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Variation in clinical pictures of syphilis, when co-infected with HIV are well known.1 Normally, a classic Hunterian chancre heals within 1–2 weeks of treatment without scarring.2 Primary chancre, healing with perforation of the site, does not commonly occur.3 Here we report four patients with primary syphilis, in whom the chancres healed with perforation of the genitalia. Concomitant infection with HIV is presumed to be responsible for this destructive sequela.
A 21 year old woman presented with a painless, indurated ulcer on the inner aspect of the left labia majora, along with …