Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_911_Библиотеки_им_академика_М_И_Перельмана

of several progressive stages: primary (chancre or proctitis), secondary (condyloma lata) or tertiary (with involvement of the nervous and vascular systems). Anal syphilis occurs during anal receptive intercourse. The primary stage begins within 2–10 weeks of exposure with the appearance of an anal ulcer called a chancre. This is a raised, 1–2cm lesion that begins as a small papule that progresses into an indurated, clean-based ulcer without exudates. Anal ulcers are frequently painful (in contrast to genital ulcers), they may be single or multiple, and can be located on the perianal skin, in the anal canal or in the distal rectum. Differentiation from idiopathic anal fissure may be difficult; however, chancres are usually eccentrically located (off the midline), multiple and, if opposite each other, are known as ‘kissing ulcers’. Painless but prominent lymphadenopathy is also common. If secondary bacterial infection occurs, patients can experience worsening anorectal pain. Rectal mucosal involvement results in tenesmus, rectal discharge or bleeding, though proctitis may occur with or without chancres.