Assessing the Genitalia and Rectum
Patient information
Name initials: CF
Age: 21
Sex: Female
Ethnicity: Caucasian
SUBJECTIVE DATA
Subjective
Chief Complain: “I have bumps on my bottom that I want to have checked out.”
History of Presenting Illness: CF, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the lumps are painless and feel rough. She says 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 three years ago, and no dysplasia was found; the exam results were normal. She reported one sexually transmitted infection (chlamydia) about two years ago. She completed the treatment for chlamydia as prescribed.
PMH: Asthma
Medications: Symbicort 160/4.5mcg
Allergies: NKDA
FH: No history of breast or cervical cancer, Father history HTN, Mother history HTN, GERD
Social: Denies tobacco use; occasional EtOH, married, three children (1 girl, two boys)
ROS
General: Well looking woman seated on a chair, whose age corresponds to her outlook. She is composed and a good historian
HEENT: Patient denies loss of vision, loss of hearing, epistaxis, and headaches. He had seen the dentist two months ago.
Respiratory: she denies hemoptysis
Cardiovascular: Denies chest pain.
Gastrointestinal: no constipation and no abdominal pain.
Genitourinary: Denies incontinence, denies dysuria, no hematuria. LMP: 07/12/19. Last Pap smear exam was one year ago, and no dysplasia was found; the exam results were normal.
Musculoskeletal: Denies muscle, back pain, joint pain or stiffness
Psychiatric/ cognitive: no depression, no mood swings
Neurological: no seizures, no balance problems, no coordination challenges
Skin: denies skin lesions, no rashes, denies moles
Hematologic: denies epistaxis, gum bleeding and eye and skin bruising
Endocrine: denies tremors and excessive urination and thirst
Immunologic: denies asthma
OBJECTIVE:
VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
HEENT: no ear infection, no discharge from the eyes and the ears. No epistaxis, no polyps, no sinus inflammation, no gingivitis, no dental appliances, and no gum bleeding.
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.
Abdomen: soft, normoactive bowel sounds, negative rebound, negative murphy’s, negative McBurney
Musculoskeletal: Normal muscle tone, proper range of motion, and normal muscle strength of both extremities.
Neurological: Mood and affect congruent. Alert and oriented to time, place, and person.
Skin: Intact skin
Diagnostics:
- HSV antibody test: This test may detect past infection of HSV (Goljan, 2014).
- Pap Smear: It will help in ruling out or diagnosing cervical cancer that could be caused by the HPV virus. In the process, Pap smear helps in making a precise diagnosis of genital warts.
- CT scans Will help in diagnosing sebaceous and Bartholin’s cyst.
- Serum tests: This test is used to confirm the presence of syphilis, which will be shown by the presence of neutrophils that are fighting against bacteria, causing the infection. Always the antibodies against the bacteria causing syphilis will remain in the body for several years.
- Polymerase chain reaction (PCR) test: The test will help in identifying the type of virus that is involved in causing genital warts. Besides, it helps in differentiating genital warts from herpes simplex (Hammer & McPhee, 2014).
Differential diagnosis
Human Papilloma Virus (HPV): This virus causes genital warts in humans. Besides, the virus is one of the causal viruses of cervical cancer (Mays et al., 2015). There are various varieties of HPV, and they cause different disease. HPV 16 and HPV 18 causes cervical cancer. On the other hand, HPV can cause the cancer of the vagina, anus, vulva, penis, and oropharyngeal.
HPV transmission is increased with an increase in the number of sexual partners that an individual is involved in sex with. Patients with the low immune system are at risk of acquiring HPV diseases. Besides, the areas of the body that have bruises, open wounds or punctured areas are at risk of developing warts when they are exposed to HPV. According to (Mays et al., 2015), some of the types of warts that affect the human body include common warts, flat warts, genital warts, and plantar warts. In women, genital warts affect the cervix, vulva, anus, and vagina. The appearance of warts depends on the HPV that is involved in causing it. HPV can be quickly diagnosed through the use of Pap smear, DNA test and acetic acid solution test which helps in detecting abnormal cells in the cervix, vulva, vagina, and anus(Mays et al., 2015). The above patient could be suffering from genital warts caused by HPV because of the presenting symptoms and her involvement in sexual intercourse with various men.
Genital Herpes: herpes simplex virus causes this sexually transmitted infection. The virus is usually dormant for several years before it reappears and causes disease. It causes the itching of the genitalia, formation of red blisters that later become ulcers and begin to bleed (Mays et al., 2015). The disease is transmitted through sexual intercourse with an infected partner, and it affects women mostly.
Bartholin’s cyst: The Bartholin’s glands are involved in the secretion of a fluid that helps in lubricating the vagina. According to (McCance et al., 2014) the obstruction of the Bartholin’s glands causes the accumulation of the fluid in it, which later results in the swelling of the glands. As a result of fluid buildup, an infection may occur and cause an abscess.
Sebaceous cyst: This is non-cancerous growths that develop in the areas surrounding the torso (McCance et al., 2014). It is painless and non-life threatening though uncomfortable and a source of embarrassment if left unmanaged.
Syphilis: It is a sexually transmitted disease that is caused by bacteria. Syphilis can remain dormant for a long time, after the initial symptoms such as sores on the skin, genitalia, and mucous membranes (Hammer & McPhee, 2014). It presents itself with various symptoms depending on the stage of the infection. The disease may be transmitted to the unborn babies through vertical transmission.
References
Goljan, E. F. (2014). Rapid review: Pathology (4th ed.). Philadelphia, PA: Elsevier.
Hammer, G. D., & McPhee, S. J. (2014). Pathophysiology of disease: An introduction to clinical medicine (7th ed.). China: McGraw Hill.
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MS: Elsevier.
Mays, R. M., Zimet, G. D., Winston, Y., Kee, R., Dickes, J., & Su, L. (2015). Human papillomavirus, genital warts, Pap smears, and cervical cancer: knowledge and beliefs of adolescent and adult women. Health care for women international, 21(5), 361-374.
