Syphilis early syphilis primary effect A 51.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Acquired lues; Early syphilis; French disease; Pleasure Disease; Syphilis; syphilis chancre

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Worldwide spread, bacterial venereal disease ( compulsory registration) with typical, chronic, systemic course.

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Predilection site is the genital region.

  • In men, the inner preputile leaf, sulcus coronarius, more rarely the penis shaft or penis root
  • In women, small and large labia, posterior commissure, perineum.

Extragenital: labial mucosa, tongue, palate, pharynx, rectum, perianal region

Clinical features
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Early syphilis (Syphilis I):

  • Syphilis I: incubation period 3-4 weeks.
  • Primary effect: painless, mostly solitary (see also imprint chancre), indurated papules of different sizes, which ulcerates very quickly and changes into a painless, different sized, coarse ulcer ( ulcus durum). In about 5% of cases the primary effect also occurs extragenitally (mainly orally; rarely on fingers or mammilla).
  • The ulcer is accompanied by a regional, less painful lymphadenopathy of the groin region (primary complex), which occurs about 1-2 weeks after the onset of the ulcer.
  • Special form: Oedema indurativum. Primary complex = indolent regional lymphadenitis (bubo) + primary effect.
  • Syphilis II: After about 2-3 weeks spontaneous remission of the primary complex. The patients are free of symptoms during the first latency phase of 4-6 weeks. The stage of generalized spirochetosis begins about 7-8 weeks after infection. There are general clinical symptoms such as fatigue, exhaustion, slight fever, sore throat, generalized lymphadenopathy (indolent, shifting, an important sign from a differential diagnostic point of view [DD: lymphatic systemic diseases!]), muscle and joint pain.

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  • Clinic
  • Native detection of spirochetes from irritant secretion using the darkfield method (this method is now only used by a few people and is therefore no longer relevant in practice).
  • Syphilisserology: detection of IgM antibodies (IgM FTA-Abs test) is possible 2-3 weeks after infection (i.e. ready in an early phase of ulcer formation)

Differential diagnosis
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Herpes genitalis, Ulcus molle, Aphthae nbei M. Behçet; Erythroplasia Queyrat, Balanitis plasmacellularis

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Benzathine penicillin G 2.4 million IU 1x i.m. Alternatively: Ceftriaxone 1.0 daily i.v. over 10 days. Doxycycline 100mg 2x/day p.o. over 14 days

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  1. Adam B (2001) The punishment of Venus. A cultural history of venereal diseases. Orbis, Munich
  2. Nenoff P et al (2017) Nonviral sexually transmitted infections-epidemiology, clinical manifestations,
    diagnostic workup, therapy: Part 3: Treponemes, Gardnerella and trichomonads. Dermatologist 68:136-148.


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020