II. Signs

  1. Solitary Chancre (hallmark of Primary Syphilis)
    1. Painless Papule ulcerates
    2. Indurated lesion with smooth base and firm border
  2. Chancre distribution
    1. Forms a Genital Ulcer in nearly all cases (may form on Cervix or perianally)
      1. May be difficult to visualize
      2. Men and women
        1. Carefully examine the perianal area
      3. Women
        1. Use a speculum and examine the vaginal mucosa
        2. Examine the introitus and between the labia
    2. Extragenital involvement (fingers, Oral Mucosa, nipples) in up to 5-7% of cases
  3. Chancre Course
    1. Chancre at 10 to 90 days after exposure (mean 21 days)
    2. Chancre heals within 3 to 6 weeks
  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. Mattel (2012) Am Fam Physician 86(5): 433-40 [PubMed]

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Related Studies

Ontology: Syphilitic chancre (C0007939)

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, バイドクセイゲカン
Swedish Schanker
Czech šankr, vřed tvrdý, Syfilitický šankr
Finnish Sankkeri
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, セイキバイドクダイ1キ, セイキバイドク
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, ゲカン
Czech Šankr
Hungarian Ulcus durum