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All Journal Jurnal Kedokteran Syiah Kuala Jurnal Kesehatan Andalas Berkala Ilmu Kesehatan Kulit dan Kelamin Bioscientia Medicina : Journal of Biomedicine and Translational Research JURNAL MEDIA KESEHATAN Andalas obstetrics and gynecology journal Warta Pengabdian Andalas: Jurnal Ilmiah Pengembangan Dan Penerapan Ipteks Bioscientia Medicina : Journal of Biomedicine and Translational Research Scientific Journal Journal of General Procedural Dermatology and Venereology Indonesia Prosiding Seminar Nasional Unimus Proceeding International Conference Of Innovation Science, Technology, Education, Children And Health Proceeding International Conference Of Innovation Science, Technology, Education, Children And Health
Anum, Qaira
Fakultas Kedokteran, Universitas Andalas
Humanities Biochemistry, Genetics & Molecular Biology Computer Science & IT Education Engineering Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Other

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Overlapping Chancre and Syphilitic Roseola in an Immunocompetent Patient: A Case Report Anum, Qaira; Vesri Yossy; Putera, Agung Bima
Scientific Journal Vol. 5 No. 2 (2026): SCIENA Volume V No 2, March 2026
Publisher : CV. AKBAR PUTRA MANDIRI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56260/sciena.v5i2.333

Abstract

Background: Syphilis is a sexually transmitted infection caused by Treponema pallidum that typically progresses through primary, secondary, latent, and tertiary stages. Primary syphilis presents with a painless genital chancre, whereas secondary syphilis manifests with systemic and mucocutaneous findings. Overlapping primary and secondary syphilis is uncommon and is rarely reported in immunocompetent individuals.  Case: A 38-year-old immunocompetent man presented with a painless penile ulcer that progressively enlarged over two months, accompanied by non-pruritic erythematous macules with whitish scaling on both palms for one month. Physical examination revealed a solitary, shallow, indurated genital ulcer with well-defined borders and palmar macules. Dermoscopy demonstrated “Biett’s collarette”. Serological testing showed reactive VDRL (1:32) and TPHA (1:5120), with a non-reactive HIV test. Histopathological examination of the penile ulcer revealed epidermal ulceration, dense perivascular plasma cell and lymphohistiocytic infiltration, and endarteritis obliterans, consistent with syphilitic ulcer. Urethral culture identified Neisseria gonorrhoeae, indicating concomitant gonococcal urethritis. The patient was diagnosed with overlapping primary and secondary syphilis with gonorrhea co-infection and was treated with intramuscular benzathine penicillin G, oral cefixime, and azithromycin, resulting in marked clinical improvement.  Discussion: Persistence of the chancre beyond the expected healing period together with concurrent palmar syphilitic roseola supports stage overlap rather than sequential progression. Delayed diagnosis and coexisting gonococcal infection may have contributed to this presentation despite preserved immune status. Conclusion: Overlapping primary and secondary syphilis can occur in immunocompetent patients. Recognition of this atypical presentation and comprehensive clinicopathological correlation are essential to ensure accurate diagnosis and appropriate management.
Co-Authors Agnes Sri Siswati Agustin Vira Agustin Vira Andrini Ariesti Andrini Ariesti Annisa Anggraini Ariani, Tutty Asri, Ennesta Astria Rima Rara Yuswir Astria Rima Rara Yuswir Bagus Haryo Kusumaputra Cita Rosita Sigit Prakoeswa Dhelya Widasmara Dwi Sabtika Julia Ennesta Asri Ennesta Asri Fifa Argentina Gardenia Akhyar Heffi Anindya Putri Hendriati, Hendriati Indah Indria Sari Indah Indria Sari Indah Kencana Irdawati Izrul Irdawaty Izrul Isramiarti Isramiarti Jayawarsa, A.A. Ketut Jefrizal Wirman Jefrizal Wirman Julita Julita Julita Julita Kemala Sayuti Kencana, Indah Lubis, Ramona Sari Luh Made Mas Rusyati M. Yulianto Listiawan Machdawaty Masri Mamuaja, Enricco Hendra Mardhiati Mardhiati Medhi Denisa Alinda, Medhi Denisa Muchtar, Vitayani Mulianto, Nur Rachmat Mutia Sari Novian Novian Novian Novian Puridelko Kampar Puridelko Kampar Putera, Agung Bima Putri, Heffi Anindya Regitta Indira Agusni Rendra Darma Satria Rendra Darma Satria Renni Yuniati Rika Desviorita Rika Desviorita Rina Gustia Rina Gustia Riri Prima Yolanda Rizal, Yosse Rizki Dwayana Rizki Dwayana Rizkia Chairani Asri Satya Wydya Yenny Silvia Wilvestra Sri L. Menaldi Sri Lestari Sri Lestari Tutty Ariani Tutty Ariani Utama, Redha Cipta Vesri Yossy Vitresia, Havriza Wirman, Jefrizal Yenni Raflis Yola Fadilla yosep - prabowo Yosse Rizal Yosse Rizal