Syphilis, an infection caused by Treponema pallidum, is usually sexually transmitted and is characterized by episodes of active disease interrupted by periods of latency. About 20,000 cases of primary and secondary syphilis and 32,000 cases of early latent syphilis are reported each year. I. Clinical evaluation A. Primary syphilis
1. The incubation period for syphilis is 10-90 days; 21 days is average.
2. The lesion begins as a painless, solitary nodule that becomes an indurated ulceration (chancre) with a ham-colored, eroded surface, and a serous discharge found on or near the genitalia. Atypical lesions are frequent and may take the form of small multiple lesions.
3. The chancre is usually accompanied by painless, enlarged regional lymph nodes. Untreated lesions heal in 1-5 weeks.
4. The diagnosis is made by the clinical appearance and a positive darkfield examination; the serologic test (VDRL, RPR) is often negative in early disease.
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