Clinical Manifestations and Sequelae

Primary Syphilis

As some organisms lodge at the entry site, proliferate, sensitize lymphocytes and activate macrophages, a primary lesion or "chancre" develops at the site of inoculation.

• The chancre is a major indicator of primary syphilis. Chancres progress from papule to ulcer. The chancre is typically painless, indurated, and has a clean base. It is highly infectious and heals spontaneously within 1 to 6 weeks. Multiple chancres occur in 25% of cases.
• Atypical chancres may occur and can mimic herpes or chancroid.  Evaluation of patients with genital ulcers should include a serologic test for syphilis and a diagnostic evaluation for genital herpes.  In settings where chancroid is present, testing for Haemophilus ducreyi should also be performed.
• Regional lymphadenopathy is classically rubbery, painless, and bilateral.