Abstract：
Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease. Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients\' age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed. Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget\'s disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed. Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.
摘要：
目的分析原发性梅毒下颌的误诊原因,加强对该病不典型特征的认识。方法我们的研究包括27例没有立即被识别为下颌的具有挑战性的原发性梅毒患者。包括患者年龄在内的临床数据，性别,皮肤损伤,艾滋病毒状况，梅毒血清学检测结果,治疗,并收集随访结果。对皮肤活检切片的苏木精-伊红和免疫组织化学染色进行了审查。结果4例乳头上出现红斑或糜烂性皮损的外植体转子外植体误诊为Paget病或湿疹。漏诊或误诊的男性病例表现为梅毒性龟头炎或阴茎根部和邻近的耻骨上的多个转子，而不是冠状沟或系带。初次就诊时非反应性非密螺旋体测试的患者也容易被错过或误诊。结论原发性梅毒表现为多个病变而不是单个下颌。在非典型的地方，或者非反应性非密螺旋体测试结果，容易漏诊或误诊。
