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Phagedenic chancres: a neglected diagnosis?
  1. Giulia Ciccarese1,
  2. Cristian Fidanzi2,3,
  3. Agata Janowska2,
  4. Gaetano Serviddio4,
  5. Francesco Drago5
  1. 1Unit of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  2. 2Unit of Dermatology, Department of Medical and Oncology Area, University of Pisa, Pisa, Italy
  3. 3Unit of Dermatology, Hospital of Carrara, Carrara, Italy
  4. 4Liver Unit, Department of Medical and Surgical Sciences, C.U.R.E. (University Centre for Liver Disease Research and Treatment), University of Foggia, Foggia, Italy
  5. 5Section of Dermatology, DISSAL, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genova, Italy
  1. Correspondence to Dr Cristian Fidanzi, Unit of Dermatology, University of Pisa, Pisa, Italy; cri.fidanzi{at}

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Syphilis incidence has exponentially increased in recent decades worldwide,1 particularly, although not exclusively, among men who have sex with men. The primary stage of syphilis is defined by a chancre at the site of the first contact, which is usually the anogenital area. The chancre is typically a single, painless, pink/red round ulcer with well-defined and indurated borders, varying in size from 0.3 to 3 cm, and with a smooth base sometimes covered by serous exudate. Spontaneous healing occurs within 3–4 weeks without scar.1 Regional lymphadenopathy occurs in up to 80% of cases. Atypical chancres vary in localisation, morphology and associated symptoms.1

We describe two cases of atypical primary syphilis in two immunocompetent individuals. We defined the chancres as ‘phagedenic’ because they were characterised by extensive local tissue destruction and superinfection.

Case 1. A previously healthy 54-year-old man presented with a 20-day history of a slightly painful penile lesion that appeared 1 month after unprotected sexual intercourse. Examination revealed a large oval, infiltrated erythematous plaque at the ventral surface of the shaft, 3×3 cm in diameter, …

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  • Handling editor Anna Maria Geretti

  • Contributors We declare that each coauthor of the work (GC, CF, AJ, GS and FD) made substantial contributions to the conception and design of the work; joined the acquisition, analysis and interpretation of data; participated in drafting the work; took part in the final revision; has approved the submitted version; agrees to be personally accountable for the author’s own contributions and for ensuring that questions related to the accuracy or integrity of any part of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.