Physiological Adaptation Q 138
During the initial interview, the client reports that she has a lesion on the perineum. Further investigation reveals a small blister on the vulva that is painful to touch. The nurse is aware that the most likely source of the lesion is:
A. Syphilis
B. Herpes
C. Gonorrhea
D. Condylomata
Correct Answer: B. Herpes
A lesion that is painful is most likely a herpetic lesion. Herpes genitalis can be caused by the herpes simplex virus type 1 or type 2 and manifests as either a primary or recurrent infection. Most commonly, viral replication occurs in epithelial tissue and establishes dormancy in sensory neurons, reactivating periodically as localized recurrent lesions. It remains one of the most common sexually transmitted infections (STI) but continues to be underestimated, given the vague presentation of its symptoms.
Option A: A chancre lesion associated with syphilis is not painful. The classic primary syphilis presentation is a solitary non-tender genital chancre in response to invasion by the T. pallidum. However, patients can have multiple non-genital chancres, such as digits, nipples, tonsils, and oral mucosa. These lesions can occur at any site of direct contact with the infected lesion and are accompanied by tender or nontender lymphadenopathy.
Option C: Gonorrhea does not present as a lesion, but is exhibited by a yellow discharge. Although many females, more than 50%, will not manifest symptoms of their gonococcal cervix infections, most males, more than 90%, will manifest urogenital gonorrhea symptomatically. The most common clinical manifestations of gonococcal disease in males include penile purulent discharge, dysuria, and testicular discomfort.
Option D: Condylomata lesions are painless warts, so answer D is incorrect. Patients will generally be concerned about the appearance of the lesions, as they often cause psychological and psychosexual distress. Condyloma acuminata may also be found incidentally during routine female gynecological examinations.