Floret pattern of primary chancres: An atypical manifestation of syphilis

A 32-year-old unmarried male presented with a painless penile ulcer of 15-day duration. He admitted to having had unprotected anal sexual contact 3 months prior. Examination revealed papular to verrucous, moist ulcers over the prepuce with phimosis, arranged in a floret-like pattern with bilateral painless inguinal lymphadenopathy [Figure 1]. Serological tests confirmed diagnosis of syphilis (venereal disease research laboratory 1:64, treponema pallidum hemagglutination assay positive), along with co-infection with human immunodeficiency virus (HIV). He was then started on antiretroviral therapy and treated with a single dose of benzathine penicillin G. This case highlights an unusual presentation of multiple primary chancres in an HIV co-infected individual.Figure 1: Multiple ulcers over the prepuce arranged in a floret-like patternDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.