Chancre Case Study Analysis

Chancre Case Study Analysis: For this assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting…

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Chancre Case Study Analysis

Paper details

Your first assignment is an analysis of a SOAP note. Do not write a SOAP note. Instead, review what is given and focus on answering the questions given to you.

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or why not?
• Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
• A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

For this assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Review the following Episodic note case study:

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Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”

• HPI: AB, a 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 during 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.

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• 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. 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, negMcBurney

• Diagnostics: HSV specimen obtained

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Assessment:

• Chancre

Solution

Chancre Case Study Analysis

Sexually transmitted infections (STIs) are a leading cause of public health concern among young adults, especially those in higher learning institutions. More than 20 million STIs are reported annually in the US alone, 50 % of which the cases are among young individuals aged between 15 and 24 years (Shannon, & Klausner, 2018). Studies approximate that one in every four sexually active females have an STI, the most common being Chlamydia trachomatis (CT). Most importantly, the rate of STIs in the US, just like in most other countries of the world, is on the increase in males and females, a significant portion of who happens to be in various learning institutions.

Therefore, this case study aims to analyze the episodic SOAP notes of patient AB, a 21-year-old who presents to the clinic with a chief complaint of having a painless bump around her genitalia. While prevention instead of treatment remains the most effective method of controlling the spread of sexually transmitted diseases (STIs), early detection and treatment of STIs remain a central healthcare practice to mitigate STIs’ consequences in young adults. One of the core functions of public health practice is controlling communicable diseases in the population as any infectious disease poses a risk to the community due to its virulent nature.

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Subjective

Considering that AB admits to having had an STI in the past and is sexually active, the subjective section of the SOAP note should contain questions that elicit information that would help in the case management and contact tracing of reportable STIs in case the patient is diagnosed with one(Udeagu et al., 2013). As such, the personal notes should include the last time AB became intimate with her partner or partners, their place of residence, and whether any of them has had any health issues whether they could be attributed to an STI or not. Other details include whether her male friend or friends also have other steady partners. AB should also state the type of reproductive health education or counseling that she may have had in the past, either alone or with her partners or peers.

Objective

Besides the review of systems that AB gives, I would take a look at the bump even as I ask her to describe the bumps in her own words in terms of color, sizer, shape, pattern, and the like. At this juncture, the patient should also supply information regarding whether she has had any fevers in the recent past, whether she has been in contact with someone sick, and the specific thing that made her notice the bumps for the first time. Since she noticed the bumps seven days ago, are they permanent, or they come and go. She should also compare the bumps with her Chlamydia episode 2 years earlier.

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Other additional information should be guided by LOCATES (location – you notice the external ones can you tell if any are found internally? O is if other symptoms accompany the chief complaint, C-characteristics of the symptom, for example, do the bumps ulcerate, weep or crust over, have they spread or remained unchanged in size, A- alleviating factors the patient has made to reduce the symptom or any aggravating factors. T- Time of symptom, duration, frequency, and pattern of the symptom, E- Environment where the symptom occurs if applicable, and S- the severity of the symptom on a 10 point scale where 1= hardly any pain and 10 to mean the worst pain ever felt(Podder et al., 2020).

Assessment

Going the patient’s subjective and objective information, both support the assessment of chancre since AB reports to being sexually active, has had more than one sexual partner over the last 12 months while all along she does not own up to using protection during sexual intercourse. She also has a history of sexual infection of Chlamydia 2 years before the current visit, although she completed her medication (Arando et al., 2019). Similarly, the objective assessment noted a small, painless ulcer on her vulva.

Diagnostics

In my considered opinion, the HSV specimen for viral culture would be appropriate as it yields the most specific results between 1 and 7 days (Dains et al., 2015). Other tests would be Tzanck smear, which according to Seller and Symons, 2015 should be extracted from the base of the vesicle is for definitive Herpes Virus. PCR to test for Gonorrhea and Chlamydia with a pelvic exam. ASHA (2016) also notes that serological tests for HSV 2 would also be useful to confirm if the patient has herpes lesions or not. Consider KOH wet mount and PH litmus guided by PE – look for clue cells, increased PH value, and a thin, gray discharge.

