
Just Waiting For My AnswerHello Doctor, I Am A Student

I am a student and need help with this case study. What diagnostic tests would be appropriate? What possible conditions would be consistent in a differential diagnosis for the patient. Thank you.
Subjective:
CC: “I have bumps on my bottom that I want to have checked out.”
HPI: 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 over 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 with a healed episiotomy scar present. 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, neg McBurney
Diagnostics: HSV specimen obtained
Assessment:
Chancre
Painless genital ulcer
Detailed Answer:
Hello, I'm Dr. Branch,
Thanks for using 'Ask A Doctor' service.
This is a little confusing because the HPI sounds like genital warts, but then the exam shows a genital ulcer. The differential for a painless genital ulcer would include syphilis, lymphogranuloma venereum (LGV), and granuloma inguinale, but could also be herpes or chancroid.
I would certainly want to check her for syphilis and swab the ulcer for herpes simplex. I would also check for HIV, gonorrhea, and chlamydia (because of the risk for other STIs). If the tests for syphilis and herpes were negative, I would then test for LGV, granuloma inguinale, and chancroid.
I hope that helps...
Please let me know if you have any questions, I would be glad to discuss it with you further.
Regards

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