ATT7_STD_NETSS_record_layout

Form Approved
OMB No. 0920-0819
Exp. Date 08/31/2012

Record Layout for Transmission of STD Morbidity Data
Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
RECORD TYPE

Record type will determine how the
record is handled when it arrives at
CDC.

1

M=MMWR report

Req CT,
G, S, CH

UPDATE

Currently not implemented (pad with
a 9).

2

9

Req CT,
G, S, CH

STATE

State reporting case information &
jurisdiction of case (based on patient
residence).

3-4

Standard 2-digit State FIPS
code.

Reporting state is defined using
CSTE:CDC criteria available at:
http://www.cdc.gov/ncphi/od/ai/phs/files/0
3-ID-10_residency_rules.pdf

Req CT,
G, S, CH

YEAR

MMWR Year for which case
information was reported to CDC.
Derived from MMWR week.

5-6

2-digit year (##)

Based on MMWR week assignment.

Req CT,
G, S, CH

CASE REPORT ID

Unique Case Report ID (numeric)
assigned by the state.

7-12

6-digit numeric

Non-identifying ID for case report, NOT
case-patient. Represents incident case
report. Assigned by state, in combination
with other variables (e.g. Reporting state
+/- associated date) will represent a unique
case in national data base.

Req CT,
G, S, CH

SITE CODE

Location code assigned by the state
to indicate where report originated
and who has responsibility for
maintaining the record.

13-15

S01=State epidemiologist
S02=State STD Program
S03=State Chronic Disease
Program
S04-S99=Other state offices
R01-R99=Regional or
district offices
001-999=County health
depts (FIPS codes)
L01-L99=Laboratories
within state
CD1=Historical records
(prior to new format)
CD2=Entered at CDC
(based on phone
reports)
#<##>=Entered in
STD*MIS application; 2digit code represents the
state specific installation of
STD*MIS

Project areas should NOT re-use SITE
codes over time. If a new site is added,
please assign a new, unique SITE ID. If a
site is no longer reporting to your
surveillance system, RETIRE the site ID do not re-use. Project areas should also
maintain up-to-date lists of SITE IDs with
information describing the site
characteristics (e.g. location, contact person
and contact information), so the SITE IDs
and their meaning can be shared as needed.

Req CT,
G, S, CH

WEEK

MMWR Week on Surveillance
Calendar, i.e., week for which case
information is reported to CDC.
Assigned by reporting jurisdiction.

16-17

01 through 53, dependent
upon Surveillance Calendar

EVENT or
DIAGNOSIS

STD or associated syndrome (health
event) for which the case-patient has been
diagnosed (regardless of case status per
CSTE/CDC surveillance case definition).

EVENT or
DIAGNOSIS

(EFFECTIVE AS OF 01/2011)

18-22

Req CT,
G, S, CH

10273=Chancroid

Health event = "Chancroid" per CSTE/CDC
surveillance case definition (regardless of case
classification status [confirmed, probable, or
suspect])

10274=Chlamydia trachomatis
infection

Health event = "Chlamydia trachomatis infection"
per CSTE/CDC surveillance case definition
(regardless of case classification status
[confirmed, probable, or suspect])
Reporting of non-nationally notifiable STDs is
optional. Currently, GI is not nationally
notifiable.

10276=Granuloma inguinale
(GI)

Req CT, G,
S, CH

1

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
(continued)
10280=Gonorrhea

10306=Lymphogranuloma
venereum (LGV)

Reporting of non-nationally notifiable STDs is
optional. Currently, LGV is not nationally
notifiable.

10307=Non-Gonococcal
Urethritis (NGU)

Reporting of non-nationally notifiable STDs is
optional. Currently, NGU is not nationally
notifiable.

10308=Mucopurulent Cervicitis
(MPC)

Reporting of non-nationally notifiable STDs is
optional. Currently, MPC is not nationally
notifiable.

