(Lues; Lues venerea; Pox)
Definition. – A chronic, systemic, transmissible disease due to inoculation with the spirocheta pallida, except when inherited. It is characterized by the appearance of an initial lesion at the point of infection from which the disease may spread to any or every tissue and organ of the body.
The incubation period, or the interval between the exposure to contagion and the development of the primary lesion, varies somewhat but it usually falls between the tenth and thirtieth days, averaging about twenty-one days. The chancre, or initial sore, is the focus of infection and marks the point of entrance of the causative agent. Nearly ninety per cent. of all chancres are on or about the genital organs. In the male they are situated on the frenum, prepuce, glans or shaft of the penis, at or within the meatus and, rarely, on the scrotum. In the female they are most commonly on the small or large labia, the clitoris, in the vagina or higher up. In about ten per cent. of all cases the chancres are extra-genital, often accidentally or innocently acquired and are usually located on the lips, mouth, throat, breast or nipples, fingers, hands, eyelids, chin, cheeks, nose and, rarely, on almost any region. A number of these lesions have been ascribed to infection at the time of, or subsequent to, the operations of vaccination, cupping, bleeding, circumcision and tattooing.
Chancres vary in appearance according to their location and exposure to various irritations. The earliest change at the more common genital sites may be a small red spot which, in eight or ten days, grows into a well-defined nodule, becoming harder during the following two or three weeks. Only superficial erosion of the surface may be noted or an ulcer bounded by an indurated non- elevated border (Hunterian chancre) or a desquamating papule or a small dusky spot which, without ulceration, disappears by absorption and hence is easily overlooked by the patient as well as the physician, may be the form presented. Chancres may simulate herpes or become ecthymatous and crusted form pus inoculation. The induration, by spreading out, may form a parchment-like lesion or may be annular in character or may form an elevated mass whose center may rarely become covered by a greenish membrane (diphtheritic chancre).
The well-defined induration, characterizing the chancre of the genitals two or three weeks after its origin, is not always apparent in extra-genital sores owing largely to anatomical differences. For instance, there is seldom any marked induration in chancres of the lip or nail bed, while the primary sore on the cheek may be quite obscured by the attendant edema, reaching an enormous size and resembling a malignant disease. Considerable destruction of tissue may result when the chancre coexists with or follows herpes, chancroids or other mixed infections. Chancre is usually single but it may show multiple development according to the number of points inoculated at the time of contagion or during incubation. Adenopathy or enlargement of the nearby lymph glands is invariable and, later, connecting or distant glands may become affected, but usually the enlarged glands show no signs of inflammation or tenderness. The primary sore has a tendency to heal slowly. It rarely lasts more than eight weeks if properly treated but, occasionally, its course is protracted.
The artificial division of Ricord into primary, secondary and tertiary periods does not tend to a better understanding of syphilis but it is convenient for the sake of description. Bearing this in mind, it is wise to view syphilis as a progressive infective process, influenced greatly in its course by the character of the soil in which the virus is accidentally implanted and by the treatment employed, but characterized by short or long intervals of insidious progression along the vascular channels, and culminating with a degree of systemic saturation which gives rise to the so-called “explosion” in syphilitic fever, pains, weakness, depression and perhaps a sudden efflorescence on the skin without necessary proportion or sameness in any two persons. Our consideration of this disease has chiefly to do with cutaneous manifestations known as syphilodermata or syphilids.