PRIMARY SYPHILIS
PRIMARY SYPHILIS ICD-10: A51
CLINICAL MANIFESTATION
Genital or extragenital lesions occur at sites of inoculation. Ulcers are usually painless unless secondarily infected. Incubation period: 21 days (average); range, 10 to 90 days. Chancre Button-like papule develops at the site of inoculation into a painless erosion and then ulcerates with raised border and scanty serous exudate (Figs. 30-24 and 30-25). Surface may be crusted. Lesions few millimeters to 1 or 2 cm in diameter. Usually single lesions;
less commonly, few, multiple, or kissing lesions. Extragenital chancres occur at any site of inoculation; lesions on the fingers are painful. SITES OF PREDILECTION Genital sites are most common. Male: Inner prepuce, coronal sulcus of the glans penis, shaft, base. Female: Cervix, vagina, vulva, clitoris, breast; chancres observed less frequently in women. Extragenital chancres: Anus or rectum, mouth, lips, tongue (Fig. 30-26), tonsils, fingers (painful!), toes, breast, and nipple.
A B
C
LYMPHADENOPATHY Appears within 7 days. Nodes are discrete, firm, rubbery, nontender, and more commonly unilateral; may persist for months.
DIFFERENTIAL DIAGNOSIS
GENITAL EROSION/ULCER GH, traumatic ulcer, fixed drug eruption, chancroid, and lymphogranuloma venereum (LGV).
DIAGNOSIS
Clinical suspicion, confirmed by dark-field microscopy or serologically.
TREATMENT
Intramuscular benzathine penicillin G 2.4 million units in single dose or oral doxycycline 100 mg twice daily for 14 days.
FIGURE 30-24 • Primary syphilis: penile chancre A 28-year-old male with penile lesion for 7 days. Painless ulcer on distal penile shaft with smaller erosion on the glans. The ulcer is quite firm on palpation.
FIGURE 30-25 • Primary syphilis: nodule on glans Three different men with penile nodule (A) and ulcers (B, C). These appeared within 2 weeks of clinic visit.
FIGURE 30-26 • Primary syphilis: chancre on tip of the tongue A 24-year-old man with painful lesion on the tongue for 10 days.