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The variability of syphilitic chancres
1Department of Dermatology and Syphilology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Sexually Transmitted Diseases
|April 1, 1978
Summary
Primary syphilis often presents with atypical lesions, not just the classic chancre. Many patients exhibit multiple sores or ulcers resembling other conditions, challenging early diagnosis.
Area of Science:
- Dermatology
- Infectious Diseases
- Microbiology
Background:
- Primary syphilis diagnosis relies on recognizing characteristic clinical signs.
- The 'classic' chancre of syphilis is typically a single, indurated ulcer with a clean base and regional lymphadenopathy.
Purpose of the Study:
- To investigate the clinical presentation of primary syphilis.
- To determine the frequency of 'classic' versus atypical lesions in patients with confirmed primary syphilis.
Main Methods:
- A cohort of 64 patients with darkfield microscopic evidence of primary syphilis was studied.
- Standardized interviews and physical examinations were conducted to document lesion characteristics.
Main Results:
- Only 42.7% of patients presented with the 'classic' single, indurated chancre and lymphadenopathy.
- Atypical presentations were common: 47% had two or more lesions.
- 7.8% had non-indurated ulcers, and 7.8% had irregular, undermined ulcer borders suggestive of chancroid.
Conclusions:
- The 'classic' chancre may represent an atypical presentation of primary syphilis.
- Clinical suspicion for syphilis should remain high even with non-traditional lesion appearances.
- Atypical presentations can mimic other ulcerative conditions, potentially delaying diagnosis.