WK10 NURS 6512 ASSIGN
Assignment: Lab Assignment: Assessing the Genitalia and Rectum
Patients are frequently uncomfortable discussing with healthcare professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.
In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.
To Prepare
- Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.
- Based on the Episodic note case study:
- Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
- Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
- Consider what history would be necessary to collect from the patient in the case study.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Lab Assignment
Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.
- Analyze the subjective portion of the note. List additional information that should be included in the documentation.
- Analyze the objective portion of the note. List additional information that should be included in the documentation.
- Is the assessment supported by the subjective and objective information? Why or why not?
- Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
- Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.
1- Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
2- Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
3- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
4-Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.
- Analyze the subjective portion of the note. List additional information that should be included in the documentation.
- Analyze the objective portion of the note. List additional information that should be included in the documentation.
- Is the assessment supported by the subjective and objective information? Why or why not?
- Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
- Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
Post the assignment By Day 7 of Week 10. Follow the rubric! We grade by the rubric!
GENITALIA ASSESSMENT
Subjective:
- CC: “I have bumps on my bottom that I want to have checked out.”
- HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
- PMH: Asthma
- Medications: Symbicort 160/4.5mcg
- Allergies: NKDA
- FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
- Social: Denies tobacco use; occasional ETOH married, 3 children (1 girl, 2 boys)
Objective:
- VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
- Heart: RRR, no murmurs
- Lungs: CTA, chest wall symmetrical
- Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia.
- Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney
- Diagnostics: HSV specimen obtained
Assessment:
- Chancre
Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 17, “Breasts and Axillae”
This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.
Chapter 19, “Female Genitalia”
In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.
Chapter 20, “Male Genitalia”
The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.
Chapter 21, “Anus, Rectum, and Prostate”
This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 5, “Amenorrhea”
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.
Chapter 6, “Breast Lumps and Nipple Discharge”
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.
Chapter 7, “Breast Pain”
Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.
Chapter 27, “Penile Discharge”
The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.
Chapter 36, “Vaginal Bleeding”
In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.
Chapter 37, “Vaginal Discharge and Itching”
This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
Chapter 3, “SOAP Notes” (Previously read in Week 8)
This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.
Centers for Disease Control and Prevention. (2019). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#
This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)
Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions.
Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)
In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.
Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)
The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.
Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)
Required Media (click to expand/reduce)
Special Examinations – Breast, Genital, Prostate, and Rectal – Week 10 (14m)
Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript
Online media for Seidel’s Guide to Physical Examination
It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NURS_6512_Week_10_Assignment_Rubric
ExcellentGoodFairPoorWith regard to the SOAP note case study provided and using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature:
· Analyze the subjective portion of the note. List additional information that should be included in the documentation.10 (10%) – 12 (12%)The response clearly, accurately, and thoroughly analyzes the subjective portion of the SOAP note and lists detailed additional information to be included in the documentation.7 (7%) – 9 (9%)The response accurately analyzes the subjective portion of the SOAP note and lists additional information to be included in the documentation.4 (4%) – 6 (6%)The response vaguely analyzes the subjective portion of the SOAP note and vaguely and/or inaccurately lists additional information to be included in the documentation.0 (0%) – 3 (3%)The response inaccurately analyzes the subjective portion of the SOAP note, with inaccurate and/or missing additional information included in the documentation.· Analyze the objective portion of the note. List additional information that should be included in the documentation.10 (10%) – 12 (12%)The response clearly, accurately, and thoroughly analyzes the objective portion of the SOAP note and lists detailed additional information to be included in the documentation.7 (7%) – 9 (9%)The response accurately analyzes the objective portion of the SOAP note and lists additional information to be included in the documentation.4 (4%) – 6 (6%)The response vaguely analyzes the objective portion of the SOAP note and vaguely and/or inaccurately lists additional information to be included in the documentation.0 (0%) – 3 (3%)The response inaccurately analyzes the objective portion of the SOAP note, with inaccurate and/or missing additional information included in the documentation.· Is the assessment supported by the subjective and objective information? Why or why not?14 (14%) – 16 (16%)The response clearly and accurately identifies whether or not the assessment is supported by the subjective and/or objective information, with a thorough and detailed explanation.11 (11%) – 13 (13%)The response accurately identifies whether or not the assessment is supported by the subjective and/or objective information, with a clear explanation.8 (8%) – 10 (10%)The response vaguely identifies whether or not the assessment is supported by the subjective and/or objective information, with a vague explanation.0 (0%) – 7 (7%)The response inaccurately identifies whether or not the assessment is supported by the subjective and/or objective information, with an inaccurate or missing explanation.· What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?18 (18%) – 20 (20%)The response thoroughly and accurately describes appropriate diagnostic tests for the case and explains clearly, thoroughly, and accurately how the test results would be used to make a diagnosis.15 (15%) – 17 (17%)The response accurately describes appropriate diagnostic tests for the case and explains how the test results would be used to make a diagnosis.12 (12%) – 14 (14%)The response vaguely and/or with some inaccuracy describes appropriate diagnostic tests for the case and vaguely and/or with some inaccuracy explains how the test results would be used to make a diagnosis.0 (0%) – 11 (11%)The response inaccurately describes appropriate diagnostic tests for the case, with an inaccurate or missing explanation of how the test results would be used to make a diagnosis.· Would you reject or accept the current diagnosis? Why or why not?
