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At the anus the papules acquire the characters of condylomata, also at the angles of the mouth, where they often ulcerate and leave radiating scars. Affections of the Mucous Membranes. The inflammation of the nasal mucous membrane that causes snuffles has already been referred to.
In the female, the primary lesion is not so typical or so easily recognised as in men; it is usually met with on the labia; the induration is rarely characteristic and does not last so long. The primary lesion may take the form of condylomata. Indurated œdema, with brownish-red or livid discoloration of one or both labia, is diagnostic of syphilis.
When, however, the rash is scanty or is obscured by co-existing eczema, most reliance should be placed on the distribution of the eruption, on the brown stains which are left after it has passed off, on the presence of condylomata, and of fissuring and scarring at the angles of the mouth.
It is readily found in the mucous patches and condylomata of the secondary period. It is best stained by Giemsa's method, and its recognition is greatly aided by the use of the ultra-microscope. The spirochæte has been demonstrated in every form of syphilitic lesion, and has been isolated from the blood with difficulty and from lymph withdrawn by a hollow needle from enlarged lymph glands.
In the later stages there may occur a form of creeping or spreading ulceration of the skin of the face, groin, or scrotum, healing at one edge and spreading at another like tuberculous lupus, but distinguished from this by its more rapid progress and by the pigmentation of the scar. Condylomata are more characteristic of syphilis than any other type of skin lesion.
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