10309=Pelvic Inflammatory
Disease (PID) [unknown
etiology]
10311=Syphilis, primary

10312=Syphilis, secondary

10313=Syphilis, early latent

10314=Syphilis, late latent

10315=Syphilis, unknown latent

10318=Late Syphilis with
clinical manifestations

10317=RETIRED

COUNT

Represents # of cases reported in this
'record'; supports aggregate- (when
>1)or case-specific (when=1)

Health event = "Gonorrhea" per CSTE/CDC
surveillance case definition (regardless of case
classification status [confirmed, probable, or
suspect])

Reporting of non-nationally notifiable STDs is
optional. Currently, PID is not nationally
notifiable.
Health event = "Syphilis, primary" per
CSTE/CDC surveillance case definition
(regardless of case classification status
[confirmed, probable, or suspect])
Health event = "Syphilis, secondary" per
CSTE/CDC surveillance case definition
(regardless of case classification status
[confirmed, probable, or suspect])
Health event = "Syphilis, early latent" per
CSTE/CDC surveillance case definition
(regardless of case classification status
[confirmed, probable, or suspect])
Health event = "Syphilis, late latent" per
CSTE/CDC surveillance case definition
(regardless of case classification status
[confirmed, probable, or suspect])
Health event = "Syphilis, unknown latent" per
CSTE/CDC surveillance case definition
(regardless of case classification status
[confirmed, probable, or suspect])
Health event = "Late Syphilis with clinical
manifestations" per CSTE/CDC surveillance case
definition (regardless of case classification status
[confirmed, probable, or suspect])
NOTE: Neurosyphilis code "10317" is retired (no
longer used for case reporting). Neurosyphilis
can occur at almost any stage of syphilis;
therefore it is not considered a distinct stage.
Neurosyphilis without any other symptoms or of
unknown stage of syphilis should be reported as
event code 10318. However, you should also code
the neurologic involvement variable as "Yes,
confirmed" or "Yes, probable".

23-27

#####

Number of case reports represented in this record.
Default = 00001 for case-specific records where a
single case is represented by data record.

Req CT,
G, S, CH

In combination with State FIPS, represents
a unique US county ID.

Req CT,
G, S, CH

reporting.

COUNTY

Standard FIPS code for county of
case-patient's residence in reporting
state.

28-30

3-digit county FIPS

DATE OF BIRTH

Date of birth of case-patient in
YYYYMMDD format.

31-38

YYYYMMDD
(Unknown=99999999)

2

Req CT,
G, S, CH

(EFFECTIVE AS OF 01/2011)

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
AGE

Age of case-patient at time of initial
exam or specimen collection for case
report "condition".

39-41

AGETYPE

Indicates the units (years, months,
etc.) for the AGE field.

42

0=0-120 years
1=0-11 Months
2=0-52 Weeks
3=0-28 Days
9=Age Unknown (AGE
field should be 999)

Req CT,
G, S, CH

SEX

Current sex of patient

43

1=Male
2=Female
9=Unknown

Req CT,
G, S, CH

RACE

Race

44

9=(Default)

This variable should default to 9. It has
been superseded by the individual RACE
variables located in columns 98-105.

Req CT,
G, S, CH

HISPANIC

Indicator for Hispanic ethnicity.

45

9=(Default)

This variable should default to 9. It has
been superseded by the
HISPANIC/LATINO variable located in
column 106.

Req CT,
G, S, CH

EVENT DATE

Date of disease in YYMMDD
format. This date depends upon how
case dates are assigned in the STD
program, i.e., date could be the onset
of symptoms date, diagnosis date,
laboratory result date, date case first
recognized and/or reported to STD
program, or date case reported to
CDC.

DATETYPE

Describes the type of date provided
in EVENT DATE.

CASE STATUS

Note: Must report "AGETYPE" value to
determine time units associated with
"AGE".

Req CT,
G, S, CH

YYMMDD
(Unknown=999999)

Req CT,
G, S, CH

52

1=Onset Date
2=Date of diagnosis
3=Date of laboratory result
4=Date of first report to
community health system
5=State/MMWR report date
9=Unknown

Req CT,
G, S, CH

Status of the case/event as suspect,
probable, or confirmed.

53

1=Confirmed case
2=Probable case
3=Suspect case
9=Unknown case status

Note: Please review CSTE/CDC case
definitions for information on case
classification status.
(http://www.cdc.gov/epo/dphsi/casedef/cas
e_definitions.htm)

Req CT,
G, S, CH

IMPORTED

Indicates if the case was imported
into the state or the U.S.

54

9=(Default)

This variable should default to 9. It has
been superseded by the STD IMPORT
variable located in column 113.

Req CT,
G, S, CH

OUTBREAK

Indicates whether the case was
associated with an outbreak.

