Syphilitic chancre

Syphilitic chancre (from French chancre – ulcer) is a primary affective manifestation of syphilis that occurs at the site of inoculation (introduction) of the infectious agent – pale treponema (Treponema pallidum). It is a specific erosive-ulcerous defect of the skin or genital mucous membranes.

Etiology and pathophysiology

The chancre forms at the end of the incubation period, on average 3-4 weeks after infection. Macroscopically, it is an ulcer of regular round or oval shape with clear, even edges (“saucer-shaped”) and a smooth, shiny (“varnished”) bottom in the color of “raw meat”.

The surface may be covered with a scanty serous discharge, which contains a large number of live treponemes and is highly contagious. The key pathognomonic feature that gave the element its name is the presence of a dense elastic infiltrate at the base of the ulcer, which on palpation resembles cartilage or parchment. The second most important feature is the complete painlessness of the defect.

Clinical significance

In gynecological practice, chancre is often localized on the cervix or in the posterior vaginal vault. Due to the absence of pain syndrome, the patient often does not notice the appearance of the ulcer, which leads to the lack of timely treatment at the primary stage. The shank spontaneously epithelializes after 3-6 weeks, giving the false impression of recovery, while the infection progresses to the secondary (generalized) stage. Any painless genital ulcer requires immediate exclusion of syphilis (dark-field microscopy, serology).