Primary syphilitic chancres on arms, fingers and hands: more common than reported

Abstract

Aichelburg and Rieger 1 report in this journal of a primary syphilitic chancre on the upper arm. To their knowledge only three cases of syphilitic chancres have been described on the arm, hand and finger. However, the older literature is loaded with descriptions of extra-genital chancres, among which there are numerous cases on the hands, fingers and arms. 2-5 Alfred Fournier 6 found among 642 extra-genital chancres, 56 (23%) on the upper extremity. Jeanselme 7 reported on 31,669 extra-genital chancres and found among those 1881 primary chancres on the fingers and hand and 198 on the arms. Primary chancres of the finger were at the end of the 19th century and first half of the 20th century a well-known occupational hazard of physicians, surgeons, midwives, nurses and dentists caring for syphilitic patients. They result from manipulations involving the genitalia both in diagnosis and operative work and in digital explorations of the oral cavity. Many cases of primary chancres on the fingers in health-care workers 8-11 and after direct sexual contact 12-15 are described. There are also cases of primary syphilis on the wrist, 16 hand 8,17 and arm. 18 Among the extra-genital syphilitic chancres, those on fingers, hands and arms are less rare than usually reported, especially when one studies the older handbooks and articles on venereal diseases. It is then no trouble to find literature mentioning, describing and illustrating more than 2500 cases of primary syphilis of the finger, hand and arm.

Periungual Lesion due to Secondary Syphilis

“…Extragenital involvement occurs in 2-10% of cases, with 14% of them showing a lesion on the finger [8,9]. It is usually caused by the contact with genital lesions during sexual practices and rarely occurs in health-care workers due to patient handling [9,10]. …”