55

1=Yes
2=No
9=Unknown

Req CT,
G, S, CH

FUTURE

Reserved for future use

56-60

99999

Req CT,
G, S, CH

INFOSRCE Facility Type (STD
dx, rx)

Setting or health care facility where a
person first received diagnosis,
treatment or testing for STD or
associated syndrome reported in this
case report (i.e., facility type of STD
diagnosis, facility type where person
was tested for STD).

61-62

01=HIV Counseling and
Testing Site

A public clinic whose primary mission is to
provide counseling and HIV testing
services.

02=STD clinic (Represents
PUBLIC to match old
reporting forms.)

A clinic whose primary mission is to
provide diagnosis, treatment, counseling,
and sex partner notification for sexually
transmitted diseases.

03=Drug Treatment

A residential or outpatient clinic whose

(EFFECTIVE AS OF 01/2011)

46-51

###
Unknown=999

Req CT,
G, S, CH

3

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
primary mission is to provide treatment for
an individual's drug, alcohol, and other
substance addiction.

INFOSRCE Facility Type (STD
dx, rx)
(continued)

04=Family Planning

A clinic whose primary mission is to
provide contraceptive and reproductive
health care for the prevention and
achievement of pregnancy. Such sites
receive federal and/or state family planning
funds and are situated in state or county
health departments or are community-based
organizations (may include Title X and
non-Title X funded facilities, including
Planned Parenthood clinics).

05=(RETIRED CODE ID)

Former "Prenatal/Obstetrics". Use either
"Labor and Delivery/Obstetrics" (14) or
"Prenatal" (15).

06=Tuberculosis clinic

A clinic for the screening, diagnosis,
treatment, and follow-up o findividuals
with tuberculosis and contacts of
individuals positive for TB.

07=Other Health
Department Clinic

A public clinic administered by a local or
state health department that can not be
classified in one of the other defined
disease- or medical service-specific facility
types.

08=Private Physician/HMO

A non-publicly-funded group of health care
providers or an individual health care
provider who provides medical care (e.g.,
general/family/internal medicine
practitioners, pediatricians).

09=(RETIRED CODE ID)

Formerly "Hospital - Inpatient" - now
included in "Hospital - Other (29)"

10= Hospital - Emergency
Room; Urgent Care facility

A department in a hospital or clinic staffed
and equipped to provide emergency care to
persons requiring immediate medical
treatment. (includes Urgent Care).

11=Correctional facility

A prison, jail, detention center, or other
correctional facility where persons are
incarcerated or supervised by the criminal
justice system.

12=Laboratory

Facility providing the clinical diagnostic
testing of biological or environmental
specimens using a variety of test methods
and reporting of results.

13=Blood Bank

Facility where blood donations are taken,
blood is screened and processed to ensure
viability, and stored until needed.

14=Labor and delivery

A facility providing health care services to
women during labor and delivery through
birth of the infant.

15=Prenatal

A clinic whose primary mission is to
provide health care and education to
pregnant women (from time of diagnosis of
pregnancy to the time of labor and
delivery).

16=National Job Training
Program

4

A residential, educational, and job training

(EFFECTIVE AS OF 01/2011)

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
program for at-risk youth aged 16 to 24
years. National Job Training Program is a
public-private partnership administered by
the U.S. Department of Labor and the
Employment and Training Administration.
17=School-based Clinic
A clinic located in or affiliated with a
middle school, junior high school, senior
high school, or other type of school
providing education at or below 12th grade
that provides medical care and health
education to students.
18=Mental Health Provider
Facility or provider providing inpatient or
outpatient mental health services.
29=Hospital – Other
A multidisciplinary public or private
facility that provides non-emergency
inpatient or outpatient medical services.
Includes specialty clinics within a hospital
(Excludes care sites that provide
emergency or urgent care and obstetric or
labor and delivery services.)
66=Indian Health Service
A medical care facility funded by the
Indian Health Service.
77=Military
A facility operated by the U.S. military
whose primary mission is to provide health
care.
88=Other
A clinic that can not be categorized in any
of the other defined facility types.
99=Unknown (if data not
available)
Method of Case
Detection

How did the case patient first come
to the attention of the health
department for this condition?

63-64

Facility type not available.

