Introduction
The high prevalence of sexually transmitted infections (STIs) is an issue that has to be addressed in patient education. The diagnosis of these conditions is further complicated by the fact that they are mostly asymptomatic or similar to each other in the presentation. In the first case study, a 19-year-old Asian-American female comes to the office for a checkup and states that she had a sore on her labia that resolved on its own. The physical examination does not reveal any other signs, except from maculopapular rashes on different parts of her body. This combination of symptoms can be indicative of a variety of STIs as well as other disorders.
Differential Diagnosis
The first differential and most likely diagnosis is secondary syphilis. Syphilis is an STI caused by bacteria Treponema pallidum, and it progresses in several stages. Primary syphilis presents with painless sores on or around the genitals, mouth, or rectum (Schuiling & Likis, 2017). At the end of the stage, the sores heal, and maculopapular rashes manifest on extremities. Latent syphilis may have a debilitating effect on one’s cognition, eyesight, as well as cardiovascular and nervous systems (Gnann & Whitley, 2016). Diagnostic tests include a Rapid Plasma Reagin (RPR) or a Venereal Disease Research Laboratory (VDRL) and a treponemal analysis (such as fluorescent treponemal antibody absorption) (Tharpe, Farley, & Jordan, 2017). The patient’s preliminary and current symptoms align with the typical presentation of syphilis, thus suggesting the onset of the condition’s second stage.
The second possible diagnosis is an infection caused by the herpes simplex virus (HSV). In this case, as genital sores are present, the strain HPV-2 (genital herpes) can be considered (Workowski & Bolan, 2015). The primary symptom of HPV is sores – they may appear on or around one’s genitals and rectum (Workowski & Bolan, 2015). While the patient had a sore on her genitalia, it was not painful. Moreover, the development of maculopapular rash is not consistent with this diagnosis, thus lowering its priority.
The last differential diagnosis is pityriasis rosea – a rash the exact cause of which is unknown. It is possible that some herpes virus strains may lead to this condition. Pityriasis rosea is characterized by a rash that begins on one’s back, chest, or abdomen (Drago, Ciccarese, Rebora, Broccolo, & Parodi, 2016). Later, the rash spreads to the extremities; it may itch, but it usually goes away on its own. In this particular case, the location of the rash (arms, feet, neck) does not align with the typical presentation of pityriasis rosea. Moreover, the patient does not report an itch or other minor symptoms such as headaches, fever, or fatigue.
Treatment, Management, and Education
It is vital to treat the infection as soon as it is confirmed. The preferred treatment for all stages of syphilis is Penicillin G (Workowski & Bolan, 2015). For the first and second stages of syphilis, Penicillin G Benzathine can be prescribed as a single intramuscular shot in a dosage of 2.4 million units (Workowski & Bolan, 2015). The patient’s current and previous partner or partners have to be evaluated and treated as well. Apart from pharmacological treatment, the patient has to receive education regarding common STIs. The patient should avoid sexual activity before the treatment is completed, and the tests show the absence of an infection. Moreover, the patient needs to use preventive measures – have sex with uninfected partner or partners, use latex condoms to reduce the risk of infection, and get screened for STIs regularly (Schuiling & Likis, 2017). Testing for other STIs is necessary to detect possible conditions.
Conclusion
In the first case study, the patient’s symptoms suggest the development of syphilis – an STI caused by bacteria. The patient’s treatment includes antibiotics, and patient education has to focus on sexual hygiene. The most common ways of reducing the risk of STIs is protection with condoms and sexual activity with one long-term partner. Nonetheless, sexually active people are recommended to get screened for various STIs regularly to avoid missing the infections’ escalation.
References
Drago, F., Ciccarese, G., Rebora, A., Broccolo, F., & Parodi, A. (2016). Pityriasis rosea: A comprehensive classification. Dermatology, 232(4), 431-437.
Gnann Jr, J. W., & Whitley, R. J. (2016). Genital herpes. New England Journal of Medicine, 375(7), 666-674.
Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.
Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report (MMWR): Recommendations and Reports, 64(RR3), 1-137.