Genitalia Assessment Essay Example Assignment Paper
Subjective Portion Analysis
In addition to the information provided by the client, further information on the bumps is required. As for the bumps themselves, the client reports that they are rough and painless, but she is unsure of how long they have been present since she just became aware of them a week ago. Because she has a history of chlamydia, it is critical that I question her whether she uses protection and that she get tested for this specific illness. This may be a sign of the beginning phases of syphilis. In the absence of treatment for syphilis, it may advance to a symptomless chronic underlying illness, which can then advance to high-level syphilis, which can manifest itself years down the line and manifest itself in severe neurological, cardiovascular, musculoskeletal, and coetaneous problems (Riaz & Wei 2017) Genitalia Assessment Essay Example Assignment Paper.
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Objective Analysis
Numerous physical exams are required, each of which is tailored to the client’s chief complaint. The following assessments should be performed on the client: lymph nodes, breast evaluation, HEENT, integumentary, musculoskeletal and genitourinary system, and overall demeanor of the client. Since HSV is insufficient, further tests should be performed. They are as follows: repeat Pap smear, urine analysis and culture, and complete blood count. Acetic acid testing may aid in the diagnosis of genital warts, while DNA testing can aid in the detection of herpes, syphilis, and chlamydia, among other diseases. However, each could require extra testing to ensure a higher level of responsiveness and positive isolation (Dains, Bauman, & Scheibel, 2015). An acetic acid test will also help in ruling out HPV. It has been determined that the client is sexually active and that HPV is more likely to be transmitted to women of reproductive age who are not using protection. As such, they risk developing cervical or uterine cancer.
Assessment
Chancre
Chancre has been identified based on the information given; the goal now is to determine the bacteria, virus, or pathogenic elements that were responsible for the formation of the chancre. Several other possible diagnoses may also result in the kind of chancre that the client is experiencing Genitalia Assessment Essay Example Assignment Paper.
Differential Diagnoses
Syphilitic Chancre
Syphilis is a sexually transmitted disease caused by the bacteria Treponema pallidum. Primary syphilis, secondary syphilis, and tertiary syphilis constitute the three phases of syphilis, respectively (Riaz & Wei, 2017). Primary syphilis is associated with the development of a painless lesion called a chancre, which is a sign of the disease. This lesion occurs at the location of the infection and is typically solitary in its development. Chancres are typically solid and round in appearance. It is possible to have several chancres at the same time. Chancre typically cures on its own in six weeks, without the need for any kind of intervention.
Genital Warts
Genital warts are a kind of sexually transmitted infection (STI) induced by some low-risk forms of the human papillomavirus (HPV). They are small, soft lesions that develop in the genital region. They may lead to pain, irritation, and itchiness, as well as other unpleasant effects. Unlike the high-risk strains that may cause cervical dysplasia and cancer, these strains are not associated with these conditions (Holand & Soung, 2018). Visual examination is generally sufficient for diagnosis, but a biopsy may be necessary to narrow down the differential diagnosis.
Herpes simplex virus 2 (HSV2)
Herpes Simplex Virus 2 (HSV2) is a virus that is mainly responsible for genital herpes and is the most frequent cause of genital herpes outbreaks (Alyazidi & Gantt, 2018). Throughout the genitals, HSV2 will produce red bumps that will develop into watery lesions that may break open, leak out, or bleed in the course of the infection. Direct Fluorescent Antibody (DFA) and Tzanck tests may be used to detect HSV infections Genitalia Assessment Essay Example Assignment Paper.
References
Alyazidi, R., & Gantt, S. (2018). Herpes simplex virus. Oxford Medicine Online. https://doi.org/10.1093/med/9780190604813.003.0007
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Holland, E. K., & Soung, P. J. (2018). Acquired Rashes in the Older Child. EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, 213, 142–143 https://doi.org/10.1016/B978-0-323-39956-2.00048-0
Riaz, A., & Wei, G. (2017). Chancre of primary syphilis. Journal of Education and Teaching in Emergency Medicine, 2(4). https://doi.org/10.5070/m524036787
GENITALIA ASSESSMENT
Subjective:
- CC: “I have bumps on my bottom that I want to have checked out.”
- HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
- PMH: Asthma
- Medications: Symbicort 160/4.5mcg
- Allergies: NKDA
- FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
- Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys) Genitalia Assessment Essay Example Assignment Paper
Objective:
- VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
- Heart: RRR, no murmurs
- Lungs: CTA, chest wall symmetrical
- Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia
- Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney
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Diagnostics: HSV specimen obtained
Assessment: Chancre
PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.
- Analyze the subjective portion of the note. List additional information that should be included in the documentation.
- Analyze the objective portion of the note. List additional information that should be included in the documentation.
- Is the assessment supported by the subjective and objective information? Why or why not?
- Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
- Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
Please do not write the paper in soap note format. PLEASE ANSWER ONLY THE QUESTIONS. DO NOT REWRITE THE CASE STUDY. Title page and Reference page required ( APA format )Genitalia Assessment Essay Example Assignment Paper.
Sample answers to the questions
Alternatively, she may have blood tested via RPR. If immediate testing is unavailable, the
patient should begin empiric treatment with penicillin.
Vulvar Cancer –
Skin cancer occurring on the vulva presents as an ulceration like lesion which
should be considered as a likely differential diagnosis for this patient. The patient’s chief
complaint reports rough bumps noted to labia. This differing in texture is concerning for a
cancerous origin (Alkatout, et al., 2015). Biopsy of the lesion should be taken for further study.
We are unsure of the patient’s HPV vaccination status. If HPV is present in the patient her risk
for vulvar cancer is increased.
Genital Herpes
– Genital lesions are most often associated with Herpes Simplex Virus (HSV)
type 2 infection but may also be caused by HSV type 1 (Groves, 2016). The infection may lay
latent without symptoms for a long period of time before a patient becomes symptomatic.
Genital herpes presents as more vesicular in nature rather than a large singular chancre. These
lesions are most often described as a painful burning sensation.
Chancroid –
Is caused by a sexually transmitted bacteria called Haemophilus ducreyi and
presents first as a vesicular like lesion which quickly becomes an open chancrous like ulceration
(Copeland & Decker, 2016). These lesions are most commonly associated with pain which
decreases the likelihood of this diagnosis.
Gonorrhea –
Due to the often-simultaneous infection of chlamydia and gonorrhea, and the
patient’s past history of chlamydial infection gonorrheal infection should be ruled out. Symptoms
of gonorrhea are commonly described as a purulent vaginal discharge with inflammation of the
vulva (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
PLAN:
This section is not r
Question
GENITALIA ASSESSMENT
Subjective:
CC: “I have bumps on my bottom that I want to have checked out.”
HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed Genitalia Assessment Essay Example Assignment Paper.
- PMH: Asthma
- Medications: Symbicort 160/4.5mcg
- Allergies: NKDA
- FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
- Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)
Objective:
- VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
- Heart: RRR, no murmurs
- Lungs: CTA, chest wall symmetrical
- Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia.
- Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney
- Diagnostics: HSV specimen obtained Genitalia Assessment Essay Example Assignment Paper
Assessment:
- Chancre
1) Analyze the subjective portion of the note. List additional information that should be included in the documentation.
2) Analyze the objective portion of the note. List additional information that should be included in the documentation.
3) Is the assessment supported by subjective and objective information? Why or why not?
4) Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
5) Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
…continue reading
Answered by Expert Tutors
1) Analyze the subjective portion of the note. List additional information that should be included in the documentation.
There are some subjective data provided that are helpful like for example the history of chlamydia and treatment and the presence of rough painless bumps which is very important since most ulcerations caused by genital infection can be classified according to pain. However, last sexual activity was not indicated which would be helpful to identify the probability of incubation period. Also the use of condoms during the previous sexual intercourse, and if the client noticed this lesion prior to her previous intercourse Genitalia Assessment Essay Example Assignment Paper.
2) Analyze the objective portion of the note. List additional information that should be included in the documentation.
The objective part lacks a lot of information such as the number of lesions, appearance of the lesion, color, diameter, decribe edges if sharply demarcated margins, depth, base, induration, presence or absence of lymphadenopathy, or if it is associated with a burning sensation during urination.
