Syphilis chancre (hard): what it looks like in men and women when it appears

• The causative agent of syphilis
• Primary sign of syphilis
• Features of chancre
• Chancre of atypical form
• Chancres that are localized on the genitals
• Extragenital localization of chancre
• Chancre: treatment

Syphilis is a sexually transmitted infectious disease that develops after bacteria enter the body and multiply there. First of all, this is manifested by the formation of a dense formation on the skin, similar to an ulcer, ranging in size from one millimeter to four centimeters - this is a chancre, which translated from French means an ulcer or wormhole. In the future, syphilis can affect a person’s genital and internal organs, as well as his nervous system.

Incubation period and pathogenesis of the disease

The entry points for syphilis pathogens are damaged mucous membranes and skin. The period of illness from the moment pathogens enter the patient’s body until the appearance of primary changes (chancroid) is called incubation. During the incubation period, bacteria multiply intensively in lymphatic vessels and nodes. Reproduction of pale treponema occurs by division at a rate of one division in 30 - 32 hours. There are no clinical manifestations of the disease during this period, serological tests remain negative. The incubation period averages 3 to 4 weeks. Sometimes the incubation period is shortened to 8 - 15 days, or extended to 190 days. In case of simultaneous infection of 2 sources, a shortening of the incubation period is recorded. When taking antibiotics after infection, its lengthening is noted.

At the end of the incubation period, primary syphiloma appears at the site of introduction of pale treponema - chancre (hard ulcer), erosive or ulcerative chancre, an increase in regional lymph nodes (regional lymphadenitis) is noted, and later the entire lymphatic system begins to respond to the infection (syphilitic lymphadenitis or polyscleradenitis). With maximum accumulation in the lymphatic system, bacteria penetrate through the thoracic lymphatic duct into the subclavian vein. Syphilitic septicemia develops. In some patients, this period is manifested by an increase in body temperature, severe headaches and muscle-joint pain, weakness, and general malaise.

Serological reactions become positive 3 to 4 weeks after infection.

The spread of pale treponema with blood throughout the body marks the development of the next stage of the disease - secondary syphilis.

• Primary affect (primary syphiloma) forms 3 to 4 weeks after the initial infection.
• Within 1 - 2 weeks, the chancre increases in size, and then after 6 - 8 weeks the ulcer scars even without treatment, erosion epithelializes after 4 - 5 weeks.
• On the 5th - 6th day after the appearance of primary syphiloma, regional lymph nodes enlarge.
• After 5 - 6 weeks, polyscleradenitis develops, which indicates the generalization of a specific process.
• Serological reactions become positive 3 to 4 weeks after infection.
• The primary period lasts about 7 weeks.
• The end of the primary period is marked from the moment of occurrence of secondary syphilides.

Rice. 2. The appearance of hard chancre in the anus and oral cavity is associated with sexual perversions.

How does infection occur?

There are several ways of infection:

• Sexual path. Infection is equally possible through anal, vaginal or oral sex with the pathogen entering the mucous membranes of the genitals, mouth or rectum.
• Contact and household. It is extremely rare. Isolated cases of infection of children from patients in their environment, as well as the onset of the disease among medical staff in dermatovenerological clinics, have been described.
• Secondary infection. Cases when the patient himself spreads foci of infection throughout the body after touching ulcerative formations during a visit to the toilet or self-examination.

The pathogen enters human epithelial tissue from the patient’s skin. Many streptobacilli are contained in the purulent exudate of the chancre, so direct contact with the ulcer causes transmission of microbes.

The likelihood of bacteria being introduced increases if microtrauma occurs on the skin or mucous membranes of the genital organs during sex. Minor injuries help the stick penetrate the skin and begin the formation of multiple inflamed cells. The bacillus is highly resistant to phagocytosis, so the body’s protective elements cope poorly with it, and healing of ulcers takes quite a long time.

Predisposing factors to chancroid infection:

• use of sexual services;
• age 20-30 years (due to high sexual activity during this period);
• age above 60 years (due to a decrease in the body's defenses).

In men with circumcised foreskins, the risk of developing chancroid is much lower than in men who have not been circumcised, since the pathogen does not linger under the fold of the foreskin.

Chancre is the first symptom of syphilis

After 3 - 4 weeks from the moment of infection, the patient develops primary syphiloma - an ulcer or erosion - at the site of introduction of the pathogens.

