Assessing the Genitalia and Rectum As the patient is sexually active, the bumps on the genitalia could be caused by genital warts or genital herpes, due to the herpes simplex virus. Other differential diagnoses could include contact dermatitis, folliculitis, acne inversa, and Molluscum contagiosum, which is “a viral infection characterized by lesions that can occur anywhere on the body, including the vaginal area” (Leonard, 2017).

Additional information that should be obtained from the exam would include more data about the patient’s personal medical history and whether the patient is undergoing a regular menstrual cycle. The patient’s age is listed as 21 but she is married with three children, plus sexually active with more than one partner in the past year, so there may be more information that is required about this particular set of data regarding personal history. It is important to make sure all information is up to date and accurate before making a diagnosis.

Ball et al. (2017) indicate that the signs demonstrated by the patient do not indicate a clear, definitive pathogenesis of any one symptom, though the bumps on the genitalia are likely due to genital warts or genital herpes. These could be tested, but more information about the last time the patient had sexual intercourse would be needed. This information should be elicited with sensitivity for the patient’s feelings especially if the patient is married and the implication is that the sexual activity occurred outside of marriage. This should, however, not be assumed, as the patient may have not recently engaged in sexual activity outside of marriage in the time leading up to the appearance...

No assumptions should be made and the patient should be allowed to express herself without feeling intimidated, judged, or accused or any sort of indiscretion.
What the symptoms do reveal—particularly the genital warts—are that contact with HPV is likely (Ball et al., 2017). The finding of “vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia” indicates that this is the most like diagnosis.

Additional Subjective Information that Should be Included

· Whether any pain is present when urinating

· Discharge from vagina

· Last sexual encounter

· Knowledge of sexual partner’s sexual history

· Knowledge of sexual partner’s genital disease

· Whether the patient has had genital warts before

· Whether she has experienced fever (a symptom of genital herpes)

· Whether she has pain in genitals or legs

· Whether there is itching

Additional Objective Information that Should be Included

As the “application of 3%–5% acetic acid, which causes skin color to turn white, has been used by some providers to detect HPV-infected genital mucosa” is a way to determine clinically the presence of genital warts (CDC, 2018), this can be one method of obtaining objective information that is still required—i.e., the presence of HPV infected genital mucosa. “However, acetic acid application is not a specific test for HPV infection” and would not…