01=(RETIRED CODE ID)
02=(RETIRED CODE ID)
03=(RETIRED CODE ID)
04=(RETIRED CODE ID)
05=(RETIRED CODE ID)
06=(RETIRED CODE ID)
07=(RETIRED CODE ID)
08=(RETIRED CODE ID)
09=(RETIRED CODE ID)
10=(RETIRED CODE ID)
99=(RETIRED CODE ID)

These codes have been RETIRED and are
superseded by the legal values (20-24)
below.

20=Screening

An asymptomatic patient was identified
through screening (routine testing of
populations who are asymptomatic in order
to identify those with disease). Examples of
screening programs include health
department outreach to high-risk
populations (e.g., commercial sexworkers), HIV care clinics, family
planning, blood donation, correctionsbased, and prenatal. This includes STD and
other health department clinic visits by a
client who tests positive for a condition
with which they were unaware (e.g.,
asymptomatic walk-ins) of before being
seen at the clinic.

Req S
Opt CT,
G, CH

21=Self-referred
Refers to patient who sought health
services because of signs of an STD and
was subsequently tested for the disease
being reported. This includes symptomatic

(EFFECTIVE AS OF 01/2011)

5

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
Method of Case
Detection
(continued)

STD clinic testing.
22=Patient Referred Partner
Patient referred by another infected person.
This may be a named or unnamed partner.
No health department involvement was
necessary for this referral.
23=Health Department
referred partner

This patient is a named partner of a known
case. Patient identified through DIS, or
other health department personnel, activity
following an interview of another known
case. The health department was involved
in the referral of this individual (e.g., the
DIS contacted, called, visited, sent letter,
etc., the patient to inform them of their
need to be tested).

24=Cluster related
Patient was originally identified as a Social
Contact (Suspect) or Associate. Cluster
brought to the attention of the program as a
result of a DIS interview.
88=Other
In the event that values 20-24 do not apply,
please select this value.
ZIP

5-digit Zip code of residence of the
case patient.

65-69

#####; (Unknown=99999,
if data not available)

CITY
(DISCONTINUED)

Previously collected CITY data.

70-73

9999

This variable should be set to 9999. It is no
longer being collected by DSTDP.

PID
(DISCONTINUED)

Previously collected PID data.

74

9

This variable should be set to 9. It is no
longer being collected by DSTDP.

Pregnant - initial
exam

Was the case patient pregnant at time
of initial exam for the condition
reported in this case report?

75

1=Yes
2=No
9=Unknown

ORIGIN
(DISCONTINUED)

Previously collected ORIGIN-Source
of morbidity report.

76

9

This variable should be set to 9. It is no
longer being collected by DSTDP.

DX_DATE
(DISCONTINUED)

Previously collected date of
diagnosis.

77-84

99999999

This variable should be set to 99999999. It
is no longer being collected by DSTDP.

Specimen source

Anatomic site or specimen type from
which positive lab specimen was
collected.

85-86

01=Cervix/Endocervix
02=Lesion-Genital
03=Lesion-Extra Genital
04=Lymph Node Aspirate
05=Oropharynx
06=Ophthalmia/Conjunctiva
07=Other
08=Other Aspirate
09=Rectum
10=Urethra
11=Urine
12=Vagina
13=Blood/Serum
14 - Cerebrospinal fluid
(CSF)
88=Not Applicable
99=Unknown

6

Req CT,
G, S, CH

Req S
Opt CT, G,
CH

Req CT, G
Opt S, CH

(EFFECTIVE AS OF 01/2011)

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
Date of laboratory
specimen collection

Date of collection of initial
laboratory specimen used for
diagnosis of health event reported in
this case report.

Neurological
involvement?

If event = some stage of syphilis,
does the patient have neurologic
involvement based on current case
definition?

95

1=Yes, Confirmed
2=Yes, Probable
3=No
9=Unknown

INTERVIEW
(DISCONTINUED)

Previously collected interview case
status.

96

9

This variable should be set to 9. It is no
longer being collected by DSTDP.

PARTNER
(DISCONTINUED)

Previously collected sex of sex
partners.

97

9

This variable should be set to 9. It has been
superseded by the sex partner data located
in columns 147-148.

American Indian/
Alaska native?

Case patient reported Am
Indian/Alaska Native (AI/AN) race

98

Y = Yes; Variable value is
Y or Blank, dependent upon
case-patient's reported race.

Y = Yes, case-patient reports AI/AN race.

Req CT,
G, S, CH

Asian?

Case patient reported Asian race

99

Y = Yes; Variable value is
Y or Blank, dependent upon
case-patient's reported race.