An ulcer in syphilis has a hard infiltrate at the base, which is why it is called a “hard” ulcer or chancre. With a deep ulcer, the infiltrate at the base is powerful and has a cartilaginous structure.

With erosion, the infiltrate at the base is weakly expressed and hardly noticeable upon examination.

Primary syphilomas in syphilis are painless and even without treatment, after 6 - 8 weeks the ulcers scar, after 4 - 5 weeks erosions become epithelialized, which is why patients often do not go to doctors and miss the favorable period for effective treatment. The appearance of hard chancre, the development of regional lymphadenitis and lymphangitis, positive specific serological reactions are the main signs of the primary period of syphilis. Treatment of the disease during this period always ends with a complete cure.

Chancre is the most important sign of primary syphilis.

Rice. 3. Primary syphilis - hard chancre on the penis.

What does chancre look like?

Hard chancre in the form of erosion has clear boundaries, a smooth bottom and gently sloping edges, bright red color, raised above the skin level, there is no hyperemia of the surrounding tissue, a dense infiltrate is located at the base. There is no pain on palpation. In closed areas of the body (genital mucosa, oral cavity), the surface of primary syphilomas is smooth and shiny, bright red in color, moist with exudate, round or oval in shape. The surface of syphilomas located on open areas of the body, including the red border of the lips, shrinks into a crust, but all the signs of a hard ulcer remain.

Erosive hard chancre occurs in 80% of cases. In recent years, hard chancres that lack a clearly defined compaction at the base have become increasingly common.

Hard ulcerative chancre is a deeper defect. Develops in people with reduced immunity. The bottom of such an ulcer is dirty yellow, often with small hemorrhages and copious discharge. The infiltrate at the base often has a nodular shape. Such ulcers heal with a smooth scar with a hypochromic (colorless) rim along the periphery. In recent years, ulcerative chancres, including those complicated by pyogenic infection, have been increasingly detected.

The duration of healing of the primary defect directly depends on the severity of the infiltrate at the base. If the infiltrate at the base is weakly expressed (erosive defects), then healing occurs in 1 - 2 weeks, no trace remains. Large chancres, which have a strong infiltrate at the base, persist for up to 2 - 3 months and often persist even in the secondary period of syphilis. They heal with a scar.

Rice. 4. An ulcer with syphilis has a hard infiltrate at the base, which is why it is called a “hard” ulcer.

The size of chancre

• The size of chancre in diameter is 1 - 2 cm.
• Less common are dwarf hard ulcers. Their size is 2 - 3 mm in diameter.
• There are giant hard ulcers that have pronounced compaction at the base. They are localized on the scrotum, pubis, abdomen, chin, forearms and inner thighs - in places where fatty tissue is abundant.
• There are hard ulcers that tend to grow peripherally (burn chancre). They represent erosion with blurred, irregularly shaped edges, a granular bottom, and a dark red color.

Rice. 5. Primary syphilis is a giant chancre of the anterior abdominal wall.

Number of hard chancres

In 60 - 90% of cases, single primary syphilomas occur. Multiple syphilomas are less common. They are formed during the simultaneous penetration of pathogens in different places or during repeated infections during the first 10 - 14 days. Their number can reach 50 or more.

Rice. 6. Multiple hard chancre in men and women.

Rice. 7. Multiple hard chancres on the sides of the frenulum of the penis.

Rice. 8. Multiple hard chancre on the penis.

Varieties of chancre

• Diphtheria chancre is covered with a gray necrotic crust.
• Chancroid herpetiformis resembles genital herpes.
• Cortical chancre. Located in open areas, primary syphilomas quickly dry out and become crusty, resembling pyodermic elements.
• Slit-like chancres resemble cracks; they are located in the corners of the mouth, folds of skin and interdigital spaces.
• Folman's balanitis is a rare type of primary syphiloma. It is characterized by the presence of many small erosions on the head of the penis, partially merging in places, with sharply demarcated edges; the seal at the base is absent or barely noticeable.
• The frenulum of the penis, the external opening of the urethra, the folds of the anus, and the tonsils are the main locations of painful chancre.

Localization of chancre

The localization of hard chancres can be divided into genital, extragenital and perigenital. Primary syphiloma is most often located on the genitals. The penis, scrotum, less commonly the pubic skin, and inner thighs are their main locations in men. The labia majora and minora, clitoris, frenulum, cervix and rarely the inner wall of the vagina are the main locations of primary syphilomas in women.

