On pelvic examination, you observe a non-tender, ulcerated, red ...

[laurencescou]

On pelvic examination, you observe a non-tender, ulcerated, red lesion with raised borders on a patient's labia. Her inguinal lymph nodes are enlarged but non-tender.
 
  The patient reports that her partner who is HIV+ has a similar lesion on his penis. The clinician should have a high suspicion of:
  A. Herpes simplex I
  B. Herpes simplex II
  C. Condyloma acuminata
  D. Syphilis

Question 2

A 39-year-old female patient comes to the clinic for a pelvic exam and Pap smear. She reports that her partner is infected with condyloma acuminata. In her history, she always has her partner use a condom.
 
  The external genitalia, vagina, and cervix appear normal on pelvic exam, but the Pap smear shows dysplasia. The patient is worried that she could be infected with HPV. The clinician should:
  A. Assure the patient that safe sexual practices protect against HPV infection
  B. Explain that there is no condyloma present, so HPV infection is improbable
  C. Explain that HPV infection can be transmitted in the presence of barrier contraception
  D. Teach the patient about hysterectomy since she has cervical cancer

[ebenov]

Answer to Question 1

ANS: D
The incidence of syphilis has risen dramatically in the last 30 years with the increase in HIV and other STDs. In syphilis, the primary chancre lesion appears as a firm, indurated, painless papule that erodes into an ulcer with raised or reddened borders. Chances are usually single lesions and can occur on any mucous membrane or skin area. Nontender lymphadenopathy is present in the regional nodes. Genital lesions are most commonly seen in women on the external genitalia. Symptoms may be mild enough to go unnoticed, especially when they are in areas other than the genitalia, and they heal without treatment in 4 to 8 weeks.

Answer to Question 2

ANS: C
There is an increased incidence of cervical cancer in women infected with HPV, with neoplasias being associated with types 16 and 18. Visible manifestations of HPV occur in less than a dozen genotypes, estimated at only 1 of those infected. Of those who develop condylomas, the presentation is variable. Lesions are often very small, even microscopic, and the rugae of the vaginal mucosa may mask the lesion. If dysplasia is seen on the Pap smear, biopsies should be taken to rule out intraepithelial neoplasia because more than 90 of the cervical neoplasias are caused by HPV. Unfortunately, barrier contraceptives offer only limited protection against the spread of HPV infection.