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]