The appearance of chancre in the anus and oral cavity is associated with sexual perversions. Chancres of the oral cavity and around the nipple are more often recorded in women. Primary defects in the anal area are more often recorded in men.

Extragenital chancres are recorded on the lips, tonsils, tongue, gums, facial skin, including eyelids, fingers, abdominal skin, thighs and other parts of the body.

In 12% of cases, the localization of primary syphilomas cannot be detected.

Rice. 9. Primary syphilomas on the face and upper eyelid.

Causes and timing of appearance

The formation of chancre most often occurs 3 to 5 weeks after infection with syphilis. The beginning of this process indicates the transition of the disease from the incubation to the primary stage.

Syphiloma is where the causative agent of the disease, Treponema pallidum, entered the body of an infected person.

Here it begins to actively reproduce, because for this it requires an ambient temperature of 37 degrees.

If you do not take countermeasures, the disease will progress, and there will be much more treponemes. The secondary and tertiary periods are syphilis without chancre. However, other characteristic external symptoms appear, and the carrier of the disease becomes dangerous to others.

For the formation of a chancre, it is necessary that the causative agent of syphilis penetrate into the tissues of a healthy person. This is possible under the following circumstances:

• unprotected sexual contact;
• use of non-sterile medical and cosmetic instruments;
• the presence of damage to the skin and mucous membranes upon contact with the patient;
• kiss;
• using other people's things;
• blood transfusion and surgical procedures.

Promiscuous sexual intercourse most often leads to infection with sexually transmitted diseases, including syphilis.

If syphiloma is in the oral cavity of a sick person, then you can get infected from him even through a kiss.

Unsafe sex remains the main route of transmission. Also at risk are representatives of medical professions and drug addicts.

Localization and characteristic signs

The mode of transmission of the disease affects where the chancre appears in syphilis. It is most often found on the genitals and also in the mouth. When infected through a wound on the skin, syphiloma can form anywhere, depending on the location of the damage.

Chancre may appear in the following areas:

• head and body of the penis, foreskin;
• labia;
• perianal region;
• Cervix;
• clitoris;
• pubis;
• lips;
• cheeks from the oral cavity;
• gums;
• throat;
• language;
• sky;
• fingers;
• breast;
• stomach;
• rarely - on the eyelids and conjunctiva of the eyes.

Syphiloma is quite easy to distinguish from other types of formations. It is characterized by the following symptoms:

• an area of ​​redness initially appears without any discomfort in this area;
• then a nodular neoplasm appears with a bluish tint on the surface of the skin or mucous membranes at the site of redness;
• an ulcer opens in the center of the nodule, with no pain if we are talking about a typical form of syphiloma;
• the edges of the chancre are dense and smooth, the bottom resembles cartilage in structure;
• the shape of the formation is predominantly round or oval;
• the color of the ulcer is dark red or brown;
• there is a small amount of discharge that resembles pus, and it is these discharges that contain treponema;
• There is an increase in nearby lymph nodes and a low-grade fever.

Types of formations and their features

A typical chancre makes it quite easy to diagnose the disease.

In this case, syphilomas can be classified according to a number of criteria:

Atypical forms

It is much more difficult to diagnose syphilis if the chancre manifests itself in an atypical form. That is why the final diagnosis can only be made by a qualified doctor.

The most common variants of atypical syphilomas are:

Such chancrees not only complicate the diagnostic process, but are also accompanied by various complications. In addition, they are characterized by the presence of pain, although with syphilis this symptom is extremely rare.

Chancroid

A special form of skin formation is chancroid - soft chancre. It appears under the influence of streptobacilli, it does not contain the causative agent of syphilis, Treponema pallidum.

Characteristic signs of such a neoplasm are:

• soft edges of the ulcer, lack of a hard base;
• the presence of a pain symptom;
• erosion color – bright red;
• there is copious purulent discharge;
• peeling of the skin;
• the appearance of small ulcers independent of the chancroid, which can merge with it into a single focus of inflammation.

Due to the active reproduction of streptobacilli and their spread through the bloodstream, the patient exhibits signs of general intoxication of the body: nausea, headaches and dizziness, malaise. The inflammatory process increases body temperature.