Y = Yes, case-patient reports Asian race.

Req CT,
G, S, CH

Black/African
American?

Case patient reported Black/African
American (B) race

100

Y = Yes; Variable value is
Y or Blank, dependent upon
case-patient's reported race.

Y = Yes, case-patient reports Black race.

Req CT,
G, S, CH

Native Hawaiian/
Pacific Islander?

Case patient reported Native
Hawaiian/Pacific Island (NH/PI) race

101

Y = Yes; Variable value is
Y or Blank, dependent upon
case-patient's reported race.

Y = Yes, case-patient reports NH/PI race.

Req CT,
G, S, CH

White?

Case patient reported White (W) race

102

Y = Yes; Variable value is
Y or Blank, dependent upon
case-patient's reported race.

Y = Yes, case-patient reports White race.

Req CT,
G, S, CH

Other race?

Case patient reported some other race
(not AI/NA, Asian, Black, NH/PI,
White)

103

Y = Yes; Variable value is
Y or Blank, dependent upon
case-patient's reported race.

Y = Yes, case-patient reports some other
race (not AI/AN, Asian, Black, NH/PI, or
White).

Req CT,
G, S, CH

Refused to report
race

Case patient refused to report race

104

Y = Yes; Variable value is
Y or Blank, dependent upon
case-patient's reported race.

Y = Yes, case-patient refused to report
race.

Req CT,
G, S, CH

Unknown race

Case patient could not answer this
question for any reason

105

Y = Yes; Variable value is
Y or Blank, dependent upon
case-patient's reported race.

Y = Yes, case-patient could not provide
information regarding their race.

Req CT,
G, S, CH

Hispanic/Latino?

Indicator for case-patient's
Hispanic/Latino ethnicity.

106

Y=Yes

Case-patient reports Hispanic or Latino
ethnicity.

Req CT,
G, S, CH

N=No

Case-patient does NOT report Hispanic or
Latino ethnicity.

U=Unknown

Case-patient's ethnicity information is not
known.

R = Refused to answer

Case-patient refused to respond to
questions regarding ethnicity.

Census tract of casepatient residence

Census tract where the address is
located is a unique identifier
associated with a small statistical
subdivision of a county. Census tract
data allows a user to find population
and housing statistics about a specific

87-94

107-112

YYYYMMDD format
(Unknown=99999999)

6-character length
alphanumeric

PREFERRED date for assignment of
MMWR week. First date in hierarchy of
date types associated with case
report/event.

Req CT,
G, S, CH

Req S

Opt CT,
G, S, CH

part of an urban area. A single community
may be composed of several census tracts.

(EFFECTIVE AS OF 01/2011)

7

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
STD IMPORT

Was case imported? Was disease
acquired elsewhere? Indicates
probable location of disease
acquisition relative to reporting state.

113

N - Not an imported case

Health event for this case report was
acquired in the reporting state or intrastate
jurisdiction that was responsible for case
management.

C – Yes, imported from
another country

Health event for this case report was
acquired outside the US

S - Yes, imported from
another state

Health event for this case report was
acquired in the US, but not in the reporting
state

J - Yes, imported from
another county/
jurisdiction in the state

Health event for this case report was
acquired in another county/jurisdiction in
the state. Implies intrastate crossjurisdictional activity may have been
initiated for STD control.

D - Yes, imported but not
able to determine source
state and/or country

Health event for this case report was
imported from outside the reporting state,
but there is insufficient information to
determine if the disease was acquired
within or outside the US

U - Unknown

Insufficient information is available to
determine where disease acquisition
occurred.

Opt CT,
G, S, CH

Date of initial health
exam associated
with case report
"health event"

Date of earliest healthcare
encounter/visit /exam associated with
this event/case report. May equate
with date of exam or date of
diagnosis.

114-121

YYYYMMDD format
(Unknown=99999999)
(N/A=99999999)

Req CT,
G, S, CH if
date of
laboratory
specimen
collection
is not
reported

Date of first report
of case/event to
public health system

Date of first report of case to local or
state health department (first tier of
public health system in reporting
jurisdiction; may equate to city,
county, region, or state public health
system level).

122-129

YYYYMMDD format
(Unknown=99999999)
(N/A=99999999)

Req CT, G,
S, CH if
date of
laboratory
specimen
collection
AND date
of initial
health exam
associated
with the
case report
“health
event” are
not reported

Treatment date

Date treatment initiated for the
condition that is the subject of this
case report.

