Definition

Syphilitic ulcer, commonly known as chancre, is a venereal disease that indicates primary syphilis infection and is usually found on the penis, vaginal lip, uterine neck, or anus area. Syphilis itself is a sexually transmitted infection (STI) that can cause serious health problems if not treated properly. There are several stages in the progression of a syphilis infection, namely:

• Primary stage
• Secondary stage
• Latent stage
• Tertiary or further stage

Syphilis infection progression can last a few weeks to years. Each stage has different signs and symptoms. Many call the infection "The Great Pretender" because the symptoms can resemble many other skin and genital diseases.

Causes

Chancre is a symptom of primary syphilis, which is caused by the bacteria Treponema pallidum.  Syphilis is transmitted through direct contact with a wound or ulcer during sexual intercourse (vaginal, anal, or oral), as the fluids coming out of the ulcer contain the bacteria. Syphilis can also be transmitted from the mother to her fetus during pregnancy.

You will not get syphilis through regular contacts, such as:

• Using a public toilet
• Holding the door handle
• Swimming in a public swimming pool
• Soak in a hot tub or bathtub together
• Sharing clothes or eating utensils

Risk Factor

Sexually active people can become infected through vaginal, anal, or oral sexual intercourse with a partner who has syphilis without wearing condoms. Throughout 2020, there were 133,945 new cases of syphilis (all stages). Men who had sex with men (MSM) experienced a serious effect from syphilis. A total of 43% of all primary and secondary syphilis cases in 2020 occurred in the MSM group, as well as in men who had sex with men and women. In recent years, there has been an increase in cases involving heterosexual men and women.

Symptoms

Chancre usually appears about three weeks after the primary syphilis infection occurs, but it can vary from 10 to 90 days. Chancre can be one or more. Chancre usually starts with red spots that slowly erode, forming a clean, round wound that is not painful. Wounds are smooth-bordered and elevated.

Because the chancre does not cause pain, people sometimes do not realize they have it on their bodies. The size of the chancre can vary from a few millimeters to a few centimeters. Usually, the chancre in the genital area is smaller than in other parts of the body, such as the lips and tongue. The ulcer is a place where the bacteria T. pallidum enters the body. They are usually found in the following areas:

• Penis
• Vagina
• Anus
• Rectum
• Lips or mouth

Chancre is often accompanied by the painless swelling of nearby lymph nodes. This combination of symptoms is a strong characteristic of early or primary-stage syphilis. Since ulcers in women are usually internal, they can be invisible or go unnoticed.

Diagnosis

Syphilis infections are infections with an appearance similar to other genital skin diseases. Doctors will usually interview patients and ask about their complaints, history of illness, drugs that have been consumed, and sexual activity history. In addition to conducting physical examinations by looking at the wound or ulcer, doctors can also carry out additional examinations to confirm the presence of syphilis.

Doctors can conduct blood tests as screening to find antibodies to Treponema pallidum in the patient's blood. Some will use the liquid from the ulcer to check for the presence of bacteria. Usually, doctors will also perform additional tests to determine if the patient has any other STIs.

Management

Chancers will stay for 3 to 6 weeks with or without therapy. Syphilis itself can be cured with the right antibiotics. However, therapy may not be able to repair the damage that has occurred due to infection. Follow-up laboratory examinations are important so doctors can determine the success rate of therapy.

If you are pregnant or have certain antibiotic allergies, the information must be conveyed to your doctor so that the doctor can provide alternative antibiotics. All these drugs must be used with a doctor's prescription and under the supervision of a doctor. After treatment, the doctor will do follow-up laboratory examinations to ensure the patient responds well to the therapy.

A previous history of syphilis is not a guarantee to protect yourself from recurrent syphilis infection. Even after successful therapy, you can get syphilis again. For example, if your sexual partner also has syphilis and does not get therapy, you can become infected again when you have sex with that person. Sometimes your sexual partner also doesn't realize that he or she has syphilis, for example, if a chance appears in the vagina, anus, mouth, or in other places that are difficult to see.

Complications

Although chancre can disappear alone without therapy, their syphilis disease will continue to exist and will develop into advanced stages if not properly treated.

Pregnant women with syphilis can transmit the infection to their unborn child. This can cause the baby to be born low-weight, premature, or even stillborn. Meanwhile, a baby infected with syphilis may not show any particular symptoms or signs. However, if the baby is not treated immediately, the baby will experience serious health problems within a few weeks. Babies can experience cataracts, deafness, seizures, and death.

Prevention

The only way to prevent sexually transmitted infections is by not having sex, either vaginal, anal, or oral sex. If you are sexually active, then there are several things you can do to reduce the risk of contracting syphilis, namely:

• Do not change partners. Try to be in a long-term monogamous relationship with a partner who has no syphilis
• Use condoms properly every time you have sexual intercourse. Condoms prevent the spread of syphilis by preventing the genitals from coming into contact by chance. However, sometimes ulcers develop in areas that are not covered by condoms, so they can still be transmitted

People who suffer from syphilis or are undergoing syphilis therapy should not have sex with a new partner until the ulcer or wound is completely healed. Syphilis sufferers must also notify their sexual partners so that they can undergo examinations and therapy as needed.

All pregnant women have to undergo a syphilis examination at least once, usually on their first pregnancy visit. Several pregnant women must undergo another examination during the final trimester, or 28 weeks of pregnancy, and during childbirth. This applies to pregnant women who live in areas with high syphilis rates or have a risk of being infected with syphilis. If the result is positive, then therapy must start immediately to protect the fetus.

When to See a Doctor?

Anyone with symptoms or signs resembling syphilis must see a doctor for an examination. In addition, people who have sexual relations with sexual partners who have just received a syphilis diagnosis must also be examined.

Sexually active people should also consult a doctor to determine whether it is necessary to undergo a screening for syphilis or other STIs.

You are advised to carry out regular syphilis checks if you are sexually active, and:

• Men who have sex with men or are bisexual
• Suffering from HIV
• Taking prophylactic (preventative) medication for HIV prevention
• Having partnered with syphilis