Assessing the Genitalia and Rectum

Assessing the Genitalia and Rectum

The patient needs to report whether any of her sexual partners that she has had in the one year had an STD. She will also need to state if her sexual partners were using condoms or not. The patient will need to state whether she has observed any rashes or sores in the mouth, vagina, and anus. She will also be examined for rashes on the palms of her hands and the soles of her feet.

The patient will be examined on the soles of her feet, palms of her hands, mouth, anus, and vagina. A herpes simplex virus test will be conducted. Sample fluid will be collected from the boil/sore and tested for the virus. The sample will also be isolated in a bacterial culture to detect the presence of Haemophilus ducreyi. If the results show that the sample has H. ducreyi, then the patient will be diagnosed with a form of syphilis.

The patient might be suffering from chancre, genital herpes, genital warts, cancroid, or vulva cancer. Painless ulcers in the genital area characterize the first stage of the chancre, which is firm and round in shape (Nyatsanza & Tipple, 2016). Genital herpes is characterized by sores at the point of entry which appear 2-12 days after one is infected. Women will have genital herpes sores in the vaginal area, external genitalia, and cervix (Gnann & Whitley, 2016). Genital warts are the most common STI and appear on the genital tissue area. Warts appear like cauliflowers in the vulva, vaginal walls, and between the cervix and external genitalia (Park, Introcaso, & Dunne, 2015). Cancroid is manifested with genital ulcers that are sexually transmitted and often very painful (Carvallho et al., 2015). Vulva cancer is characterized by burning or itching and sores that take a long time to heal (Rogers & Cuello, 2018).

Lab Assignment

Additional information in the subjective area that needs to be included in any medication she has taken to get rid of the bumps; medication intolerance; past hospitalizations; chronic illnesses or major traumas; whether she got her children via vaginal or cesarean birth; any recent changes in weight; any pain when urinating; whether the urine is cloudy or has a foul smell; and whether she has taken an HIV test in the last three months.

Additional information in the objective section includes her general appearance; skin appearance and if it has any lesions or rashes; HEENT; genitourinary to examine for pain or tenderness to touch, whether the bladder is distended; a psychiatric examination to determine if the patient is oriented to person, place, and time; and neurological to determine the strength of her reflexes.

The assessment is supported by subjective and objective information as the patient has a genital examination that reveals firm, round, small, painless ulcers on external labia. The patient has also stated that she has had more than one sexual partner in the last year, which increases her risk of contracting an STI.

Diagnostics would be appropriate as the presence of H. ducreyi would be confirmation of syphilis. In this case, the patient is in the first stage of the disease, referred to as chancre. After the initial infection, the symptoms appear after 21 days in the form of painless ulcers at the infection site. The current diagnosis is accurate for chancre because the patient has painless ulcers at the genitalia.

The three differential diagnoses, as mentioned earlier, are genital herpes, genital warts, and cancroid. The signs and symptoms of genital herpes are mild, appear 2-12 days after infection, and appear as sores at the site of infection. Herpes sores can appear on the external genitalia, thighs, anus, and buttocks (Gnann & Whitley, 2016). Genital warts appear on moist genital areas, including the anus, vaginal walls, and vulva lives (Park et al., 2015). The warts are itchy and uncomfortable and appear as brownish swellings in the genital area. The early signs and symptoms of cancroid mimic those of syphilis. The ulcer grows from a small pustule that appears 4-10 days after infection (Carvallho et al., 2015).

References

Carvalho, P. M. R. D. S., Guimarães, R. A., Moraes, P. Á., Teles, S. A., & Matos, M. A. D. (2015). Prevalence of signs and symptoms and knowledge about sexually transmitted diseases. Acta Paulista de Enfermagem, 28(1), 95-10.

Gnann Jr, J. W., & Whitley, R. J. (2016). Genital herpes. New England Journal of Medicine, 375(7), 666-674.

Nyatsanza, F., & Tipple, C. (2016). Syphilis: presentations in general medicine. Clinical Medicine, 16(2), 184.

Park, I. U., Introcaso, C., & Dunne, E. F. (2015). Human papillomavirus and genital warts: a review of the evidence for the 2015 Centers for Disease Control and Prevention of sexually transmitted Disease Treatment Guidelines. Clinical Infectious Diseases, 61(suppl_8), S849-S855.

Rogers, L. J., & Cuello, M. A. (2018). Cancer of the vulva. International Journal of Gynecology & Obstetrics, 143, 4-13.

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Assessing the Genitalia and Rectum

Subjective:

Assessing the Genitalia and Rectum

• 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, negMcBurney
• Diagnostics: HSV specimen obtained