130-137

YYYYMMDD format
(Unknown=99999999)

Req S
Opt CT,
G, CH

Date case report
initially sent from
reporting
jurisdiction to CDC

INITIAL date case report was sent
from reporting jurisdiction to CDC.
Generated by the reporting
jurisdiction at the time of report to
CDC. Can be generated by the
information system.

138-145

YYYYMMDD format
(Unknown=99999999)

Opt CT,
G, S,CH

HIV status?

Documented or self-reported HIV
status at the time of event.

P = HIV positive
N = HIV negative
E = Equivocal HIV test
result
U = Unknown
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

8

146

(EFFECTIVE AS OF 01/2011)

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
Had sex with a male
within past 12
months?

147

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Had sex with a
female within past
12 months?

148

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Had sex with an
anonymous partner
within past 12
months?

149

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Had sex with a
person known to
him/her to be an
IDU within past 12
months?

150

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Had sex while
intoxicated and/or
high on drugs within
past 12 months?

151

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Exchanged
drugs/money for sex
within past 12
months?

152

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

153

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

154

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Had sex with a
person who is
known to her to be
an MSM within past
12 months?

NOTE: For women only.

Engaged in injection
drug use within past
12 months?

During the past 12
months, which of
the following
injection or noninjection drugs
have been used?
Crack

M

A potent, relatively cheap, addictive
variety of cocaine; often a rock,
usually smoked through a crack-pipe
(synonyms: rock, rock cocaine).

155

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Cocaine

M

A stimulant narcotic in the form of a
white powder that users generally
self-administer by insufflation
through the nose (synonyms: coke,
snow, blow).

156

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Heroin

M

An addictive, narcotic drug derived
from opium (synonyms: horse, junk,
smack).

157

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

(EFFECTIVE AS OF 01/2011)

9

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
Methamphetamines

M

A highly addictive phenethylamine
stimulant drug (synonyms: ice,
crystal, meth).

158

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Nitrates/Poppers

M

Any one of various alkyl nitrites
(particularly amyl nitrite, butyl nitrite
and isobutyl nitrite) taken for
recreational purposes through direct
inhalation.

159

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Erectile dysfunction
(ED) medications

M

Any one of several drugs available
by prescription (e.g.Viagra) used to
treat erectile dysfunction.

160

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Other drug(s) used?

M

Other drug = type of injection or
non-injection drug used for
recreational purposes that is not
listed above.

161

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

No drug use
reported

M

162

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

163

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Been incarcerated
within past 12
months?

Note: Over-the-Counter (OTC) herbal
medicines or remedies to treat ED should
NOT be considered „eligible‟ ED drugs for
the purposes of this question.

Req S
Opt CT,
G, CH

History of ever
having an STD prior
to this STD
diagnosis?

Does the patient have a history of
ever having had an STD prior to the
condition reported in this case
report?

164

Y=Yes, patient has a history
of STD
N=No, patient has never
had
a prior STD
U=Unknown if patient has
had a prior STD
R = Patient refused to
answer any questions
regarding prior STD
history

Req S
Opt CT,
G, CH

Have you met sex
partners through the
Internet in the last
12 months?

Did the patient use an online
computer site to exchange messages
by typing them onscreen to engage in
conversation with other visitors to
the site for the purpose of having
sex?

165

Y = Yes
N = No
R = Refused to answer
D = Did not ask

Req S
Opt CT,
G, CH

Total number of claimed sex partners
that the case patient has had in the
last 12 months. Total partners equal
the sum of all male, female, and
transgender partners during the last
12 months. Those marked unknown
or refused are excluded from the
total.

166-168

###
888=Patient refused to
answer questions
regarding number of
sex partners
999=Unknown number of
sex partners in last 12
months

Req S
Opt CT,
G, CH

Total number of sex
partners last 12
months?

Clinician-observed
lesion(s) indicative
of syphilis were
identified at which
of the following
anatomic site(s)?
(Mark all that
apply.)

10

M

If condition = any stage of syphilis,
report anatomic site(s) of clinicianobserved lesion(s) (e.g., chancre,
rash, condyloma lata) at time of
initial exam or specimen collection.
Mark all that apply.

(EFFECTIVE AS OF 01/2011)

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
A=Anus/Rectum

One or more lesion(s) indicative of
syphilis were present in the anus or
rectum.

