ChancreA51.0

First local infection phase of early syphilis. The primary effect is a local, plasma cell-rich, painless inflammation of the skin at the site of inoculation of Treponema pallidum subsp pallidum (primary effect).

Clinically, a 0.4-0.6cm reddish papule or plaque develops 2-6 weeks (mean: 3 weeks) after infaction and is generally ignored. This ulcerates in a maximum period of 14 days. The ulcer that develops is also painless. It is surprisingly coarse indurated and spirochete-rich and thus highly contagious. In some cases, the primary effect also occurs extragenitally (mainly orally; rarely on fingers or nipples). Spread of the pathogen to the regional lymph nodes leads to swelling of the lymph nodes, which is also almost painless. Indolent regional lymphadenitis (bubo) + primary effect form the primary complex, the stage of a still regional infection by Treponea pallidum subsp pallidum.

Genitals: In men, the glans, sulcus coronarius and inner foreskin are affected.

In women, the large and small labia, clitoris and urethral orifice are affected.

Extragenital (5%): Occurrence mainly perianally, intrarectally, in the mouth, in the oral cavity, on tonsils, lips, buccal mucosa, female nipples.

The further clinical course characterized by the proliferation of spirochetes and dissemination of infection in several organs.

Initially, however, the primary effect heals spontaneously. Patients appear symptomless during this clinical latency phase of 4-6 weeks. The stage of generalized spirochetosis begins about 3-8 weeks after the appearance of the primary effect. There are clinical general symptoms such as fatigue, exhaustion, mild fever, sore throat, generalized lymphadenopathy (indolent, displaceable, important sign from a differential diagnostic point of view [DD: lymphatic systemic diseases!]), muscle and joint pain. In addition, there is a non-pruritic macular exanthema, on the trunk, the flexed sides of the extremities as well as the palms of the hands and soles of the feet.

Special form: Oedema indurativum.

1. Arando M et al. (2019) The Epidemiological and Clinical Characteristics of the Epidemic of Syphilis in Barcelona. Actas Dermosifiliogr 110:841-849.
2. Dupin N (2016) Syphilis. Rev Med Interne 37:735-742.
3. Su JR et al (2011) Primary and secondary syphilis among black and Hispanic men who have sex with men: case report data from 27 States. Ann Intern Med 155:145-151.