Question

A 24-year-old G0 woman presents with multiple painful ulcers involving the vulva. The sores initially were fluid filled, but are now open, weeping and crusted. She reports a fever and is having difficulty voiding due to pain. She uses a vaginal ring for contraception. She has multiple sexual partners and uses condoms for vaginal intercourse. She is distraught that she may have a sexually transmitted infection. She is healthy and does not smoke or use drugs. On physical exam, she is in obvious distress. Temperature is 100.2°F (37.9°C), pulse 100. Examination of the genital tract is limited due to her discomfort. Multiple ulcers and erosions of variable size are localized to the perineum, labia minora and vestibule. Swelling is diffuse. The lesions are eroded, some with a purulent eschar. There is exquisite tenderness to touch. What further testing should be offered to this patient?

A. RPR (rapid plasma regain)
B. HIV
C. Herpes culture
D. Cervical DNA probe for gonorrhea and chlamydia
E. All of the above

Answer 1

The symptoms and sexual history of the 24-year-old patient suggest the possibility of an STI, warranting comprehensive testing including RPR for syphilis, HIV, herpes culture, and probes for gonorrhea and chlamydia. The most inclusive and appropriate option is E. All of the above.

Step-by-step explanation:

The symptoms presented by the 24-year-old patient indicate a possibility of a sexually transmitted infection (STI). The presence of multiple painful ulcers, fever, and difficulty voiding due to pain, as well as the patient's history of multiple sexual partners, point toward an STI such as genital herpes, syphilis, gonorrhea, or chlamydia. With these considerations in mind, further testing that should be offered to this patient includes:

• RPR (rapid plasma regain) for syphilis detection,
• HIV testing due to the increased risk associated with genital lesions,
• Herpes culture to confirm the presence of herpes simplex virus,
• Cervical DNA probe for gonorrhea and chlamydia, given the high prevalence and risk of co-infection with other STIs.

Therefore, the most comprehensive choice would be:

E. All of the above

It is crucial to test for all these possible conditions to ensure the correct diagnosis and treatment plan and to inform the patient about her sexual health and potential risks.