Editing Syphilis (section)

===Primary===
[[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumb|Chancre on a penis due to primary syphilis, 1978]]
Primary syphilis is typically acquired by direct sexual contact with the infectious lesions of another person.<ref name=RedBookSyphilis>{{cite book|author=Committee on Infectious Diseases |editor= Larry K. Pickering |title=Red book 2006 Report of the Committee on Infectious Diseases|year=2006 |pages=631–44|publisher=American Academy of Pediatrics|location=Elk Grove Village, IL|isbn=978-1-58110-207-9|edition=27th}}</ref> Approximately 2–6 weeks after contact (with a range of 10–90 days) a skin lesion, called a [[chancre]], appears at the site and this contains infectious bacteria.<ref>{{cite web |title=STD Facts - Syphilis (Detailed) |url=https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm |website=www.cdc.gov |language=en-us |date=23 September 2019 |access-date=15 September 2017 |archive-date=30 July 2018 |archive-url=https://web.archive.org/web/20180730092959/https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm |url-status=live }}</ref><ref name=NEJM2020>{{cite journal |last1=Campion |first1=Edward W. |last2=Ghanem |first2=Khalil G. |last3=Ram |first3=Sanjay |last4=Rice |first4=Peter A. |title=The Modern Epidemic of Syphilis |journal=New England Journal of Medicine |date=27 February 2020 |volume=382 |issue=9 |pages=845–54 |doi=10.1056/NEJMra1901593|pmid=32101666 |s2cid=211537893 }}</ref> This is classically (40% of the time) a single, firm, painless, non-itchy [[skin ulceration]] with a clean base and sharp borders approximately 0.3–3.0&nbsp;cm in size.<ref name=Kent08/> The lesion may take on almost any form.<ref name=Pri2008/> In the classic form, it evolves from a [[macule]] to a [[papule]] and finally to an [[erosion (dermatopathology)#Primary lesions|erosion]] or [[ulcer (dermatology)|ulcer]].<ref name=Pri2008>{{cite journal |last=Eccleston|first=K|author2=Collins, L |author3=Higgins, SP |title=Primary syphilis|journal=International Journal of STD & AIDS|date=March 2008|volume=19|issue=3|pages=145–51|pmid=18397550|doi=10.1258/ijsa.2007.007258|s2cid=19931104}}</ref> Occasionally, multiple lesions may be present (~40%),<ref name=Kent08/> with multiple lesions being more common when coinfected with HIV.<ref name=Pri2008/> Lesions may be painful or tender (30%), and they may occur in places other than the genitals (2–7%).<ref name=Pri2008/> The most common location in women is the [[cervix]] (44%), the [[Human penis|penis]] in heterosexual men (99%), and [[Human anus|anally]] and [[rectal]]ly in [[men who have sex with men]] (34%).<ref name=Pri2008/> [[Lymphadenopathy|Lymph node enlargement]] frequently (80%) occurs around the area of infection,<ref name=Kent08/> occurring seven to 10&nbsp;days after chancre formation.<ref name=Pri2008/> The [[lesion]] may persist for three to six weeks if left untreated.<ref name=Kent08/>