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It should be stated that complaints of painless bumps on genitalia can signify many conditions, the diagnostics of which requires gathering more detailed information from the patient. Based on the subjective data given by AB and objective findings, it is impossible to make a final diagnosis, which means that more information should be gathered from this woman. The primary diagnosis of a chancre cannot be rejected, though it cannot be accepted unless supported with results of diagnostics. Differential diagnoses identified include sexually transmitted diseases, such as genital herpes (Simplex II), asymptomatic genital herpes with Chlamydia, and syphilis. However, additional tests should be performed in order to make a conclusive diagnosis.
Additional subjective information should be gathered from the patient by the health care professional. It is not known if the patient has noticed bumps in the past or this is for the first time. The description of painless bumps is rather broad and insufficient. The patient does not specify where the bumps are localized. She should be asked what recent illnesses she had and if she noticed bumps on any other part of her body and whether there are internal bumps.
Considering that AB had Chlamydia two years ago, she should be asked if she had any similar symptoms at that time. Currently, AB states that the bumps are painless, but it should be clarified if she felt any itching before she noticed them and whether she feels any discomfort now.
To determine a diagnosis, AB should be asked if the bumps weep or become crusty and whether they change over time. Additionally, more detailed past medical history should be obtained to learn if she had other STIs. In order to reject the diagnosis of contact dermatitis, it should be clarified which food and topical allergies the patient has. Finally, considering that AB has had an STI, a medical professional should ask what protection she currently uses, with whom she lives, and how many people share the bathroom.
Objective data also seems to be incomplete, as other body parts should be checked. In particular, it is important to assess her throat for redness and other signs of HSV and her neck for any apparent goiters or nodules. The cervix needs to be inspected for uterine size and presentation (Sullivan, 2019). Bartholin and Skene glands should be palpated for Bartholin’s and Sebaceous cysts.
It is impossible to make a diagnosis without performing appropriate diagnostics. Tzanck smear can be used to confirm the diagnosis of herpes infection (Dains, Baumann, & Scheibel, 2016). Nucleic acid amplification tests can be used to identify Gonorrhea and Chlamydia. Syphilis Serology should be used for the screening of syphilis and positive results should be confirmed using treponemal tests such as TPPA or FTA-ABS (Morshed & Singh, 2014). Scrapings from the ulcer can be taken to identify spirochetes (Dains et al., 2016). The acetic acid test can be used for examination of cervical lesions.
AB may have syphilis with painless bumps being its first signs. This is supported by the fact that the patient has had STIs and is sexually active. Since the ulcer appears on the external labia, it can be in contact with a syphilis sore. This condition can be confirmed with serology or nontreponemal and treponemal tests. The second differential diagnosis to be considered is genital herpes (Simplex II). The condition has an erythematous base and is located in the genital region. The ulcer can be painful, but it does not itch or burn (Ball, Dains, Flynn, Solomon, & Stewart, 2015). The third possible diagnosis is asymptomatic genital herpes with Chlamydia.
AB can have Chlamydia and Herpes due to her prior history of Chlamydia and sexual habits. In some cases, genital herpes can be asymptomatic, which may explain why AB does not feel itching or burning in her genitalia (Dains et al., 2016). NAATs with vaginal self-swabs are recommended for diagnostics of asymptomatic Chlamydia (Westhoff, Jones, & Guiahi, 2011). However, the lack of data does not make it possible to make a conclusive diagnosis.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
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.
Morshed, M. G., & Singh, A. E. (2014). Recent trends in the serologic diagnosis of syphilis. Clinical and Vaccine Immunology, 22(2), 137-147. Web.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5-10. Web.