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Assessing the Genitalia and Rectum

Proper analysis of information obtained from the patient is crucial for a clinician to make a diagnosis. The purpose of this paper is to assess the subjective and objective information of a 21-year-old White female college student who complains of painless and rough bumps on her genital area. The paper also established the possible differential diagnosis of the patient (A.B.).

Analysis of subjective portion and additional information

The patient is 21 years old and a White female college student.  She states having rough and painless bumps around her genital area. AB is sexually active with multiple sexual partners, although married with three children – a girl and two boys. She first indulged in sexual intimacy at the age of 18 and is unsure how long the bumps have been there, although she noticed them a week ago. She denies abnormal virginal discharge. AB has a history of STI (chlamydia), which she contracted two years ago and completed its treatment. She has no known allergies and denies using tobacco, and occasionally takes alcohol. Additional information includes inquiring about the circumstances under which the patient noticed the bumps and their variation over the days. The patient should state if the bumps are itchy, and if so, under what circumstances or what time of the day the itching accelerates and reduces. Has the patient taken any medication to ease the spread of the bumps? It is also important to inquire whether the patient uses protective tools such as condoms during sexual intimacy with multiple partners.

Analyze the Objective Portion

According to the objective information, the patient’s temperature and blood pressure are normal at 98.6ºF and 120/86 mmHg. The respiration rate and weight are also average. The lungs are normal by being symmetrical and has normal female hair pattern distribution with no swelling or masses.  The urethral meatus has no discharge, and the perineum is intact with a healed scar for an episiotomy. The vaginal mucosa is moist and pink in color with rugae. A painless ulcer was noted on the external labia, and the assessment indicated the presence of chancre or syphilis.  Additional objective information would include assessing for edema, cold sores, lesions, tonsils, oral thrush, or other viral infections.  It is also crucial to evaluate for non-labored or labored breathing, nipple discharge, nodules or tenderness.  Checking for retractions, nasal flaring, or wheezing is also important. The assessment was chancre which is supported by subjective and objective information. A chancre is characterized by a painless blotch red rash around the genitals, as reported by AB, which is an early sign of chancre.

Appropriate Diagnostic Tests

Following the probability for various health conditions, appropriate diagnostic tests would include HIV testing. The patient has multiple sex partners, which renders her at risk of contracting HIV/AIDs. The results would aid to assess the presence of HIV in the blood. A pregnancy test is also vital since the woman is young and hence highly productive. The test will aid in assessing if it is the cause of the pinkish vaginal mucosa, which is a sign of implantation bleeding in early pregnancy (Sally et al., 2021). Chlamydia testing is also crucial in this case due to the patient’s history of the health condition. AB is 21 years old and sexually active with multiple sex partners and with a history of chlamydia, which subjects her to high risks of the disease, hence a necessary test. Further, I would also contact Pap smear test to screen for cervical cancer. Cervical cancer is characterized by rough warts around the genitalia and hence a necessary test.  Following the crucial signs and symptoms of chancre identified with the patient, I would accept the current diagnosis. However, I would take a rapid plasma reagin (RPR) to screen for and diagnose syphilis.

Differential Diagnosis

The possible conditions for consideration as differential diagnosis include:

1. Molluscum contagiosum: The condition affects the labia, anal, and perineum areas. The genital lesions are usually painless, and interviewing the patient regarding the spread over the week would be vital to confirm or eliminate the diagnosis (McCollum et al., 2014).
2. Chlamydia: Considering AB’s history of the condition and her current sexual habits, chlamydia could be diagnosed. According to Wong et al. (2017), chlamydia is asymptomatic and affects any sexually active person, especially between 14 and 24 years.
3. Herpes (Simplex II): It causes genital herpes and sores, spreading through general interactions such as kissing. AB is sexually active and hence prone to kissing and at risk of contracting the disease. The disease is prevalent among women than men (Caldeira et al., 2013).
4. Hidradenitis Suppurativa (HS) is characterized by painful lumps forming under the skin, especially where it rubs together, such as groins and genitals (. However, this diagnosis could be disqualified since AB’s bumps are painless and rough, while in HS, they are painful. The condition is prevalent among women than men and the young population (Calao et al., 2018).
5. Condyloma Acuminate (CA): CA describes anogenital warts that are spread through sexual contact. AB is sexually active and hence at risk of this condition. According to Pennycook & McCready (2020), it affects people between the age of 20 and 39 years.

Generally, physical examination and diagnostic tests are vital in assessing health conditions affecting the genital area. Various factors contribute to bumps around the genitalia, including health conditions such as HIV/AIDs, chlamydia, and syphilis. The paper assessed the potential diagnosis of AB by analyzing subjective and objective information.

References

• Calao, M., Wilson, J. L., Spelman, L., Billot, L., Rubel, D., Watts, A. D., & Jemec, G. B. (2018). Hidradenitis Suppurativa (HS) prevalence, demographics and management pathways in Australia: A population-based cross-sectional study. PloS one, 13(7), e0200683.
• Caldeira, T. D. M., Gonçalves, C. V., Oliveira, G. R. D., Fonseca, T. V. D., Goncalves, R., Amaral, C. T. D., … & Martinez, A. M. B. D. (2013). Prevalence of herpes simplex virus type 2 and risk factors associated with this infection in women in southern Brazil. Revista do Instituto de Medicina Tropical de São Paulo, 55, 315-321.
• McCollum, A. M., Holman, R. C., Hughes, C. M., Mehal, J. M., Folkema, A. M., Redd, J. T., … & Reynolds, M. G. (2014). Molluscum contagiosum in a pediatric American Indian population: incidence and risk factors. PLoS One, 9(7), e103419.
• Pennycook, K. B., & McCready, T. A. (2020). Condyloma Acuminata. StatPearls [Internet].
• Sally, R., Shaw, K. S., & Pomeranz, M. K. (2021). Benign “Lumps and Bumps” of the Vulva: A Review. International Journal of Women’s Dermatology.
• Wong, W. C. W., Zhao, Y., Wong, N. S., Parish, W. L., Miu, H. Y. H., Yang, L. G., … & Tucker, J. D. (2017). Prevalence and risk factors of chlamydia infection in Hong Kong: A population-based geospatial household survey and testing. PloS one, 12(2), e0172561.