Primary Syphilis

Aka: Primary Syphilis, Primary Genital Syphilis, Chancre

1. See Also
   1. Syphilis
   2. Sexually Transmitted Disease
   3. Primary Syphilis
   4. Secondary Syphilis
   5. Latent Syphilis
   6. Tertiary Syphilis
   7. Syphilitic Gumma
   8. Cardiovascular Syphilis
   9. Neurosyphilis
   10. Syphilis Testing
   11. Genital Ulcer
2. 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. Forms a Genital Ulcer in nearly all 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
      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 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
3. Labs
   1. See Syphilis Testing
   2. Dark field exam of tissue sample may reveal Spirochetes
   3. Blood testing is often negative in Primary Syphilis
4. Management
   1. See Syphilis
5. 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]
   3. Ricco (2020) Am Fam Physician 102(2): 91-8 [PubMed]