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| Fig. 28.3 A typical presentation of primary syphilis demonstrating two chancres. (Courtesy of William James, MD.) |
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| Fig. 28.2 Typical Hunterian chancre of syphilis demonstrating characteristic indurated border. |
The classic Hunterian chancre develops at the site of inoculation as a painless ulcer with a firm, indurated border (Fig. 28-2). The size may vary from a few millimeters to several centimeters in diameter. Associated unilateral or bilateral, painless, regional, nonsuppurative lymphadenopathy develops in 50% to 85% of patients approximately 1 week after the appearance of the primary ulcer. It is important to realize that up to 50% of all chancres are atypical. Painful ulcers, multiple ulcers (Fig. 28-3), secondarily infected ulcers, and nonindurated ulcers are variations on the classic chancre.
Lee V, Kinghorn G: Syphilis: an update,
Clin Med 8:330–333, 2008.