3) Is the assessment supported by subjective and objective information? Why or why not?
The assessment is partly supported by the subjective and objetive information, in that we have identified that the patient is sexually active, has a history of chlamydia, she states the presence of painless and rough bumps on genital area, and on objective it was identified to be a firm, round, small, painless ulcer on external labia. It isn’t well supported in the sense that it lacks a lot of data especially in the objective part.
4) Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
Yes, to identify the causative agent. Diagnostics include a culture and staining, or polymerase chain reaction.
- Culture and staining- isolates the caustive agent.
- Polymerase chain reaction – will detect the DNA of the virus.
5) Would you reject/accept the current diagnosis? Why or why not?
No diagnosis was given.
But I believe the diagnosis is Syphilis with the assessment referring to a painless chancre while HSV-2 or herpes simplex virus 2 on the other hand is painful ulcer presenting Genitalia Assessment Essay Example Assignment Paper
Based on NCBI (https://www.ncbi.nlm.nih.gov/books/NBK554427/), Herpes genitalis can be caused by the herpes simplex virus type 1 or type 2 and manifests as either a primary or recurrent infection. Genital symptoms are commonly seen in the outpatient primary care setting, despite many going without a clear diagnosis. HSV-2, in particular, may present as a primary infection with painful genital ulcers, sores, crusts, tender lymphadenopathy, and dysuria. The classical features are of macular or papular skin and mucous membrane lesions progressing to vesicles and pustules that often last for up to 3 weeks. Genital lesions can be especially painful, leading to swelling of the vulva in women, burning pain, and dysuria. The study further stressed that it is important to note that HSV-2 does not typically present with painless ulcers. Systemic symptoms can occur to include fever, headache, and malaise and are often due to concurrent viremia, which has been reported in up to 24% of patients in one study.
Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
SYPHILIS
Syphilis is caused by Treponema pallidum. The lesion of primary syphilis occurs at the site of initial inoculation of T pallidum. It is usually single and painless but can be multiple and painful. It tends to begin as a macule that becomes a papule, which then ulcerates. A two to three week incubation period usually occurs between the inoculation of T pallidum and development of the lesion (the range of incubation period is reported as being 9-90 days). Local, non-tender lymphadenopathy is often associated with this lesion.
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Source: NCBI Syphilis By Dr. Patrick French,
DONOVANOSIS
Also known as “granuloma inguinale”. Donovanosis lesions usually start as a painless papule or subcutaneous nodule. The lesions develop the classic “beefy-red” appearance due to their high vascularity. The initial lesion takes on an ulcerative morphology after minor trauma. There is usually no regional lymphadenopathy. Developing subcutaneous granulomas known as pseudobuboes is possible. The lesions are progressive in an outward direction from the center. The borders of the lesions are sometimes described as “snake-like” in appearance. Self-inoculation is possible and may create mirror-image lesions in the same general location, usually across skin folds. Patients often delayed seeking health care for many reasons, and therefore, they usually present with a more progressed lesion. There are 4 types of lesions. Classic ulcerogranulomatous lesions are the most common with beefy-red, non-tender ulcers that bleed easily. The second type is hypertrophic or verrucous with irregular raise edges and dry texture. The third type is necrotic, offensive-smelling, deep ulceration that causes tissue destruction. The last type is sclerotic or cicatricial with fibrous and scar tissue. The genitals are affected in 90% of cases and the inguinal region in 10% of cases. The most common sites where men are affected are the prepuce, coronal sulcus, frenum, glans, and anus. The most common sites where women are affected are the labia minora, fourchette, cervix, and upper genital tract Genitalia Assessment Essay Example Assignment Paper.
Source: NCBI Granuloma Inguinale by Jenna N. Santiago-Wickey; Brianna Crosby.
