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In the case study, a subjective portion of the note provides a clear picture of the patient’s habitus, complaints, and anamnesis. However, it needs particularization about the last time the patient had unprotected sexual intercourse as it can help indicate the incubation period. The presence of similar skin defects at the patient’s recent sexual partners and the previous existence of similar skin defects on the patient’s skin and mucosae can define the duration of the disease and the episode number. The appearance of spread rash all over the patient’s body can indicate of duration and period of the disease. The intake of any medications, including antibiotics, for the last one month, can affect further diagnostics, tactics, and treatment plans; indicate fixed drug eruption. The patient’s anamnesis lacks gynecological questioning on menstruation details, number of pregnancies and abortions, and pregnancy prophylaxis. It is also significant to specify the patient’s travel history for differential diagnosis of chancroid, lymphogranuloma venereum (LGV), and granuloma inguinale (Afzal, 2020).
The objective notes should primarily include physical examination such as palpation of the lymph nodes because one of the significant signs of primary syphilis is regional lymphadenitis, and secondary syphilis manifests with systemic lymphadenopathy. The assessment of the skin and mucosae in the rectal area, periorbital space, mouth mucosa, examination per vaginam is also needed. Multiple chancres can occur if numerous sexual contacts with the contaminated partner during the recipient’s incubation period happened or if numerous locations of bacteria invasion during one sexual act took place. An attentive examination of oral mucosa can indicate Behçet disease if the ulcers in the mouth are painful and correlate with uveitis, skin lesions, muscular and joint pain, gastrointestinal symptoms.
The diagnostic tests should include tests for syphilis (VDRL together with darkfield microscopy or direct fluorescent antibody test), polymerase chain reaction (PCR) for HSV, DNA amplification tests for chancroid, and LGV (Roett, 2020). The last instanton in diagnostic search, if all previous tests are negative, should be a histological examination of a tissue biopsy searching for Donovan bodies specific for granuloma inguinale (Kang et al., 2019).
The assessment is mostly supported by objective data as tests results are the most trustworthy. A contingent of patients with STDs has peculiarities of providing false data to the doctor, and their anamnesis information should be critically evaluated. Syphilis is an appropriate diagnosis for this case, and test results can be used to confirm or reject it. It is significant to every medical worker to be concerned about syphilis; even though the disease is not spread overall, the impact on all systems and organs of the human body has dramatic consequences. Syphilis is one of the ancient diseases; still, current medicine lacks the alertness on its diagnosing as it may, for instance, mimic other oral manifestations (Dybeck Udd & Lund, 2016). As a differential diagnosis, HSV infection can be reviewed, and the differential search for it will be grouped vesicles on an erythematous background, leaving shallow ulcers (Vestergaard, 2018) afterward. Chancroid, or soft chancre, is caused by Haemophilus ducreyi, is spread in Africa and Asia, has an incubation period from 24 hours up to 15 days, and represents a painful ulcer located unilaterally (Agharbi, 2019).
Lymphogranuloma venereum is caused by L-serovars of chlamydia trachomatis and is spread in endemic regions of Africa, South-Eastern Asia, South, and Central America and manifests with inguinal and anorectal syndromes (Kand et al., 2019). Granuloma inguinale is caused by Klebsiella granulomatis and is endemical for South Africa, India, South China, and Brasilia, and ulcers tend to slowly enlarge and have raised rolled margins (Afzal, 2020). Behçet disease can also be used for differential diagnosis though it is a rare multisystemic disorder engaging several organs into the pathogenic process. The clinical picture is bright with painful and deep oral and genital ulcers, uveitis, and non-obligatory gastrointestinal, muscle, and joint involvement (Davatchi et al., 2017). Syphilis lesions are rarely painful, have a variety of skin elements, especially in the second period, and primary ulcer has a typic induration in the basement (Kang et al., 2019).
References
Afzal, O. (2020). Genital ulcer disease. Obstetrics and Gynecology, 31, 253–257. Web.
Agharbi, F-Z. (2019). Chancroid. Pan African Medical Journal, 33, 1-5. Web.
Davatchi, F., Chams-Davatchi, C., Shams, H., Shahram, F., Nadji, A., Akhlaghi, M., Faezi, T., Ghodsi, Z., Abdollahi, B. S., Ashofteh, F., Mohtasham, N., Kavosi, H., & Masoumi, M. (2017). Behcet’s disease: Epidemiology, clinical manifestations, and diagnosis. Expert Review of Clinical Immunology, 13(1), 57-65. Web.
Dybeck Udd, S., & Lund, B. (2016). Oral syphilis: A reemerging infection prompting clinicians’ alertness. Case Reports in Dentistry, 2016, 1–3. Web.
Kang, S., Amagai, M., Bruckner, A. L., Enk, A. H., Margolis, D. J., McMichael, A. J., & Orringer, J. S. (2019). Fitzpatrick’s dermatology, 9e. McGraw-Hill Education.
Roett, M. A. (2020). Genital ulcers: Differential diagnosis and management. American Family Physician, 101(6), 355-361.
Vestergaard, T. (2018). Genital herpes. Ugeskr Laeger, 180(20), V01180024.
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