Bilateral chancre of the tongue: An unusual presentation of primary syphilis.

Syphilis is a sexually transmitted infectious disease caused by the spirochete bacterium Treponema pallidum. A characteristic lesion of primary syphilis is chancre. It can develop over genital or extra genital sites, depending on the site of contact with the infectious agent. Cases of oral syphilis have been on the rise in the previous two decades, probably because of the involvement of the oral cavity in sexual practices. We here report an unusual case of primary syphilis who presented with a painless indurated oral ulcer over the lateral borders of the tongue.

[Syphilitic chancre in the mouth: an unusual location. Case report]. / Chancro sifilítico en la boca: localización poco frecuente. Reporte de un caso.

Background: Syphilis is an infectious disease caused by the spirochete Treponema pallidum, transmitted mainly by direct contact with the lesion. Primary syphilis usually presents with a chancre at the site of infection, which is highly contagious and resolves without treatment. The aim of this article is to illustrate an unusual location of a syphilitic chancre, in order to consider this diagnosis within the approach to patients with oral ulcers. Clinical case: a 30-year-old man who presented a dermatosis located in the left labial commissure, characterized by a painless ulcer of 1 cm in diameter of 20 days of evolution. The patient has a history of HIV/AIDS. A punch biopsy of the dermatosis was performed, with a histopathological report compatible with syphilitic chancre and a negative VDRL result. He was treated with penicillin G benzathine showing improvement. Conclusions: Primary syphilis is characterized by the development of the syphilitic chancre, which is the first manifestation of syphilis in up to 60% of cases. Extragenital presentation is rare, with only 12-14% of all cases, and of these between 40-70% occur in the mouth, being the lips the most frequent location. Oral manifestations can represent a diagnostic challenge due to its wide spectrum of clinical presentations.

Introducción: la sífilis es una enfermedad infecciosa causada por la espiroqueta Treponema pallidum, transmitida principalmente por contacto directo con la lesión. La sífilis primaria generalmente se presenta con un chancro en el sitio de la infección, el cual es altamente contagioso y se resuelve sin tratamiento. El objetivo de este trabajo es ilustrar una localización poco común de un chancro sifilítico, ya que conocer la existencia de presentaciones poco frecuentes permitirá favorecer su sospecha al abordar las causas de úlceras orales. Caso o casos clínicos: hombre de 30 años de edad, el cual presenta una dermatosis localizada en la comisura labial izquierda, caracterizada por una úlcera no dolorosa de 1 cm de diámetro de 20 días de evolución. El paciente tiene antecedente de VIH/SIDA. Se realizó biopsia en sacabocados de la dermatosis, siendo el informe histopatológico compatible con chancro sifilítico y resultado de VDRL negativo. Fue tratado con penicilina G benzatínica, con lo que presentó mejoría. Conclusiones: la sífilis primaria se caracteriza por la aparición del chancro sifilítico, el cual es la primera manifestación de la sífilis hasta en el 60% de los casos. La presentación extragenital es rara, con solo un 12-14% de todos los casos y, de estos, entre un 40-70 % se presentan en la boca, siendo los labios la localización más frecuente. Las manifestaciones orales pueden representar un desafío diagnóstico debido a su amplio espectro de presentaciones clínicas.

Primary syphilis of the finger: report of four cases.

Although primary syphilis generally involves the genitalia, literature reports that 12% of chancres are extragenital, with the anus and oral cavity as the most frequent locations. We present hereby a case series of four chancres of the finger observed at the sexually transmitted infection centre of Milan between 2010 and 2021.

The Great Imitator: Atypical Cutaneous Manifestations of Primary Syphilitic Chancre.

Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease. Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients' age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed. Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget's disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed. Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.

Analysis of Treponema pallidum Strains From China Using Improved Methods for Whole-Genome Sequencing From Primary Syphilis Chancres.

BACKGROUND: Whole-genome sequencing (WGS) of Treponema pallidum subspecies pallidum (TPA) has been constrained by the lack of in vitro cultivation methods for isolating spirochetes from patient samples. METHODS: We built upon recently developed enrichment methods to sequence TPA directly from primary syphilis chancre swabs collected in Guangzhou, China. RESULTS: By combining parallel, pooled whole-genome amplification with hybrid selection, we generated high-quality genomes from 4 of 8 chancre-swab samples and 2 of 2 rabbit-passaged isolates, all subjected to challenging storage conditions. CONCLUSIONS: This approach enabled the first WGS of Chinese samples without rabbit passage and provided insights into TPA genetic diversity in China.

The Great Imitator: Atypical Cutaneous Manifestations of Primary Syphilitic Chancre / 中国医学科学杂志(英文版)

Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease. Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients' age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed. Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget's disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed. Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.

Chancro sifilítico oral en varón de 30 años / Oral syphilitic chancre in a 30-year-old man

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Syphilitic Chancre of the Lip.

Syphilis is a sexually transmitted disease caused by Treponema pallidum. The primary stage of the disease (the chancre) mainly involves the genital areas. Extragenital areas are involved in 5%-14% of cases, many of which occur in the oral cavity. Among the extragenital locations, the lip is the most frequent; however, despite this, published cases of the chancre of the lip are few. We present a case of a chancre presenting on the lip of a nonimmunocompromised 55-year-old male patient with immunohistochemical confirmation.

Chancro extragenital en paciente homosexual / Extragenital chancre in a homosexual patient

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Rollet's mixed chancre in Brazilian pregnant women: An unusual case report.

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum and has shown a significant increase in recent decades. It may be associated with other STIs such as soft chancre or chancroid, which is an uncommon infection in Brazil. The presence of ulcerated genital lesions is associated with a higher risk of HIV transmission. An accurate clinical and laboratory diagnosis of genital ulcer disease is essential for the appropriate treatment of pregnant women, in order to avoid congenital syphilis, a severe complication of mother-to-child vertical transmission. We report the case of a woman in the third trimester of pregnancy with Rollet's mixed chancre and describe the clinical and laboratory diagnosis, as well as the treatment of these diseases in pregnancy. We emphasize the importance of training health professionals on early diagnosis and treatment in order to avoid mother-to-child transmission.

Nódulo ulcerado en el cuello: chancro sifilítico / Ulcerated nodule on the neck: Syphilitic chancre

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Concurrent Primary Chancre and Ocular Syphilis in an Human Immunodeficiency Virus-Negative Man.

We believe this to be the first report of coexisting polymerase chain reaction (PCR)-confirmed primary genital and ocular syphilis in a patient with penicillin allergy treated with doxycycline. The case examines the use of nonpenicillin and corticosteroid treatment of ocular syphilis and highlights the risk of eye involvement early in the disease process.