LYMPHOGRANULOMA VENEREUM
LGV is caused by chlamydia trachomatis. Characteristically lymphogranuloma venereum has three stages. The primary stage begins in 3 to 12 days after exposure or sometimes it may be longer up to 30 days. The patient characteristically develops a painless genital ulcer or papules which are about 1 to 6 mm in size. Sores can also be present in the mouth or throat. An inflammatory reaction can occur at the site of inoculation. This stage often goes unnoticed due to the location of the lesions and as the lesions are usually small and there are no associated symptoms. The lesions resolve or heal spontaneously after few days. The secondary stage presents with the development of unilateral or bilateral tender inguinal and/or femoral lymphadenopathy (also called buboes), which occurs two to six weeks after the primary stage; this is called the inguinal syndrome. An anorectal syndrome also presents which is characterized by proctitis or proctocolitis-like symptoms. Pain during urination, rectal bleeding, pain during passing stools, abdominal pain, anal pain, tenesmus. Generalized symptoms like body aches, headache, and fever can occur during this stage. This syndrome usually occurs when the transmission is via the anal route. An oral syndrome can occur in people get LGV through the oral route. Cervical lymphadenopathy can occur. The late sequelae usually occur when the disease is left untreated where necrosis and rupture of the lymph nodes are present with anogenital fibrosis, and strictures, anal fistulae and elephantiasis of the genital organs can also occur in some cases.
Source: Lymphogranuloma Venereum by Prashanth Rawla; Krishna C. Thandra; Faten Limaiem.
Explanation
The case is actually quite confusing since the diagnostic indicates the presence of HSV specimen, however, the manifestation (according to subjective, objective and assessment) is different indicating that it is a painless ulcer. I would also like to indicate the lack of important objective data as I’ve stated above. Which is why diagnostics are very important to identify the causative agent for the ulcer, a PCR is ideal since it identifies the DNA/RNA of the causative agent. The problem with culture and staining is it sometimes has to be specific to the agent you want to test. For example, HSV can be cultured using Tzank smear while Syphilis cannot. And Syphilis will need dark staining. So these are some culture staining factors that needs to be considered. With this case, I feel it is incomplete with respect to the lack of diagnostic results and the lack of proper complete physical exam. It is important to note that although signs and symptoms of sexually transmitted infections may overlap, culture and/or PCR is needed to identify the specific causative agent. For the differential diagnosis, I have highlighted in bold the reason as to why I considered these diseases and mostly all of them can present with painless genital ulcer Genitalia Assessment Essay Example Assignment Paper.
GENITALIA ASSESSMENT Subjective: • CC: “I have bumps on my bottom that I want to have checked out.” • HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed. • PMH: Asthma • Medications: Symbicort 160/4.5mcg • Allergies: NKDA • FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD • Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys) Objective: • VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs • Heart: RRR, no murmurs • Lungs: CTA, chest wall symmetrical • Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia • Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg Mc Burney Diagnostics: HSV specimen obtained Assessment: Chancre PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature. • Analyze the subjective portion of the note. List additional information that should be included in the documentation. • Analyze the objective portion of the note. List additional information that should be included in the documentation. • Is the assessment supported by the subjective and objective information? Why or why not? • Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis? • Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature. Please do not write the paper in soap note format. PLEASE ANSWER ONLY THE QUESTIONS. DO NOT REWRITE THE CASE STUDY. Title page and Reference page required ( APA format ) Genitalia Assessment Essay Example Assignment Paper.
Sample answers to the questions Alternatively, she may have blood tested via RPR. If immediate testing is unavailable, the patient should begin empiric treatment with penicillin. Vulvar Cancer – Skin cancer occurring on the vulva presents as an ulceration like lesion which should be considered as a likely differential diagnosis for this patient. The patient’s chief complaint reports rough bumps noted to labia. This differing in texture is concerning for a cancerous origin (Alkatout, et al., 2015). Biopsy of the lesion should be taken for further study. We are unsure of the patient’s HPV vaccination status. If HPV is present in the patient her risk for vulvar cancer is increased. Genital Herpes – Genital lesions are most often associated with Herpes Simplex Virus (HSV) type 2 infection but may also be caused by HSV type 1 (Groves, 2016). The infection may lay latent without symptoms for a long period of time before a patient becomes symptomatic. Genital herpes presents as more vesicular in nature rather than a large singular chancre. These lesions are most often described as a painful burning sensation. Chancroid – Is caused by a sexually transmitted bacteria called Haemophilus ducreyi and presents first as a vesicular like lesion which quickly becomes an open chancrous like ulceration (Copeland & Decker, 2016). These lesions are most commonly associated with pain which decreases the likelihood of this diagnosis. Gonorrhea – Due to the often-simultaneous infection of chlamydia and gonorrhea, and the patient’s past history of chlamydial infection gonorrheal infection should be ruled out. Symptoms of gonorrhea are commonly described as a purulent vaginal discharge with inflammation of the vulva (Ball, Dains, Flynn, Solomon, & Stewart, 2019). PLAN: This section is not r Question GENITALIA ASSESSMENT Subjective: CC: “I have bumps on my bottom that I want to have checked out.” HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago Genitalia Assessment Essay Example Assignment Paper.