Unlike hard chancre, soft chancre is transmitted exclusively through sexual contact. In addition, after healing it leaves noticeable scars, which is associated with severe inflammation of the superficial lymph nodes and the formation of bubonic ulcers, as well as their opening. Syphiloma disappears almost without a trace.

Consequences

The presence of chancre clearly indicates the presence of the causative agent of syphilis in the body. This disease in itself is very dangerous, as it can affect internal organs, causing their failure.

Also, the consequences of infection are destructive processes in bone tissue, which deprives a person of the ability to lead normal life activities and provokes physical deformities. Without treatment, the risk of developing neurosyphilis increases. Later, as the disease progresses, death occurs - this is the price of ignoring the problem.

If we consider directly the consequences associated with the formation of chancre, it is worth highlighting the following:

• damage to deep tissue layers;
• suppuration and tissue necrosis;
• self-amputation of damaged areas, in particular the external genitalia;
• bleeding;
• formation of rough scars;
• urethral perforation;
• accession of infections;
• endocervitis of the cervix;
• balanoposthitis;
• syphilitic gangrene;
• bartholinitis.

Such complications occur mainly with atypical syphilomas. Common chancre often goes unnoticed and disappears without a trace as the disease moves into the secondary phase.

Signs and symptoms of syphilis in men during the primary period of the disease

Hard chancre in men has its own characteristics, which depend on their location:

• small erosive chancres are often located on the head of the penis;
• ulcerative chancres are located in the head groove, they are large in size, and have a powerful infiltrate at the base;
• primary syphilomas, located on the frenulum of the penis, have an elongated shape, are easily injured and bleed during erection;
• in primary syphilomas located on the sides of the frenulum, there is no compaction at the base;
• in the region of the edge of the foreskin there are linear chancres;
• the seal at the base of the chancre, located in the area of ​​the inner layer of the foreskin, looks like a visor;
• the hard chancre located on the crown of the glans penis resembles a swallow's nest;
• when located in the urethra, chancres have a dense consistency, are painful on palpation, always bleed, urination is also painful, scanty serous-bloody discharge is noted, in some cases, when cured, a cicatricial narrowing of the organ occurs;
• when the lymphatic capillaries are damaged and the outflow of lymph is impaired in the area of ​​the scrotum and penis, indurative edema occurs, characterized by a sharp increase in the organ, which becomes dense; after pressing, no hole remains. There is no pain. The swelling subsides slowly even with treatment.

Rice. 10. Primary syphilomas in men - localization on the head of the penis (photo on the left) and in the area of ​​the inner layer of the foreskin (photo on the right).

Rice. 11. Ulcerative chancre, located in the head groove, is large in size, has a powerful infiltrate at the base and is linear in direction.

Signs and symptoms of syphilis in women during the primary period of the disease

Chancroid in women has its own characteristics, which depend on their location:

• erosive chancres are more often located in the area of ​​the labia majora, indurative edema is less often recorded;
• chancre located in the area of ​​the urethra always has a dense base;
• in chancre located in the area of ​​the vulvovaginal fold, the compaction at the base is not pronounced;
• primary syphilomas, located on the cervix, are erosions of round shapes, with a flat bottom, clearly defined boundaries, intense red color, scanty serous discharge;
• when lymphatic capillaries are damaged and lymph outflow in the area of ​​the clitoris and labia is impaired, unilateral indurative edema occurs, characterized by a significant increase in the organ, which becomes dense, dark red in color, often with a bluish tint. After pressing, there is no hole left. There is no pain. The swelling subsides slowly even with treatment.
• Primary vaginal syphiloma is extremely rare;
• in the area of ​​the nipple in women, chancre is recorded in the form of erosions, usually single, with pronounced compaction at the base, covered with a crust;
• The crescent-shaped crack has a primary defect localized at the base of the nipple.

Rice. 12. Primary syphilis in women on the labia majora (photo on the left) and cervix (photo on the right).

Rice. 13. The first signs of syphilis in women are primary ulcers on the genitals.

Rice. 14. The photo shows an atypical form of chancre in a woman - indurative edema (photo on the left) and a primary defect in the nipple area (photo on the right).

The appearance of an erosive ulcer on the genitals or inducing swelling of the labia majora is the first sign of syphilis in women.

