Dermatovenerology Faculty – of foreign students Course – 4 Practical classes for distancial education

Varieties of solid chancres 
By nature: erosive, ulcerative. 
Localization: genital, extragenital, bipolar. 
By quantity: single, multiple (sequential, twin chancres, chancres-prints). 
In shape: cortical, combiform, petechial, cockard, "herpetic", "diphtheria". 
Outlines: round, oval, oblong, slit-like, horseshoe-shaped. 
 
Atypical hard chancres 
- Inductive edema (cold edema) Formed in places rich in lymphatic vessels. It is 
more common in women and spreads to the labia majora. In men, this form occurs 
on the preputial sac, scrotum. The affected organ increases in size, becomes dense. 
With pressure, the fossa does not remain. Usually has a dark red color. No 
soreness. 
- Chancre-amygdalitis Syphilitic amygdalitis appears to be a unilateral 
enlargement of the tonsil, its significant density, and the absence of various 
hyperemia. Expressed submandibular, cervical and aortic lymphadenitis, often 
painful. 
- Chancroid panaritium Observed usually by surgeons, gynecologists, 
pathologists. Its occurrence is more oftenassociated with professional injury in the 
form of a cut or an injection of a finger during surgery. Chancroid panaritium is 
localized on the terminal phalanx of the index or thumb. The finger takes on a b- 
shaped form, becomes a deep red color. The ulcer has uneven overhanging, as if 
gnawed edges. The bottom is deep, sometimes penetrating to the brush, covered 

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with fetid contents. The patient experiences sharp shooting pains. Painful regional 
lymphadenitis. 
Complications of hard chancre 
1. accession of a secondary infection; 
2. irritation by discharge; 
3. self-medication. 
Clinical manifestations: 
- Balanitis - vulgar inflammation of the glans penis; 
- Balanoposthitis - vulgar inflammation of the glans penis and inner sheet of the 
foreskin; 
- Phimosis is the narrowness of the foreskin, in which it is impossible to detect the 
glans penis. The foreskin swells, loses elasticity. The penis is shaped like a 
"clapper". 
- Paraphimosis - compression of the glans penis. The glans penis is naked and 
squeezed by a ring of edematous inflammatory foreskin at the border of the 

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coronary sulcus. Phenomena of necrosis and ulceration of the glans penis may be 
observed. 
- Gangrene of the glans penis. 
- Phagedenism. 
The second symptom of the primary period of syphilis is regional sclerodenitis. It 
occurs 7-10 days after the appearance of a solid chancre. Lymph nodes are 
enlarged (0.7-1 cm), dense-elastic consistency, mobile, unsoldered with 
surrounding tissues, painless. The skin over the lymph ical nodes is not changed. 

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The third symptom of the primary period of syphilis is a lymphangitis.