Diagnosing HSV

Introduction Patient AB has a history of sexually transmitted infection (STI). She has also had more than one partner in the last twelve months. The last known STI was chlamydia over two years ago. She also has an ulcer on external labia. While the bumps on her genitals are painless, they are a recent event, and says the bumps feel rough. While there several potential diagnoses available, not enough information has been given.

A current blood test to screen for STDs/STIs would be beneficial along with hygiene habits like does she shave regularly. This essay is a thought process of what she could have from the collected information. Subjective Portion of the Note Analysis Patient stated her bumps are rough feeling and painless. She did not say how many sexual partners she has had. All she said was she had more than one in the last twelve months. She also says she reports no abnormal vaginal discharge.

However, additional information to potentially rule out an STI would be if she has painful urination or a burning sensation when she urinates. Additionally, does she have pelvic pain or has had bumps in the past in other areas like the mouth or where she shaves. More information on patient’s personal hygiene habits may provide definitive answers for proper diagnosis. Objective Portion of the Note Analysis Her last pap smear was three years ago.

When a woman is sexually active and has a history of STI, she should get a pap smear annually. “The Pap smear is a screening test for cervical cancer. The American Cancer Society recommends an annual Pap test and pelvic examination for all women who are or who have been sexually active, or who have reached age 18 years” (Weber & Kelley, 2010, p. 457). Although no dysplasia was found, potential abnormalities could occur from STIs caused by unprotected sex like HPV (Weber & Kelley, 2010).

Therefore, it is important for patient AB to schedule another pap smear as well as a full STD screening. Patient also includes occasional drinking of alcoholic beverages and an episiotomy scar from a previous childbirth event. Both parents have a history of hypertension and she is borderline overweight for her height. This could mean she does not make appropriate food or lifestyle choices. It may contribute to discovering what is wrong with her. For example, the ulcer on her labia or the bumps could be a sign of Herpes.

Her lifestyle could contribute to stress that could exacerbate her condition. Stress can be associated with the exacerbation of clinical symptoms of Herpes simplex viruses 1 and 2 (HSV-1 and HSV-2) and “the induction of recurrences in humans and animal models. The viruses preferentially replicate and establish latency in different subtypes of sensory neurons, as well as in neurons of the autonomic nervous system that are highly responsive to stress hormones” (Ives & Bertke, 2017, p. 1).

Patient should reveal eating habits and potential stress indicators to rule out also hormonal imbalance from high cortisol (Ragnarsson, Trimpou, Oleröd, & Landin-Wilhelmsen, 2016). Assessment: Objective or Subjective Supported? The assessment regarding the various diagnoses is supported more by objective information. This has to do with lack of details from patient regarding sexual history and personal hygiene habits. Without giving a definitive answer towards these two subjects, patient has not provided enough information to determine outcome.

The objective data shows an ulcer on her external labia and that she had chlamydia before. This could point towards an STI. Is Diagnostics Necessary? Yes. There are several key details missing from patient information and some questions remaining. Therefore, getting a more detailed patient history as well as some additional blood tests could prove useful in getting an accurate diagnosis. Agree with the Diagnosis? Some diagnostics was recommended like HSV specimen. Therefore, the potential diagnosis is Herpes Simplex Virus (HSV). I do not agree with this diagnosis.

It could be razor bumps. Considering the bumps are rough and painless, it may not be STI/STD related. One possible condition as a differential diagnosis is folliculitis. It is frequently caused by yeast/bacteria at the base of the vulva’s hair follicle (Eichenfield, Frieden, Zaenglein, & Mathes, 2014). Although the bumps were not described as inflamed, they are rough feeling. Another possible condition is clogged sweat glands. Tiny blister-like bumps that ooze fluid and itch could develop from the condition called hidradenitis supprativa (Micali, 2017).

While patient AB stated the bumps did not hurt, she has not stated if she has scratched them. It could early stages of the condition. The last differential diagnosis is sebaceous cysts. They are blocked glands, resembling big pimples. While they frequently are painful. Sometimes they can be painless (Ammer, 2009). “A slow-growing tumor of the skin, frequently found on the scalp, ears, face, back, scrotum, vulva, or breasts. It rarely causes discomfort unless it becomes infected” (Ammer, 2009, p. 130).

This can be a potential diagnosis because of the cyst on her external labia. It.