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chancre | pathology
chancre, typical skin lesion of the primary stage of infectious syphilis, usually appearing on the penis, labia, cervix, or anorectal region. (Because in women the chancre often occurs internally, it may go unnoticed.) The lesion often occurs in combination with a painless swelling of the regional lymph nodes, and together these symptoms are the major characteristics of syphilis in its earliest stage.The chancre usually occurs approximately three weeks after infection; it is a single, red papule that gradually begins to erode, forming a painless, clean ulcer with a smooth, raised border. The fluid expressed from the lesion contains the spirochete Treponema pallidum, the causative agent of syphilis. The size of the eroded area ranges from a few millimetres to several centimetres; usually chancres that occur at extragenital sites (most often on the lips and tongue) are larger than genital chancres. Although the chancre itself can heal without treatment in two to six weeks, the underlying syphilis will progress to the secondary phase unless treatment with penicillin is undertaken.Lesions that look like the chancres typical of syphilis may occur in people infected with one form of tuberculosis; these lesions appear two to three weeks after the tubercle bacillus penetrates the skin and heal spontaneously over a 12-month period. True chancres, however, have a syphilitic origin, and examination of the causative organism (in material taken from the base of the ulcer) can reveal the nature of the lesion.
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Syphilis ; definition, cause, transmission and primary stage
Syphilis is a chronic venereal disease with multiple presentations caused by a spirochete, T. pallidum subsp. pallidum, referred to simply as T. pallidum.Sexual contact is the usual mode of spread.
The organisms are very fragile, destroyed rapidly by heat, cold and drying.Sexual transmission most commonly occurred when abraded skin or mucous membranes come in contact with an open lesion.Rare transmission
from needle stick or blood transfusion.
Congenital syphilis occurs when T. pallidum crosses the placenta from an infected mother to the fetus.
Maternal transmission happens most frequently during primary or secondary syphilis, when the spirochetes are most numerous.
Public health programs and penicillin treatment reduced the number of cases of syphilis in the United States from the late 1940s until the 1970s.
Cases of syphilis surged upward in the mid-1980s, reaching a total of 50,000 cases in 1990.
Renewed public health efforts led to a sharp drop in the incidence of syphilis over the next 10 years,
but since 2000 there has been a steady rise in the number of cases reported annually, to ∼10,000 in 2006.Syphilis is divided into three stages, with distinct clinical and pathologic manifestations The Primary Stage It occurs about 2-3 weeks after contact with infected individual
Site of Lesion: site of Treponemal Invasion
lesion of primary syphilis is called syphilitic “chancre” or hard sore.
Genital sites: Penis, Scrotum, Vulva, Vaginal wall , Cervix, or Anus.
Penis or Scrotum in 70% of male patents, Vulva or Cervix in 50% of female patients.
Extragenital sites: Mouth, Tongue, and Lips
Spirochetes are plentiful within the chancre
Can be seen by immunofluorescent stains of serous exudate.
Treponemes spread throughout the body by hematologic and lymphatic dissemination even before the appearance of the chancre.Lesion of Primary stage(Chancre or hard sore)Gross pathology:Usually Single but it may be multiple.
Painless, non-itchy Papule, which ulcerates.
Small, but it may reach several cm.in dia.
The ulcer is shallow, round or oval with
Flat edges and
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