Primary syphilis is characterized by a skin lesion at the initial site of entry of the infectious agent and usually occurs 2 - 10 weeks after infection. The patient's rash is on his back, this is a very unlikely port of entry for syphilis. Also the skin lesion in primary syphilis, referred to as chancre, looks quite different from the rash seen in your patient.
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Used with permission of © Dr. Norm Levine
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