II. Signs
- Solitary Chancre (hallmark of Primary Syphilis)
- Painless Papule ulcerates
- Indurated lesion with smooth base and firm border
- Multiple lesions may be present
- Chancre distribution
- Extragenital involvement (fingers, Oral Mucosa, nipples) in up to 5-7% of cases
- Forms a Genital Ulcer in most cases (may form on Cervix or perianally)
- Chancre may be difficult to visualize
- Men
- Distal penis involved in most cases
- Men and women
- Anal and rectal involvement occurs in both men and women
- Carefully examine the perianal area
- Women
- Typically affects vagina and Cervix
- Use a speculum and examine the vaginal mucosa
- Examine the introitus and between the labia
- Chancre Course
- Chancre at 10 to 90 days after exposure (mean 21 days)
- Chancre heals within 3 to 6 weeks without scarring and without treatment
- With treatment, Chancres may resolve in days
- Nonsuppurative Regional Lymphadenopathy (uncommon)
- Follows Chancre development within 30 days and resolves over months
III. Labs
- See Syphilis Testing
- Dark field exam of tissue sample may reveal Spirochetes
- Blood testing is often negative in Primary Syphilis
IV. Management
- See Syphilis
V. References
- Green, Cohen, Billington (2016) Crit Dec Emerg Med 30(11): 4-10
- Kirk, McHugh and Parnell (2023) Crit Dec Emerg Med 37(8): 23-9
- Mattel (2012) Am Fam Physician 86(5): 433-40 [PubMed]
- Ricco (2020) Am Fam Physician 102(2): 91-8 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | The primary sore of syphilis, a painless indurated, eroded papule, occurring at the site of entry of the infection. |
| Concepts | Sign or Symptom (T184) |
| MSH | D002601 |
| ICD10 | A51.0 |
| SnomedCT | 266127002, 58433006 |
| English | Chancre, Chancres, Syphilitic chancre, Syphilitic chancre NOS, Chancre [Disease/Finding], primary syphilis, chancre syphilitic, chancres, chancre, syphilis primary, Primary syphilis - chancre, chancre; syphilitic |
| Dutch | syfilitische venerische zweer, sjanker; syfilis, Sjanker |
| German | syphilitischer Schanker, Schanker |
| Italian | Ulcera venerea sifilitica, Sifiloma iniziale |
| Portuguese | Cancro sifilítico, Cancro |
| Spanish | Chancro sifilítico, chancro sifilítico, Chancro |
| Japanese | 梅毒性下疳, ﾊﾞｲﾄﾞｸｾｲｹﾞｶﾝ |
| Swedish | Schanker |
| Czech | šankr, vřed tvrdý, Syfilitický šankr |
| Finnish | Sankkeri |
| Russian | TVERDYI SHANKR, ТВЕРДЫЙ ШАНКР |
| Polish | Wrzód twardy, Szankier, Zmiana pierwotna w kile |
| Hungarian | Syphilises ulcus durum |
| Croatian | ČANKIR |
| French | Chancre syphilitique |
Ontology: Primary genital syphilis (C0017418)
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 091.0 |
| ICD10 | A51.0 |
| SnomedCT | 58433006, 186847001 |
| English | Genital syphilis (primary), Primary genital syphilis, Syphilis genital, primary genital syphilis, syphilis primary genital, primary genital syphilis (diagnosis), Genital chancre, Primary genital syphilis (disorder), genital; syphilitic, primary; syphilitic, genital, syphilis; genital, syphilis; primary, genital, Primary genital syphilis (disorder) [Ambiguous], Genital syphilis |
| Italian | Sifilide genitale, Sifilide genitale (primaria) |
| Dutch | genitale syfilis (primair), genitaal; syfilis, primair; syfilis, genitaal, syfilis; genitaal, syfilis; primair, genitaal, Primaire genitale syfilis, syfilis genitaal |
| French | Syphilis génitale (primitive), Syphilis génitale |
| German | Syphilis der Geschlechtsorgane (primaer), Primaerer syphilitischer Genitalaffekt, Syphilis der Geschlechtsorgane |
| Spanish | Sífilis genital (primaria), chancro genital, sífilis genital primaria (concepto no activo), sífilis genital primaria (trastorno), sífilis genital primaria, Sífilis genital |
| Japanese | 性器梅毒（第１期）, 性器梅毒, ｾｲｷﾊﾞｲﾄﾞｸﾀﾞｲ1ｷ, ｾｲｷﾊﾞｲﾄﾞｸ |
| Czech | Syfilis genitálu, Syfilis genitálu (primární) |
| Korean | 제1기 성기 매독 |
| Hungarian | genitalis syphilis, Genitalis syphilis (primaer) |
| Portuguese | Sífilis genital |
Ontology: Chancre (C0600049)
| Concepts | Pathologic Function (T046) |
| SnomedCT | 84052006 |
| English | Chancre, chancre, Chancre (morphologic abnormality), Chancre, NOS |
| Dutch | sjanker |
| French | Chancre |
| German | Schanker |
| Italian | Complesso primario |
| Portuguese | Cancro duro |
| Spanish | Chancro, chancro (anomalía morfológica), chancro |
| Japanese | 下疳, ｹﾞｶﾝ |
| Czech | Šankr |
| Hungarian | Ulcus durum |
