discussion response

A 19-year-old Asian American female comes into the clinic for a well-woman checkup. She states that about three weeks ago she had a non-tender sore on her labia that resolved without treatment. Her gynecologic exam is normal but she has maculopapular lesions on her trunk, neck, palms, and soles of her feet. The remainder of her exam was unremarkable.

 

6551 Week 4 Case Study 1

Primary Diagnosis

 

            After reading the limited information given for this case study, I would diagnose this patient with syphilis. Primary syphilis presents with a lesion or papule that is typically painless at the site of inoculation (Hicks & Clement, 2019). The lesion or chancre heals spontaneously within three to six weeks even in the absence of treatment (Hicks & Clement, 2019). Since the ulcer is painless, many patients don’t seek medical attention which leads to increased transmission of the disease (Hicks & Clement, 2019). 

            Secondary syphilis can produce a variety of symptoms including a rash in any form although vesicular lesions are uncommon (Hicks & Clement, 2019). The rash is classically a diffuse symmetric macular or popular eruption involving the entire trunk and extremities including the palms and soles (Hicks & Clement, 2019). Since this patient is presenting with this type of rash and had a painless sore resembling a chancre about three weeks ago, this diagnosis is likely and would be my primary diagnosis. 

Treatment

            The preferred treatment for syphilis is Penicillin G benzathine 2.4 million units IM once (Hicks & Clement, 2019). If the patient is not allergic to Penicillin and the medication was available to give the patient at her visit, this is what I would give for treatment. Alternatively, I would order Doxycycline 100 mg orally BID for 14 days, Ceftriaxone 1 to 2 g daily IM for 10 to 14 days, Tetracycline 500 mg orally QID for 14 daily or amoxicillin 3 g plus probenecid 500 mg both given PO BID for 14 days (Hicks & Clement, 2019). 

Differential Diagnoses

            Genital herpes presents with varying symptoms including but not limited to painful genital ulcers, dysuria, fever, and headache (Albercht, 2019). Symptoms can be mild, subclinical or entirely asymptomatic (Albrecht, 2019). Although the patient’s sore was painless, patients have varying degrees of pain tolerance and some patients present with herpes which is asymptomatic, making this a possible diagnosis. 

            Behcet’s disease is a multisystem disease characterized by recurrent oral and genital ulcers as well as skin rashes and joint pain (Kamal, 2019). The ulcers generally subside in one to two weeks (Kamal, 2019). Although this disease is rare and unlikely, it is a possible differential based on the genital lesion and rash with which the patient presented. 

Education on STI’s

            The major goal and primary focus of screening for STI’s is to identify and treat infected persons before they develop complications and to identify, test and treat their sexual partners to prevent transmission and reinfection (Ghanem & Tuddenham, 2019).  It is essential to educate the patient on safe sexual practices, to educate on the importance of screening for STI’s with any new sexual partner, specifically if engaged in unprotected sexual intercourse, and to have testing completed with any new or concerning symptoms. Education is essential and to ensure that the patient knows the consequences of leaving STIs untreated. 

            

References

 

Albrecht, M.A. (2019). Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus infection. UpToDate. Retrieved from https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-genital-herpes-simplex-virus-infection?search=genital%20herpes&source=search_result&selectedTitle=2~130&usage_type=default&display_rank=2#H9

Ghanem, K.G. & Tuddenham, S. (2019). Screening for sexually transmitted infections. UpToDate. Retrieved from https://www.uptodate.com/contents/screening-for-sexually-transmitted-infections?search=education%20on%20STI%27s&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4

 

Hicks, C.B. & Clement, M. (2019). Syphilis: epidemiology, pathophysiology, and clinical manifestations in HIV-uninfected patients. UpToDate. Retrieved from https://www.uptodate.com/contents/syphilis-epidemiology-pathophysiology-and-clinical-manifestations-in-hiv-uninfected-patients?search=syphyllis&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3

Kamal, A. (2019). Behcet’s disease.Magill’s Medical Guide (Online Edition). Retrieved from 

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