II. Signs

  1. Solitary Chancre (hallmark of Primary Syphilis)
    1. Painless Papule ulcerates
    2. Indurated lesion with smooth base and firm border
    3. Multiple lesions may be present
  2. Chancre distribution
    1. Extragenital involvement (fingers, Oral Mucosa, nipples) in up to 5-7% of cases
    2. Forms a Genital Ulcer in most cases (may form on Cervix or perianally)
      1. Chancre may be difficult to visualize
      2. Men
        1. Distal penis involved in most cases
      3. Men and women
        1. Anal and rectal involvement occurs in both men and women
        2. Carefully examine the perianal area
      4. Women
        1. Typically affects vagina and Cervix
        2. Use a speculum and examine the vaginal mucosa
        3. Examine the introitus and between the labia
  3. Chancre Course
    1. Chancre at 10 to 90 days after exposure (mean 21 days)
    2. Chancre heals within 3 to 6 weeks without scarring and without treatment
      1. With treatment, Chancres may resolve in days
  4. Nonsuppurative Regional Lymphadenopathy (uncommon)
    1. Follows Chancre development within 30 days and resolves over months

III. Labs

  1. See Syphilis Testing
  2. Dark field exam of tissue sample may reveal Spirochetes
  3. Blood testing is often negative in Primary Syphilis

IV. Management

  1. See Syphilis

V. References

  1. Green, Cohen, Billington (2016) Crit Dec Emerg Med 30(11): 4-10
  2. Kirk, McHugh and Parnell (2023) Crit Dec Emerg Med 37(8): 23-9
  3. Mattel (2012) Am Fam Physician 86(5): 433-40 [PubMed]
  4. Ricco (2020) Am Fam Physician 102(2): 91-8 [PubMed]

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