Case Study Option #2:

STI Maria is a 46-year-old Hispanic female who comes to your clinic complaining of a lesion in her vaginal area that she recently noticed while bathing. Maria came to the U.S. from Mexico over 10 years ago, but her husband was not able to join her until just two months ago. Maria reports she abstained from sexual activity during the years she was separated from her husband and is not aware of any sexual activity on the part of her husband. Maria and her husband have been sexually active since his arrival in the U.S. two months ago. Maria reports she has not been to a health care provider while in the United States because she has no insurance coverage. She has no medical records and has not had any screenings or well-woman exam visits for over a decade. Maria has three healthy, grown children all delivered vaginally without pregnancy or delivery complications. Her mother is 62, lives in Mexico, and suffers from diabetes and hypertension. Her father died from colon cancer at age 55. Maria’s LMP was one week ago, and all of her VS are WNL. Upon PE, you note a lesion on the left labia minora that has the appearance of a chance, and you note that it is not painful to Maria when touched.

1. What are your presumptive and differential diagnoses?

2. What screening and/or diagnostic tests will you perform/order to ascertain the correct diagnosis and what current screenings will you recommend in adherence to evidence-based guidelines?

3. What is pathophysiology? Describe all stages, modes of transmission, any incubation periods.

4. What is the evidence-based treatment guidelines for this diagnosis?

5. How will you explain this diagnosis and plan of care to Maria?

Sample Solution

1. Presumptive Diagnosis: The lesion on Maria’s labia minora has the appearance of a chancre, which is a primary symptom of syphilis. Differential diagnosis could include other sexually transmitted infections (STIs) or non-infectious conditions such as vulvar cancer or a Bartholin gland cyst.
2. Screening and diagnostic tests that can be performed to ascertain the correct diagnosis include:

• Blood tests for syphilis (Rapid Plasma Reagin test and confirmatory Treponema Pallidum Particle Agglutination test).
• A wet mount or swab test to examine the lesion for other STIs such as gonorrhea or chlamydia.
• A biopsy of the lesion to rule out cancer.

Current screening recommendations for women include regular Pap tests for cervical cancer screening, which should be recommended to Maria given her lack of medical history.

3. Syphilis is caused by the bacterium Treponema Pallidum and is usually transmitted through sexual contact with an infected individual. The incubation period for syphilis is typically 3 weeks to 3 months, but can range from 10 to 90 days. The infection has four stages: primary, secondary, latent, and tertiary. During the primary stage, a painless sore or chancre appears at the site of infection. In the secondary stage, a rash may appear on the palms of the hands or soles of the feet, along with flu-like symptoms. During the latent stage, the infection is dormant and may last for years. In the tertiary stage, the infection can cause serious damage to the brain, heart, and other organs.
4. Treatment guidelines for syphilis recommend penicillin as the first-line treatment for all stages of the infection. The dose and duration of treatment depend on the stage of…NEED A COMPREHENSIVE ANSWER? POST YOUR ORDER