Clinical Diagnosis of Patient Condition

Diagnosis and Assessment in a Clinical Setting

Given the information provided in the subjective portion of the note, the clinician would want to find out if the patient has ever engaged in anal intercourse. If the patient has engaged in such intercourse, the clinician would want to know how many partners she’s had in this regard and when was the last incidence of anal intercourse. The clinician would also want to find out if the patient used protection when engaging this form of intercourse. Getting the total number of partners that this woman has had over the past year might shed some light on the situation as well. Additionally, it might be worth asking if the patient has made an obvious changes in personal hygiene or underwear. For example, the sudden usage of baby wipes in the vaginal or anal area has been found to cause irritation in some cases. Likewise, wearing underwear or thongs made out of material that can cause irritation, such as latex or polyester, which prevents proper ventilation to the skin can also cause irritation. Hence, asking the patient if she’s made an sudden changes in dress, or personal hygiene are necessary. Furthermore, asking about the last bowel movement the patient had would be valuable information, as well as asking about the nature of her bowel movements. Does the patient strain or have difficult or leaky bowel movements? Does the patient sit for long periods of time or engage in any heavy lifting?

In regards to the objective portion of the note, it would be worthwhile to determine if the woman has any pelvic pain or tumors via a thorough pelvic exam. The bumps should be swabbed along with a swab taken of the anus area, and a microscopic examination should be conducted (nih.gov). For example, herpes sores often break and ooze a fluid. If this is in fact a herpes outbreak, the bumps might not be at the stage where they yet break and emit a fluid. Conducting a swab might also help one determine if these bumps are the telltale sores or fever blisters that are often red, white or clear, that forms on the genitalia. Testing the area to determine if it looks swollen would also help in determining a diagnosis. Assessing if the sores are appearing in clusters or groups is also important to note down for the patient’s file; alternatively, the sores or bumps might be manifesting in a more individualized manner. A clinician who has experience in diagnosing herpes should be able to tell if these are the bumps commonly associated with herpes; even if they are not yet emitting a fluid, an experienced clinician can generally tell if that will eventually happen. “The sores will burst and the fluid will begin to discharge, leading to the formation of wet ulcers. Just like cold sores, these ulcers are very sensitive. They’re reddish and resemble a small cut. Although these ulcers generally disappear after a day, they’re one of the most painful stages of oral herpes” (mercola, 2018).

Doing a swab of the entire rectal area is useful, as trace fluids may be collected. “This fluid can also be cultured over a few days to see whether infectious bacteria or yeast can be detected” (nih.gov). The patient also needs to have another pap smear immediately. “The effects of human papilloma virus (HPV), which causes genital warts and cervical cancer, can be detected in a woman when her health care provider performs a pap smear test and takes samples of cells from the cervix to be checked microscopically for abnormal changes” (nih.gov). Hence, it would definitely be worthwhile to engage in a pap smear to see if any abnormalities arose in the findings.

Conducting a comprehensive urine test would also help as there are tests which can immediately detect pathogenic bacteria that is commonly associated with STDs (Lee et al., 2007). Ordering a full round of blood tests in order to detect a comprehensive range of STDs such as hepatitis A, B, and C or HIV/AIDS would be a necessary precautionary aspect of the diagnosis. “Blood testing means looking for antibodies. The immune system produces antibodies in response to an infection, and so the presence of antibodies means that at some point there was an infection somewhere with herpes” (Gunter, 2013). However, with something like herpes, most people are unaware they have the infection as most people don’t carry symptoms of it and don’t have reoccurring sores on their lips or genitals, but have what most people refer to as a silent infection (Gunter, 2013). Thus, a blood test would be essential in order to determine what antibodies are present in the blood. Nevertheless, in the possibility of herpes, there is only one reliable type of blood test that can identify herpes antibodies; this test is known as the Type Specific IgG and it can consistently offer distinction between the antibodies that originate from herpes 1 versus herpes 2. This should be ordered for the patient immediately.

As already implied in this paper, five possible conditions that could be causing this outbreak of bumps on the rectum could be: Herpes, HPV, hemorrhoids, perianal hematomas, or change in lifestyle causing irritation (such as a new soap, cleanser or underwear). It’s unlikely to be a perianal hematoma, as that is usually painful as it involves a burst blood vessel; however, these bumps are often confused with hemorrhoids and are caused by straining during bowel movements (Columbia.edu, 2017). The strongest likelihood in this case is that these bumps are just minor skin irritation, as there is no pain or irritation associated with them, however, a full round of the tests recommended is necessary.

References

Columbia.edu. (2017, August 31). Bump on side of anus: Hemorrhoids or something else? | Go Ask Alice! Retrieved from http://goaskalice.columbia.edu/answered-questions/bump-side-anus-hemorrhoids-or-something-else

Gunter, J. (2013, April 16). Understanding blood tests for herpes. Retrieved from https://drjengunter.wordpress.com/2013/01/19/understanding-blood-tests-for-herpes/

Lee, S. R., Chung, J. M., & Kim, Y. G. (2007). Rapid one step detection of pathogenic bacteria in urine with sexually transmitted disease (STD) and prostatitis patient by multiplex PCR assay (mPCR). The Journal of Microbiology, 45(5), 453-459.

Mercola. (2018, May 5). Stages of Herpes That You Should Know About. Retrieved from https://articles.mercola.com/herpes/stages.aspx

Nih.gov. (n.d.). How do health care providers diagnose a sexually transmitted disease (STD) or sexually transmitted infection (STI)? Retrieved from https://www.nichd.nih.gov/health/topics/stds/conditioninfo/diagnosed