Rigi10™ Malleable Penile Prosthesis
Also Known As
Primary syphilitic ulcer, hard chancre, Hunterian chancre, syphilitic primary lesion, primary syphiloma
Definition
A chancre is a painless, firm, round ulcer that forms at the site of entry of the bacterium Treponema pallidum, representing the primary lesion and first clinical manifestation of syphilis infection.1 The chancre typically appears approximately 3 weeks (range 10-90 days) after exposure to the infectious organism.2 It begins as a papule that quickly erodes to form a clean-based, non-exudative ulcer with raised, indurated borders measuring approximately 1-2 cm in diameter.3 The lesion contains numerous spirochetes, making it highly contagious, and is usually accompanied by regional lymphadenopathy.4 Without treatment, the chancre spontaneously heals within 3-6 weeks, leaving minimal or no scarring, but the infection progresses to secondary syphilis as the bacteria disseminate throughout the body.5
Clinical Context
Chancres are clinically significant as they represent the initial manifestation of primary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum.1 The lesion typically appears at the site of inoculation, most commonly on the genitalia, but can also occur on the lips, tongue, pharynx, rectum, or other sites of sexual contact.2 In women, chancres may develop on the cervix or within the vagina, often going unnoticed due to their painless nature and internal location.3
Clinically, chancres are important diagnostic markers that should prompt immediate testing and treatment. The presence of a chancre indicates active, highly infectious syphilis that can be readily transmitted through direct contact with the lesion.4 Regional lymphadenopathy, characterized by firm, rubbery, and painless lymph nodes, is present in approximately 80% of patients with primary syphilis.5
Diagnosis is typically confirmed through dark-field microscopy of lesion exudate, which can demonstrate the characteristic corkscrew-motile spirochetes, or more commonly through serologic testing.1 It is important to note that while the chancre is developing, serologic tests may still be negative, necessitating repeat testing if clinical suspicion is high.4
Treatment of primary syphilis with a chancre consists of benzathine penicillin G 2.4 million units administered intramuscularly as a single dose.2 Early treatment is crucial to prevent progression to secondary and tertiary stages of syphilis, which can lead to significant cardiovascular, neurological, and other systemic complications.3 For penicillin-allergic patients, alternative regimens include doxycycline or tetracycline, although these are considered less effective.5
Healthcare providers should maintain a high index of suspicion for syphilis in patients presenting with genital ulcers, particularly those that are painless, as early diagnosis and treatment are essential for preventing transmission and complications.1