Hard chancre - Primary syphilis

Low urgency
-Moderately severe

Sexually transmitted infection caused by a bacterium called Treponema pallidum.

It manifests itself as a small, painless sore or ulcer on the genitals, which usually heals on its own after about three weeks. The ulcer can also appear on the mouth, rectum or skin. The lymph nodes near the skin lesion are usually inflamed.

The diagnosis is made by asking specific clinical questions and carrying out a full physical examination. Tests may be done on the fluid secreted by the ulcer and blood tests to look for the syphilis bacterium.

Syphilis infection is treated with antibiotics and the infected person's sexual partners should be treated in the same way, as syphilis is highly contagious in its early stages.

Any genital lesion should be seen urgently so that appropriate treatment can be started immediately, even if the lesion appears to heal on its own.

Bibliographic references
  1. Charles B Hicks, Meredith Clement. Syphilis: Screening and diagnostic testing. UpToDate Jul 18, 2016.
  2. Charles B Hicks, Meredith Clement. Syphilis: Treatment and monitoring. UpToDate Sep 07, 2016.
  3. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
  4. Ghanem KG. Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis 2015; 61 Suppl 8:S818.
  5. Kingston M, French P, Higgins S, et al. UK national guidelines on the management of syphilis 2015. Int J STD AIDS 2016; 27:421.
  6. Sheila A Lukehart. Sífilis. Harrison. Principios de Medicina Interna. Volumen 2. 19º Edición. 1132:1140.
  7. L Olmos. Sífilis. Farreras Rozman. Medicina Interna. Volumen 2. 12º edición. pp2312:2318.
Author
Dr. Oscar Garcia-Esquirol
Copyright
© TeckelMedical 2026

Symptoms

    Hard lesion develops into ulcer in penis, anus and/or mouth


    Hardened sore turns into an ulcer in the genital area and/or anus


    Hardened sore developing into an ulcer in the mouth


    Painless glands


    Ulcer is hard to the touch

Symptoms to watch out for

High fever (39 ºC or more)
Acute belly pain
History of immunodeficiency (HIV, diabetes mellitus, oncological disorders, long-term corticosteroid consumption).

Self-care

Reduce alcohol consumption.
Check with your general practitioner about the prescription for antibiotics.
Notify your sexual partner or partners so that they can get treated.
Use a condom during oral, anal and vaginal intercourse.