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Differential Diagnosis

I would accept the current diagnosis of the chancre, which is a sign of primary syphilis. The three differential diagnoses would be Syphilis, Herpes progentalis simplex II and Herpes Progentalis with asymptomatic chlamydia.

• Syphilis: Use serology to confirm. Based on the patient’s history with STIs and having multiple sexual partners. Penetrative sex could expose the vulva to direct contact with an infected partner leaving the lesion now syphilis sore. The genital ulcers, which are painless, strongly indicate syphilis in its primary stages (da Silva Santos et al., 2017).
• Herpes Progentalis (Simplex II): The likelihood of only limiting this likelihood as superficial vesicles cannot be eroded. The ulcer was reported to be firm. However, HSV-2 is often extended to keep recurring are localized and manifest with more than one lesion (Natu, Iuppa, & Packer, 2017). That the patient does not feel pain, has no burning sensation when urinating makes this the second most likely sensation.
• Herpes Progentalis with Chlamydia that manifests with no symptoms: The fact that chlamydia can have no clinical manifestations and be comorbid with either syphilis or Herpes makes it the third most likely diagnosis (Watts, Greenberg, & Khachemoune, 2016). However, conducting a physical exam could help rule out any cervical or uterine tenderness.

Conclusion

In conclusion, it is essential to acknowledge that STIs remain a leading cause of morbidity among young adults. There is a need to adopt early screening and treatment to address the increased STIs rate in communities. Prevention efforts should also be reinforced using the public health approach where the case is managed, the contact (partner) traced, and both are given treatment, counseled, and educated accordingly. Finally, research should focus on establishing optimal strategies that will enhance the adoption of routine screening, especially among young women, constitute a high-risk group in contemporary societies.

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References

• American Sexual Health Health Association(2016) The Herpes Testing Tool kit- A resource for Healthcare providers.URL: http://publichealth.lacounty.gov/dhsp/You/Herpes_Testing_Toolkit_2016.pdf Accessed on Nov 10th, 2020.
• Arando, M., Fernandez-Naval, C., Mota-Foix, M., Martinez, D., Armengol, P., Barberá, M. J., … & Vall-Mayans, M. (2019). Early syphilis: risk factors and clinical manifestations are focusing on HIV-positive patients. BMC infectious diseases, 19(1), 727.
• da Silva Santos, I., Bastos, D. B., Valente, V. B., D’Avila, S. P., Tjioe, K. C., Biasoli, É. R., … & Bernabé, D. G. (2017). Reemerging syphilis: diagnosis from oral lesions. Journal of Oral Diagnosis, 2(1), 1-5.
• Henao-Martínez, A. F., & Johnson, S. C. (2014). Diagnostic tests for syphilis: new tests and new algorithms. Neurology: Clinical Practice, 4(2), 114-122.
• Natu, A., Iuppa, G., & Packer, C. D. (2017). Herpes simplex virus hepatitis: a presentation of multi-institutional cases to promote early diagnosis and disease management. Case Reports in Hepatology, 2017.
• Podder, V., Lew, V., & Ghassemzadeh, S. (2020). SOAP Notes. StatPearls [Internet].
• Roett, M. A., Mayor, M. T., & Uduhiri, K. A. (2012). Diagnosis and management of genital ulcers. American family physician, 85(3), 254-262.
• Shannon, C. L., & Klausner, J. D. (2018). The growing epidemic of sexually transmitted infections in adolescents: a neglected population. Current opinion in pediatrics, 30(1), 137.
• Udeagu, C. N., Bocour, A., & Ramos, Y. (2013, April). Bringing sexually-transmitted disease (STD) contact tracing into the age of social media and mobile connectivity. In Annual Conference on Youth+ Tech+ Health, YTH Live.
• Watts, P. J., Greenberg, H. L., & Khachemoune, A. (2016). Unusual primary syphilis: Presentation of a likely case with a review of the stages of acquired syphilis, its differential diagnoses, management, and current recommendations. International Journal of Dermatology, 55(7), 714-728.

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