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To the Editor.—
The poor results obtained by Thomas A. Chapel, MD, in "Physician Recognition of the Signs and Symptoms of Secondary Syphilis" (1981;246:250) are not surprising. I dare say the recognition rate would have been no better for chancre, unless it appeared on the penile location. Perhaps what is needed is a memory slot to bring syphilis to mind. One such "law" goes roughly as follows: There is a basic contradiction between the cardinal sign and the expected symptom of both primary and secondary syphilis. The primary chancre looks painful but is not; the secondary rash looks pruritic but is not.There are exceptions, of course, but it seems to help keep lues in mind.
Kirkland LR. Recognition of Syphilis. JAMA. 1982;247(2):175. doi:10.1001/jama.1982.03320270015010
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