Cases Studies 3 & 4 – Primary Care
A 47-year-old male patient (A) presents to your office c/o painful and bleeding defecation that started a
couple of days ago. Pt also states that he noticed some intermittent pruritus on his back. Pt comes to
your consultation accompanied by his male husband of 45 years old (Patient B), who suddenly states to
you that he had noticed a painless “blister” on his genital area, but he is not quite sure when it
Patient A: With no past or family relevant history and with no known allergies (NKA).
Patient B: With a PMH of seasonal allergic rhinitis and NKA. No other family or relevant history.
On complete physical examination of both patients your assessment reveals the following findings:
On Patient A: You noticed a visible anal fissure in the inferior region of the anal sphincter. Besides, you
also noticed disseminated papules in the trunk and macules on palms and soles (as shown below).
Patient B: On examination, you noticed a visible ulceration in the genital area, and patient denies any
pain on palpation. On general assessment, no adenopathy noted or reported by patient (B).
Since both patients are a marital couple, you proceed with serological testing for each patient (A & B).
You suspect a sexually transmitted disease. On your verbal assessment, both patients (A&B) deny having
or being treating in the past for STD’s in the past, to which you believe.
Patient A: Leukocytosis - Treponema (Positive) – Non-Treponema (Positive) – HIV (Negative) – Hepatitis
Patient B: Treponema (Positive) – Non-treponema (Negative) – HIV (negative) – Hepatitis (Negative)
--------------------- Do not include the above section in your paper. ONLY THE QUESTIONS BELOW-------
Please answer the following questions in APA format and include in-text references.
1) What serological lab works would you order to obtain the above results? (Be specific with the lab
2) What is the diagnosis for Patient A?
3) What is the diagnosis for Patient B?
4) What would it be the differential diagnosis for patient A and patient B? (be specific. Your diagnosis
contains stages. Therefore, be specific on them)
5) How are you going to treat Patient A? (Be specific and include the time of treatment)
6) How are you going to treat Patient B? (Be specific and include the time of treatment)
7) What would be the possible cause of this infection if both patients did not have any sexual encounter
outside their relationship in the last year? Again, you believe both patients did not have any sexual
encounter outside their marital sexual relationship.