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
accompanied by his male husband of 45 years old (B), who states that he had noticed a painless “blister”
on his genital area, but he is not quite sure when it appeared.
Patient A: with no past or family relevant history and NKA
Patient B: PMH of seasonal allergic rhinitis and NKS. No other family or relevant history.
On complete physical examination:
On Patient A: a visible anal fissure in the inferior region of the sphincter was noted. It is also noticed
disseminated papules in the trunk and macules on palms and soles.
Patient B: A visible ulceration in the genital area noted and patient denies pain on palpation. No
adenopathy noted or reported by patient (B).
Since patients are a marital couple, you proceed with serological testing for each patient (A &B) because
you suspect a sexually transmitted disease. Both patients deny having or being treating in the past for
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?
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?