04-28-2009, 05:33 PM
The correct answer is B. This patient's girlfriend most likely has human papillomavirus (HPV) infection, which is associated with dysplastic changes and cervical cancer. This patient should be evaluated for an HPV infection, and if there are no visible lesions, acetic acid (vinegar) should be applied to the anogenital region to detect the presence of the virus. Invisible lesions typically turn white when acetic acid is applied. This is thought to occur because the acetic acid causes maceration and swelling of virally induced epithelial hyperplasia, which usually has an increased glycogen content and enhanced permeability. Even though this is not specific for HPV and false-positives can occur, it may enhance the detection of an HPV infection.
If no lesions are found when acetic acid is applied, you should advise him to return if he develops any lesions (choice A) and recommend that he use condoms during all sexual activity (choice C). Condoms will probably not completely prevent the spread of infection, but they should theoretically reduce transmission.
Since his sexual partner most likely has an HPV infection and he is sexually active with many partners, syphilis screening may be appropriate, but the VDRL (Venereal Disease Research Laboratory) and RPR (rapid plasma reagin) tests are used for screening, not the FTA-ABS (choice D). The FTA-ABS is more specific, but it is usually not considered a screening test because it is more expensive and remains reactive in patients with a prior, treated syphilis infection.
Taking random biopsies of the penis (choice E) is completely inappropriate, and it will make a patient very unhappy. Acetic acid should be applied to help see invisible lesions and biopsies can be taken from suspicious areas.
Since many patients infected with HPV have no visible signs and symptoms, it is inappropriate to tell him that he is healthy (choice F) before further evaluation (application of acetic acid).
If no lesions are found when acetic acid is applied, you should advise him to return if he develops any lesions (choice A) and recommend that he use condoms during all sexual activity (choice C). Condoms will probably not completely prevent the spread of infection, but they should theoretically reduce transmission.
Since his sexual partner most likely has an HPV infection and he is sexually active with many partners, syphilis screening may be appropriate, but the VDRL (Venereal Disease Research Laboratory) and RPR (rapid plasma reagin) tests are used for screening, not the FTA-ABS (choice D). The FTA-ABS is more specific, but it is usually not considered a screening test because it is more expensive and remains reactive in patients with a prior, treated syphilis infection.
Taking random biopsies of the penis (choice E) is completely inappropriate, and it will make a patient very unhappy. Acetic acid should be applied to help see invisible lesions and biopsies can be taken from suspicious areas.
Since many patients infected with HPV have no visible signs and symptoms, it is inappropriate to tell him that he is healthy (choice F) before further evaluation (application of acetic acid).