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January 1981

Nontypical Syphilitic Chancres

Author Affiliations

Santa Ana, Calif

Arch Dermatol. 1981;117(1):2. doi:10.1001/archderm.1981.01650010006004

To the Editor.—  Primary lesions of syphilis are typically described as solitary, painless, round-to-oval, ulcerated papules with firmly indurated borders. If the ulcers are covered with crust, removal of this crust will reveal a clean granulating base. Reference texts often state that multiple chancres may be seen, but are unusual.1,2Because a number of patients have come to us with nonclassic chancres, we serially examined male patients with penile ulcers during a six-month period (October 1979 to March 1980) to determine what constituted the typical chancre. Sixty-three male patients were included in the series based on positive darkfield examinations. Chancres were evaluated for multiplicity of lesions, pain on manipulation, purulent exudate, and lack of firm induration. Thirty-three patients (52.4%) had multiple chancres. The average number of lesions was 2.5, with a range of one to six. Substantial pain on palpation was noted in 26 (45.6%) of 57 patients, purulent

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