Answer

Ulcers

Chancre

(Treponema pallidum)

A 18 year old male prostitute comes into the family practice clinic asking about a local, nontender ulcer (chancre) on penis. The ulcer is about 1 cm (note that the case gives the range of 0.3 to 2 cm) with a hard edge and clean, yellow base. Physical exam reveals slight lymphadenopathy.

Laboratory: Spirochete on darkfield and immunoflourescence microscopy. FTA-ABS positive. VDRL positive.

Discussion: The clinical presentation of a single chancre and labs indicate primary syphilis caused by Treponema pallidum. The lesions are usually found on genitalia and are frequently solitary, may be multiple and may have regional lymphadenopathy. It heals with scarring in 3 to 6 weeks with 75% of patients having no further symptoms. The primary and secondary form of syphilis are both highly infectious.

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