Syphilitic
chancre of the lower lip
Lingyi Zhao1Yao Ni1,3Jingying Sun1Janzhou Ye2*
- Department of Dermatovenereology, Chengdu Second People’s Hospital,
Chengdu, China
- Department of Dermatovenereology, Yunnan Provincial Hospital of
Traditional Chinese Medicine, Kunming, China
- Department of Dermatovenereology, Nanjing University of Traditional
Chinese Medicine, Nanjing, China
* Corresponding Author:
kmyjz63@sina.com
running head: Syphilitic chancre of the lower lip
The category of the article: Letter
Keywords: Syphilitic chancre, lower lip
Manuscript word count: 679 words
The number of figures: 2
The number of tables: 0
The number of references: 7
Correspondence to: Janzhou Ye, M.D, Ph.D., Department of
Dermatovenereology, Yunnan Provincial Hospital of Traditional Chinese
Medicine, Kunming, 650021, China.
Tel: +86 13908710661; E-mail: kmyjz63@sina.com
Full conflict of interest statement: Lingyi Zhao, and my
co-authors have no conflict of interest to declare.
Ethics statement: The patient has consented to publish this
information.
Data availability statement:Data sharing does not apply to
this article as no new data were created or analyzed in this study.
Funding sources: none
Dear Editor,
Syphilis is a chronic infectious disease usually caused by spirochete
Treponema pallidum. Nowadays, it is estimated that there are more than
11 million new cases of syphilis in the world every year, and more than
90% of the cases are in developing countries1.
Syphilis re-emerges mainly in men who have sex with men(MSM)in
high-income countries. In contrast, it is an endemic disease in
low-income countries. Although its mortality rate decreases, its varied
clinical manifestations are likely to lead to misdiagnosis or delayed
diagnosis, especially when the primary lesions occur in the extragenital
regions. Treponema pallidum usually enters the human body through
microlesions in the skin or mucous membrane. The typical primary
painless ulcerative lesion, which is called a chancre, often develops at
the site of inoculation within 10 to 90 days after unprotected sexual
intercourse.
Here we report a 26-year-old man presented to the dermatology department
with a painless ulcer on the midline of his lower lip for 3 weeks (Fig.
1). The isosceles triangular ulcer is measured 1.3cm in waist length,
0.7cm in base length with a smooth, clean base and indurated, elevated
borders, which was slightly bleeding. The patient announced not any
other lesion on his trunk or limbs. He initially visited a clinic and
was prescribed mupirocin ointment. He used the ointment for a week and
went to another clinic due to no significant improvement of the ulcer.
This time he applied acyclovir cream. After two weeks, the ulcer had not
improved. The patient claimed to have had unprotected orogenital sex
with two women in two months. He declared he had not any prior sexually
transmitted infection. Physical examination showed no remarkable signs
on the trunk, limbs, especially genitals or anus. Peripheral
lymphadenopathy was not revealed clearly. Toluidine red unheated serum
testing was positive with a titer of 1:16, in the meantime treponema
pallidum particle agglutination assay was positive. He tested negative
for human immunodeficiency virus. The situation of those women was
unclear because he had been out of touch with them. The patient was
treated with benzathine penicillin (2.4 million) once a week for 3
consecutive weeks. The lesion was undetectable completely after 4 weeks
(Fig. 2).