Diagnostics

The diagnosis of chancroid is made on the basis of:

• examination, during which, in typical forms of the disease, diagnosis based on characteristic symptoms does not present any difficulties;
• laboratory diagnostics, which allows you to identify the pathogen in any form of the disease.

Laboratory diagnostics include:

• Dark-field microscopy, which makes it possible to detect treponema pallidum in the discharge from lesions (treponema pallidum is stained only with complex specific staining methods).
• Polymerase chain reaction or DNA probing, which allows identifying a single DNA molecule of the pathogen.
• Methods of serological diagnosis, which are based on the detection of antibodies to the pathogen in blood serum or liquor. They include non-treponemal tests (MRP with inactivated serum or plasma, RPR, TRUST test, etc.), which are accessible but low-sensitive, and more highly sensitive treponemal tests (Wassermann reaction, TPI, etc.).

Other types of chancre

In primary syphilis, 75% are chancre located in the oral cavity, on the face, and very rarely on the scalp. The remaining 25% are primary syphilomas of the upper extremities, anus, mammary glands, thighs and abdomen. Bipolar chancre is the name given to primary syphilomas that appear simultaneously on the genitals and other parts of the body. They are rare.

Hard chancre of the oral cavity

Among the primary defects of extragenital localization, the most common are hard chancre on the lips, tonsils and tongue. The gums, pharynx, hard and soft palate are rare localizations.

Hard chancre on the lips is almost always single, located on the red border of the lips, has the appearance of an ulcer or erosion, covered with a dense crust, less often with a grayish coating. Sometimes the ulcerative defect hypertrophies with the appearance of painful cracks. Primary syphiloma contains many pale treponema. There is an increase in the mental and submandibular lymph nodes.

The hard chancre in the corners of the mouth looks like a crack. When the mouth is wide open, its oval shape and compaction at the base are visible.

Hard chancre on the tongue is often single, erosive or ulcerative in nature, sometimes has a slit-like shape and is located along the tongue.

Chancres of the tonsils can have ulcerative, sore throat-like (chancre-amygdalitis) or combined forms. On an enlarged and dense tonsil with an ulcerative form, an oval-shaped meat-colored ulcer with flat edges appears. The mucous membrane around the ulcer is hyperemic.

With chancre-amygdalitis, the tonsil enlarges and thickens, acquires a copper-red color, there are no acute inflammatory phenomena, there is no primary defect in the form of an ulcer or erosion and there is no inflammation of the surrounding tissues, and there are many pale treponemas on the surface of the organ.

Eye damage due to syphilis.

Chancres of the conjunctiva, skin of the eyelid and ciliary margin are isolated.

Rice. 15. Primary syphilomas on the lips.

Rice. 16. Syphilis of the tongue in the primary period - chancre. It is an erosion or ulcer with a dense infiltrate at the base.

Rice. 17. In the photo there is chancre-amygdalitis.

Primary syphilomas of the rectum

Around the anus, primary syphilomas have a “gathered” or fissured appearance. There is pain on palpation, and chancre often bleeds during defecation. With primary syphilomas of the rectum, there is pain before and after defecation, and the stool is glassy in nature.

Chancre felon

Primary syphilomas of the hands are more common in men, mainly on the terminal phalanges of the thumb, index or middle fingers of the right hand. Due to swelling and inflammation, the finger becomes club-shaped and bluish-red in color, “shooting” pains appear, the edges of the ulcer are uneven, overhanging, corroded, the bottom of the ulcer is covered with necrotic-purulent discharge.

Fungal chancroid is characterized by fleshy growths in the form of cauliflower.

Rice. 18. Chancre felon.

Complications of primary syphilis

When a secondary infection occurs, the clinical manifestations of chancroid may change. Inflammation of the glans penis (balanitis) and the inner layer of the foreskin (posthitis) may develop. Balanoposthitis causes the development of complications such as narrowing of the foreskin (phimosis) and pinching of the head of the penis by the ring of the foreskin (paraphimosis). In weakened individuals, gangrenization and phagedenism develop. Decreased immunity and poor hygiene contribute to the development of complications.

Complications in men develop when hard chancre is localized in the coronary sulcus or on the inner sheet of the foreskin.

