuberculosis disease, without known HIV infection, and with a negative IGRA. Applicants with a remote history of tuberculosis disease who have a negative IGRA, no current signs or symptoms of tuberculosis disease, and no known HIV infection are also assigned “No Class A or Class B TB.”
Class A TB
All applicants who have tuberculosis disease. This class includes applicants who are diagnosed with tuberculosis disease by the civil surgeon and health department and applicants who present to the civil surgeon already on tuberculosis treatment at the time of their medical exam. This class also includes applicants with extrapulmonary tuberculosis who have a chest x-ray suggestive of tuberculosis disease, regardless of sputum smear and culture results.
Class B0, Pulmonary TB
Applicants who were diagnosed with tuberculosis by the civil surgeon and health department during the medical examination process and successfully completed directly observed therapy.
Class B1, Pulmonary TB
Applicants who have signs or symptoms, physical exam, or chest x-ray findings suggestive of tuberculosis disease; or have known HIV infection; are referred to the health department for additional evaluation; but have negative AFB sputum smears and cultures and are not diagnosed with tuberculosis disease.
Class B1, Extrapulmonary TB
Applicants with extrapulmonary tuberculosis, a normal chest x-ray, and negative sputum smears and cultures (if required).
Class B2 TB, Latent TB Infection
Applicants who have a positive IGRA, or history of a positive IGRA, and a chest x-ray not suggestive of tuberculosis disease. The IGRA result, the applicant’s status with respect to LTBI treatment, and the medication(s) used must be documented. For applicants who had more than one IGRA, all dates and results must be documented. All of these applicants must be reported to the health department of jurisdiction. The civil surgeon can treat these applicants for LTBI or refer them for treatment elsewhere, but the applicants do not have to complete treatment before they are medically cleared and their I-693 forms are completed, because LTBI is not a Class A condition.
Class B, Other Chest Condition (non-TB)
Applicants with an abnormal chest radiograph suggestive of disease that is not tuberculosis in an applicant with no clinical signs or symptoms of active TB.