STD

Primary Syphilis

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Primary Syphilis, Primary Genital Syphilis, Chancre

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