Chinese Medical Sciences Journal ›› 2021, Vol. 36 ›› Issue (4): 279-283.doi: 10.24920/003842

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  1. 中国医学科学院 北京协和医学院,北京协和医院皮肤科
  • 收稿日期:2020-10-05 出版日期:2021-12-31 发布日期:2021-10-14
  • 通讯作者: 李军,郑和义;

The Great Imitator: Atypical Cutaneous Manifestations of Primary Syphilitic Chancre

Huizi Gong,Mengyin Wu,Jun Li(),Heyi Zheng()   

  1. Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2020-10-05 Published:2021-12-31 Online:2021-10-14
  • Contact: Jun Li,Heyi Zheng;


目的 本研究探讨了梅毒硬下疳误诊的原因,以期加强临床医师对此病不典型特征的认识。
方法 我们纳入了27例因临床表现不典型导致误诊和漏诊的梅毒硬下疳患者。
结果 女性患者的不典型表现主要为生殖器外的乳头红斑或糜烂性皮损,易被误诊为Paget病或湿疹。男性患者的不典型表现主要有多发性病变、梅毒龟头炎及非典型部位(如阴茎根部及邻近耻骨部位)的硬下疳。此外,非梅毒螺旋体试验阴性的患者也容易被漏诊或误诊。
结论 梅毒硬下疳的非典型表现多种多样,主要包括多发性病变、非典型部位、非梅毒螺旋体检测结果阴性,临床医师需警惕由此导致的漏诊或误诊。

关键词: 初期梅毒, 梅毒硬下疳, 误诊


Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease.
Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients’ age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed.
Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget’s disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed.
Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.

Key words: primary syphilis, chancre, misdiagnosis

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