Primary syphilis - Oral Mucosal Lesion
Chancres vary in size from a few millimeters to several centimeters. They have an incubation period of 10-90 days (average 21 days). The chancre lasts 3-6 weeks and heals spontaneously. All patients with primary syphilis will go on to develop secondary syphilis if the condition is left untreated. Secondary syphilis usually appears 3-10 weeks after the primary chancre and is characterized by a papulosquamous eruption and mucosal involvement, in some cases. Tertiary syphilis may appear months to years after secondary syphilis resolves and can involve the central nervous system (CNS), heart, bones, and skin.
Ocular screening (eg, slit lamp examination) is advised for patients with suspected or proven syphilis.
Immunocompromised patient considerations: Ulcers caused by syphilis increase the risk of HIV transmission due to epithelial barrier compromise and increased numbers of macrophages and T-lymphocytes with HIV-specific receptors.
HIV infection can alter the clinical presentation of syphilis. Manifestations include multiple chancres, atypical cutaneous eruptions, increased severity of organ involvement (such as hepatitis and glomerulonephritis), and rapidly developing arteritis and neurosyphilis. Neurosyphilis can occur at any stage of syphilis.
Related topics: ocular syphilis, endemic syphilis
A51.0 – Primary genital syphilis
266127002 – Primary syphilis
Differential Diagnosis & Pitfalls
- Oral herpes simplex virus – Look for multiple small vesicles on an erythematous base; usually painful.
- Cytomegalovirus infection
- Traumatic ulcer
- Aphthous ulcer – Single lesion with gray base.
- Oral trauma – Preceded by known insult.
- Fixed drug eruption – Recurrent lesions are always located at the same site.
- Behçet disease – Associated with recurrent oral ulceration, genital ulceration, and ocular abnormalities.
- Lichen planus
- Pemphigus vulgaris
- Mucous membrane pemphigoid
- Ulcerative squamous cell carcinoma
- Crohn disease