In retrospect, I agree with Dr Prestia that "rare" is perhaps too confining a term to use when referring to multiple primary syphilitic chancres. I must, however, take issue with the fact that chancres in multiplicity (ie, ten lesions or more) are not a somewhat atypical clinical presentation for a case of primary syphilis.Whereas Dr Prestia is correct that the reference works by Olansky and Norins1 and Lomholt2 do not refer to multiple chancres as rare in occurrence, the same authors do state that primary chancres "tend to be"1 or are "in most cases"2 single lesions. According to Stokes et al3 in their classic reference work on syphilis, the chancre tends to be single rather than multiple, but 2,3, or 4 chancres are not uncommon. One of the references cited in the article by Dr Huntley and me carries this theme even further by
Wade TR. Chancres in Syphilis-Reply. Arch Dermatol. 1980;116(1):20–21. doi:10.1001/archderm.1980.01640250022008
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