• When a trichomonas or bacterial infection is attached, acute inflammation develops around primary syphilomas, which is complicated by narrowing of the foreskin, which makes it impossible to open the head of the penis. The penis enlarges, turns red and becomes painful. Forcible opening of the glans penis can lead to paraphimosis. Failure to provide medical care in a timely manner can lead to necrosis of the foreskin and tissues of the glans penis.
• When infected with B. fusiformis, gangrenization of chancre develops. A black scab forms on the surface of a hard ulcer, which, when sloughed off, reveals a deep ulcer. There is severe swelling and hyperemia of the surrounding tissues. The patient's general condition deteriorates sharply.
• The surrounding tissues are swollen and hyperemic. It's getting worse.
• As the disease progresses, the process spreads beyond the chancre. Bleeding occurs. As a result of necrosis, the head of the penis may be torn away, causing perforation and destruction of the urethra (phagedenism).

Rice. 19. In the photo, urethral chancre complicated by balanoposthitis.

Rice. 20. Complications of chancroid in men - phimosis.

Rice. 21. Complications of chancroid in men - paraphimosis.

Rice. 22. Complicated course of primary syphilomas in men.

Rice. 23. Development of gangrenous inflammation of primary syphiloma.

initial stage

At the initial stage, a visual examination of the patient is performed at an appointment with a doctor, who will subsequently carry out all the necessary treatment.

Chancre is determined at this stage by external visible signs that are characteristic of this disease.

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The initial stage of diagnosis usually does not involve sending the patient for tests to determine the exact nature of what is happening.

The reasons for the occurrence of such a problem and the external signs of the formation of a situation that led to the occurrence of chancre are determined.

Subsequently, a verbal interview with the patient may be performed to identify underlying circumstances. Which contributed to the creation of the current situation.

Regional lymphadenitis, lymphangitis and polyscleradenitis

Regional lymphadenitis

Regional lymphadenitis (scleradenitis) is, after chancre, the second most important symptom of primary syphilis. Scleradenitis develops 6 - 7 days after the initial manifestation of syphilis - chancre and often on the affected side (unilateral localization).

The lymph nodes are painless, woody in density, mobile, and not fused with the surrounding tissues. Sometimes lymph nodes appear simultaneously with primary syphiloma. Several lymph nodes may enlarge at the same time, the largest of which is located closer to the chancroid. When a secondary infection occurs, the lymph nodes become fused into conglomerates, the phenomena of periadenitis are pronounced, and sometimes fistulas are formed. Syphilitic lymphadenitis resolves slowly.

Inguinal lymphadenitis is often bilateral, it develops when hard chancre is localized on the external genitalia, ulnar and axillary lymph nodes increase when syphilomas are localized on the hands, cervical and submandibular - when localized on the lower lip, preauricular and submandibular - when localized on the upper lip, submandibular , cervical and preauricular - when localized on the tonsils, sublingual - on the tongue, preauricular - on the skin of the eyelids, axillary - when primary syphiloma is localized on the skin of the mammary gland, when chancre is localized in the rectum and on the cervix, the lymph nodes located in the small pelvis.

Rice. 24. Regional lymphadenitis is, after chancre, the second most important symptom of primary syphilis. The photo shows inguinal lymphadenitis.

Syphilitic lymphangitis

Inflammation of the lymphatic vessels (lymphangitis) is the third main symptom of primary syphilis. The causative agents of syphilis multiply in the lymphatic system and the lymphatic vessels are the first to be affected in this process. Lymphangitis begins from the site of primary syphiloma and reaches nearby lymph nodes. The inflamed vessels thicken and become like a dense elastic painful cord. Lymphangiitis, like lymphadenitis, resolves slowly.

Rice. 25. The photo shows sclerosing lymphangitis.

Healing of syphilitic chancre

Without specific therapy, patients with syphilitic chancre heal in 3-6 weeks. If treatment was started with the use of benzylpenicillin, this period is reduced to two weeks.

The infiltrate itself heals after a much longer period (up to several months). If the patient had an ulcerative form of chancre, an oblong or rounded scar without irregularities on the surface will form in its place. After complete healing of the syphilitic chancre, only temporary pigmentation remains. The chancre completely resolves.

Let's celebrate! Healing of bipolar extragenital chancre is somewhat different. All signs occur much faster, and serological reactions can be positive at an earlier date. The incubation period is reduced, as are the signs of the primary form (up to 20 days). Afterwards, polyadenitis, baldness and other signs of the secondary form occur.