Primary syphilis

The primary lesion or chancre usually develops at the point of inoculation after an incubation period averaging 21 days (ranging from 10 to 90 days). The chancre is typically firm, painless, punched out and clean. The adjacent lymph nodes are discretely enlarged, firm and non-suppurating. Anorectal chancres may occur in homosexual men.

Untreated, early clinical syphilis usually resolves spontaneously leading to latent disease which may proceed to late destructive lesions.

Secondary stage

The interval between the appearance of the primary chancre and the onset of secondary manifestations varies from 6 to 8 weeks. Constitutional symptoms including fever, headache, malaise and general aches and pains may precede or accompany the signs of secondary syphilis.

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