Instruction
Maria is a 46-year-old Hispanic female who comes to your clinic complaining of a lesion in her
vaginal area that she recently noticed while bathing. Maria came to the U.S. from Mexico over
10 years ago but her husband was not able to join her until just two months ago. Maria reports
she abstained from sexual activity during the years she was separated from her husband and is
not aware of any sexual activity on the part of her husband. Maria and her husband have been
sexually active since his arrival in the U.S. two months ago. Maria reports she has not been to a
health care provider while in the United States because she has no insurance coverage. She
has no medical records and has not had any screenings or well-woman exam visits for over a
decade. Maria has three healthy, grown children all delivered vaginally without pregnancy or
delivery complications. Her mother is 62, lives in Mexico, and suffers from diabetes and
hypertension. Her father died from colon cancer at age 55. Maria’s LMP was one week ago
and all of her VS are WNL. Upon PE, you note a lesion on the left labia minora that has the
appearance of a chancre and you note that it is not painful to Maria when touched.
1. What are your presumptive and differential diagnoses?
2. What screening and/or diagnostic tests will you perform/order to ascertain the correct
diagnosis and what current screenings will you recommend in adherence to evidencebased guidelines?
3. What is the pathophysiology? Describe all stages, modes of transmission, any
incubation periods.
4. What are the evidence-based treatment guidelines for this diagnosis?
5. How will you explain this diagnosis and plan of care to Maria?