Primary Syphilis

A 17-year-old woman noted a gradually increasing, asymptomatic “sore” on her lower lip.

Key point: The patient was sure that this was merely a chancre sore, but became alarmed when the lesion failed to resolve after several weeks. This painless, indurated ulcer is typical of the chancre of primary syphilis. She also had palpably enlarged submental and submaxillary lymph nodes and a positive RPR in a titer of 1:32. She admitted to multiple episodes of oro-genital contact with different partners within the past 3 months; this led to an extra-genital chancre.

Treatment: Primary syphilis was treated with intramuscular benzathine penicillin (2.4 milion units).

Note: Aside from referral to the county health department for contact tracing, the patient was also offered, but refused, HIV testing.