She completed the treatment for chlamydia as prescribed. • PMH: Asthma • Medications: Symbicort 160/4.5mcg • Allergies: NKDA • FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD • Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys) Objective: • VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs • Heart: RRR, no murmurs • Lungs: CTA, chest wall symmetrical • Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia. • Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney • Diagnostics: HSV specimen obtained Assessment: • Chancre 1) Analyze the subjective portion of the note. List additional information that should be included in the documentation. 2) Analyze the objective portion of the note. List additional information that should be included in the documentation. 3) Is the assessment supported by subjective and objective information? Why or why not? 4) Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis? 5) Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature. …continue reading Answered by Expert Tutors 1) Analyze the subjective portion of the note. List additional information that should be included in the documentation. There are some subjective data provided that are helpful like for example the history of chlamydia and treatment and the presence of rough painless bumps which is very important since most ulcerations caused by genital infection can be classified according to pain. However, last sexual activity was not indicated which would be helpful to identify the probability of incubation period. Also the use of condoms during the previous sexual intercourse, and if the client noticed this lesion prior to her previous intercourse. 2) Analyze the objective portion of the note. List additional information that should be included in the documentation. The objective part lacks a lot of information such as the number of lesions, appearance of the lesion, color, diameter, decribe edges if sharply demarcated margins, depth, base, induration, presence or absence of lymphadenopathy, or if it is associated with a burning sensation during urination. 3) Is the assessment supported by subjective and objective information? Why or why not? The assessment is partly supported by the subjective and objetive information, in that we have identified that the patient is sexually active, has a history of chlamydia, she states the presence of painless and rough bumps on genital area, and on objective it was identified to be a firm, round, small, painless ulcer on external labia Genitalia Assessment Essay Example Assignment Paper.
It isn’t well supported in the sense that it lacks a lot of data especially in the objective part. 4) Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis? Yes, to identify the causative agent. Diagnostics include a culture and staining, or polymerase chain reaction. • Culture and staining- isolates the caustive agent. • Polymerase chain reaction – will detect the DNA of the virus. 5) Would you reject/accept the current diagnosis? Why or why not? No diagnosis was given. But I believe the diagnosis is Syphilis with the assessment referring to a painless chancre while HSV-2 or herpes simplex virus 2 on the other hand is painful ulcer presenting. Based on NCBI (https://www.ncbi.nlm.nih.gov/books/NBK554427/), Herpes genitalis can be caused by the herpes simplex virus type 1 or type 2 and manifests as either a primary or recurrent infection. Genital symptoms are commonly seen in the outpatient primary care setting, despite many going without a clear diagnosis. HSV-2, in particular, may present as a primary infection with painful genital ulcers, sores, crusts, tender lymphadenopathy, and dysuria. The classical features are of macular or papular skin and mucous membrane lesions progressing to vesicles and pustules that often last for up to 3 weeks. Genital lesions can be especially painful, leading to swelling of the vulva in women, burning pain, and dysuria. The study further stressed that it is important to note that HSV-2 does not typically present with painless ulcers. Systemic symptoms can occur to include fever, headache, and malaise and are often due to concurrent viremia, which has been reported in up to 24% of patients in one study. Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature. SYPHILIS Syphilis is caused by Treponema pallidum. The lesion of primary syphilis occurs at the site of initial inoculation of T pallidum. It is usually single and painless but can be multiple and painful. It tends to begin as a macule that becomes a papule, which then ulcerates. A two to three week incubation period usually occurs between the inoculation of T pallidum and development of the lesion (the range of incubation period is reported as being 9-90 days). Local, non-tender lymphadenopathy is often associated with this lesion. Source: NCBI Syphilis By Dr. Patrick French, DONOVANOSIS Also known as “granuloma inguinale”. Donovanosis lesions usually start as a painless papule or subcutaneous nodule. The lesions develop the classic “beefy-red” appearance due to their high vascularity. The initial lesion takes on an ulcerative morphology after minor trauma. There is usually no regional lymphadenopathy. Developing subcutaneous granulomas known as pseudobuboes is possible. The lesions are progressive in an outward direction from the center. The borders of the lesions are sometimes described as “snake-like” in appearance. Self-inoculation is possible and may create mirror-image lesions in the same general location, usually across skin folds. Patients often delayed seeking health care for many reasons, and therefore, they usually present with a more progressed lesion. There are 4 types of lesions. Classic ulcerogranulomatous lesions are the most common with beefy-red, non-tender ulcers that bleed easily. The second type is hypertrophic or verrucous with irregular raise edges and dry texture. The third type is necrotic, offensive-smelling, deep ulceration that causes tissue destruction. The last type is sclerotic or cicatricial with fibrous and scar tissue. The genitals are affected in 90% of cases and the inguinal region in 10% of cases. The most common sites where men are affected are the prepuce, coronal sulcus, frenum, glans, and anus Genitalia Assessment Essay Example Assignment Paper.
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The most common sites where women are affected are the labia minora, fourchette, cervix, and upper genital tract. Source: NCBI Granuloma Inguinale by Jenna N. Santiago-Wickey; Brianna Crosby. LYMPHOGRANULOMA VENEREUM LGV is caused by chlamydia trachomatis. Characteristically lymphogranuloma venereum has three stages. The primary stage begins in 3 to 12 days after exposure or sometimes it may be longer up to 30 days. The patient characteristically develops a painless genital ulcer or papules which are about 1 to 6 mm in size. Sores can also be present in the mouth or throat. An inflammatory reaction can occur at the site of inoculation. This stage often goes unnoticed due to the location of the lesions and as the lesions are usually small and there are no associated symptoms. The lesions resolve or heal spontaneously after few days. The secondary stage presents with the development of unilateral or bilateral tender inguinal and/or femoral lymphadenopathy (also called buboes), which occurs two to six weeks after the primary stage; this is called the inguinal syndrome. An anorectal syndrome also presents which is characterized by proctitis or proctocolitis-like symptoms. Pain during urination, rectal bleeding, pain during passing stools, abdominal pain, anal pain, tenesmus. Generalized symptoms like body aches, headache, and fever can occur during this stage. This syndrome usually occurs when the transmission is via the anal route. An oral syndrome can occur in people get LGV through the oral route. Cervical lymphadenopathy can occur. The late sequelae usually occur when the disease is left untreated where necrosis and rupture of the lymph nodes are present with anogenital fibrosis, and strictures, anal fistulae and elephantiasis of the genital organs can also occur in some cases. Source: Lymphogranuloma Venereum by Prashanth Rawla; Krishna C. Thandra; Faten Limaiem. Explanation The case is actually quite confusing since the diagnostic indicates the presence of HSV specimen, however, the manifestation (according to subjective, objective and assessment) is different indicating that it is a painless ulcer. I would also like to indicate the lack of important objective data as I’ve stated above. Which is why diagnostics are very important to identify the causative agent for the ulcer, a PCR is ideal since it identifies the DNA/RNA of the causative agent. The problem with culture and staining is it sometimes has to be specific to the agent you want to test. For example, HSV can be cultured using Tzank smear while Syphilis cannot. And Syphilis will need dark staining. So these are some culture staining factors that needs to be considered. With this case, I feel it is incomplete with respect to the lack of diagnostic results and the lack of proper complete physical exam. It is important to note that although signs and symptoms of sexually transmitted infections may overlap, culture and/or PCR is needed to identify the specific causative agent. For the differential diagnosis, I have highlighted in bold the reason as to why I considered these diseases and mostly all of them can present with painless genital ulcer Genitalia Assessment Essay Example Assignment Paper