169

Y= Yes; Variable value is Y or
Blank, dependent upon whether a
lesion compatible with syphilis was
observed at this anatomic site.

Req S
Opt CH

B=Penis

One or more lesion(s) indicative of
syphilis were present on the penis.

170

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed
at this anatomic site.

Req S
Opt CH

C=Scrotum

One or more lesion(s) indicative of
syphilis were present on the scrotum.

171

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed
at this anatomic site.

Req S
Opt CH

D=Vagina

One or more lesion(s) indicative of
syphilis were present in the vagina.

172

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed
at this anatomic site.

Req S
Opt CH

E=Cervix

One or more lesion(s) indicative of
syphilis were present on the cervix.

173

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed
at this anatomic site.

Req S
Opt CH

F=Nasopharynx

One or more lesion(s) indicative of
syphilis were present in the
nasopharynx.

174

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed
at this anatomic site.

Req S
Opt CH

G=Mouth/Oral
cavity

One or more lesion(s) indicative of
syphilis were present in the mouth or
oral cavity.

175

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed
at this anatomic site.

Req S
Opt CH

H=Eye/conjunctiva

One or more lesion(s) indicative of
syphilis were present on the eye or
conjunctiva.

176

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed
at this anatomic site.

Req S
Opt CH

I=Head

One or more lesion(s) indicative of
syphilis were present on the head.

177

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed
at this anatomic site.

Req S
Opt CH

J=Torso

One or more lesion(s) indicative of
syphilis were present on the torso.

178

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed
at this anatomic site.

Req S
Opt CH

K=Extremities
(Arms, legs, feet,
hands)

One or more lesion(s) indicative of
syphilis were present on the
extremities (arms, legs, feet, hands).

179

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed
at this anatomic site.

Req S
Opt CH

N= No lesion noted

Patient was evaluated but no
lesion(s) indicative of syphilis were
observed.

180

Y= Yes; Variable value is Y
or Blank, dependent upon
whether a lesion compatible
with syphilis was observed.

Req S
Opt CH

(EFFECTIVE AS OF 01/2011)

11

Data Element
Name

N/
M* Data Element Definition

Columns

Data Element "legal"
Values

Data Element "legal" value definition

Required/
Optional+

CODE KEY
*N=New (2011); M=Modified (2011)
+
Req=Required; Opt=Optional; CT=Chlamydia; G=Gonorrhea; S=Syphilis; CH=Chancroid
O=Other anatomic
site not represented
in other defined
anatomic sites

One or more lesion(s) indicative of
syphilis were present in some other
anatomic site not represented in the
defined anatomic sites.

181

Y= Yes; Variable value is Y or
Blank, dependent upon whether a
lesion compatible with syphilis was
observed at some other anatomic site
not represented in other defined
anatomic sites.

Req S
Opt CH

U=Unknown

Anatomic site of lesion information
is not available for whatever reason,
e.g. patient not evaluated or
information is not available for data
entry.

182

Y= Yes; Variable value is Y
or Blank, dependent upon
whether information on the
anatomic site of lesion
compatible with syphilis
was available.

Req S
Opt CH

Type of
nontreponemal
serologic test for
syphilis

What type of non-treponemal
serologic test for syphilis was
performed on specimen collected to
support case patient's diagnosis of
syphilis?

183

1= Rapid Plasma Reagin
(RPR)
2= Venereal Disease
Research Laboratory test
(VDRL) (serology)
3=VDRL test of
cerebrospinal fluid (CSF)
9 = Unknown test type

Req S

Quantitative syphilis M
test result

If the test performed provides a
quantifiable result, provide
quantitative result (e.g. if RPR is
positive, provide titer, e.g. 1:64)

NETSS Version

12

N

What version of the NETSS record
layout are you providing?
i.e. Version 3 (January 2011)

184-189

190-191

###### (see Ex. A)
<##### (see Ex. B)
>##### (see Ex. B)
NR= nonreactive
WR= weakly reactive
999999= unknown

Example A: If titer is 1:64, enter 64; if titer
is 1:1024, enter 1024.
Example B: Valid entries: titer value. For example, <64 or >16384.

Req S

All entries should be left justified (no
preceding or trailing zeroes).

03=Version 3

(EFFECTIVE AS OF 01/2011)