· Identify three possible conditions that may be considered as a differenial diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.23 (23%) – 25 (25%)The response states clearly whether to accept or reject the current diagnosis, with a thorough, accurate, and detailed explanation of sound reasoning. The response clearly, thoroughly, and accurately identifies three conditions as a differential diagnosis, with reasoning that is explained clearly, accurately, and thoroughly using three or more different references from current evidence-based literature.20 (20%) – 22 (22%)The response states whether to accept or reject the current diagnosis, with an accurate explanation of sound reasoning. The response accurately identifies three conditions as a differential diagnosis, with reasoning that is explained using three different references from current evidence-based literature.17 (17%) – 19 (19%)The response states whether to accept or reject the current diagnosis, with a vague explanation of the reasoning. The response identifies two to three conditions as a differential diagnosis, with reasoning that is explained vaguely and/or inaccurately using three or fewer references from current evidence-based literature.0 (0%) – 16 (16%)The response inaccurately states or is missing a statement of whether to accept or reject the current diagnosis, with an explanation that is inaccurate and/or missing. The response identifies three or fewer conditions as a differential diagnosis, with reasoning that is missing or explained inaccurately using two or fewer references from current evidence-based literature.Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.5 (5%) – 5 (5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.4 (4%) – 4 (4%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.3 (3%) – 3 (3%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.0 (0%) – 2 (2%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation5 (5%) – 5 (5%)Uses correct grammar, spelling, and punctuation with no errors.4 (4%) – 4 (4%)Contains a few (1 or 2) grammar, spelling, and punctuation errors.3 (3%) – 3 (3%)Contains several (3 or 4) grammar, spelling, and punctuation errors.0 (0%) – 2 (2%)Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.5 (5%) – 5 (5%)Uses correct APA format with no errors.4 (4%) – 4 (4%)Contains a few (1 or 2) APA format errors.3 (3%) – 3 (3%)Contains several (3 or 4) APA format errors.0 (0%) – 2 (2%)Contains many (≥ 5) APA format errors. Total Points: 100
Name: NURS_6512_Week_10_Assignment_Rubric
Patient Initials: AB Age: 21 Gender: Female
SUBJECTIVE DATA:
Chief Complaint (CC): External bumps in genital area.
History of Present Illness (HPI): AB, a 21-year-old white female presents to the clinic today with the complaints of external bumps to her genital area for unknown time. The patient has noticed the painless but rough to touch bumps about a week ago. She is sexually active since she was 18-year-old and had sex with more than one sexual partner the past year. Her last pap smear exam was 3 years ago with normal exam results. However, she reports that she previously was infected with chlamydia about 2 years ago with completed treatment. She denies abnormal vaginal discharge. The patient did not treat the bumps prior to coming to the clinic today.
Medications: Symbicort 160/4.5mcg
Allergies: No Known Drug Allergies
Past Medical History (PMH): Asthma
Past Surgical History (PSH): N/A
Sexual/Reproductive History: positive for chlamydia once
Personal/Social History: Denies tobacco use. Occasional alcohol use. Lives with spouse and three children (1 girl and 2 boys) in a single-family home in a suburban area. Patient is currently unemployed but attends business online school.
Immunization History: N/A
Significant Family History: No family history of breast or cervical cancer. Father: HTN, Mother: HTN, GERD
Lifestyle: N/A
Review of Systems: Heart: RRR, no murmurs Lungs: CTA, chest wall symmetrical
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Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney Diagnostics: HSV specimen obtained
OBJECTIVE DATA:
Physical Exam: VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs Heart: RRR, no murmurs Lungs: CTA, chest wall symmetrical Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney Diagnostics: HSV specimen obtained
ASSESSMENT: Primary Diagnosis:
Syphilis: Chancre Differential Diagnoses:
Chlamydia, Human Papilloma Virus, Herpes Simplex Virus, Gonorrhea, Contact Dermatitis
Additional Subjective Information
The subjective information is missing any detailed information about the patient’s sexual
practices and current use of contraceptives which is imperative to assess risk factors for
certain sexual-transmitted diseases. Providers should also interview the patient on
potential allergies and irritants. More subjective information is also needed on the
patient’s lifestyle choices and sexual/reproductive history to get a clearer picture of the
patient’s medical history to avoid ordering unnecessary tests.
Additional Objective Information
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The objective data should contain details about the review of each body system in order
to appropriate diagnose a patient and to rule out potential differential diagnosis. It is
important to know a patient’s general health state, to assess the lymph nodes for
swelling, throat and mouth for any other sores and lesions. The provider should assess
the patient’s respiratory system more detailed since there is a history of asthma.
Healthcare providers should also assess the patients bowl and bladder habits for any
changes or symptoms.
Assessment Support
The objective and subjective assessment has supported the provider to make the
primary diagnosis. However, the provider should include a head-to-toe assessment and
gather more details on the patient’s sexual history and practices to rule out differential
diagnoses. Also, the provider should be more precise about the genital lesions including
information about the borders, color, and size.
Current Diagnosis and Differential Diagnoses
The current diagnosis of the patient scenario is chancre. Chancre is also known
as the medical condition of a painless lesion or sore commonly found in the genital
area. With the patient’s current symptoms, risk factors, and unsafe sexually practices
this diagnosis may be warranted. However, a healthcare professional will need more
details and diagnostics done to confirm the primary diagnosis.
Chlamydia: The patient has a history of chlamydia which raises the highest
suspicion for reinfection of chlamydia along with the risk factors of being 21 years old,
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having more than one sexual partner, and not using barrier methods of contraception
(Dains, Baumann & Scheibel, 2016). Chlamydia can be asymptomatic but vaginal
discharge or bleeding may be another indicator in the later stages of the disease
(Centers for Disease Control and Prevention, 2017). However, chlamydia is not
associated with genital lesions but a chlamydia infection with syphilis infection is
possible.
Human Papilloma Virus (HPV): Genital warts are very commonly caused by the
human papillomavirus. Patients usually have few symptoms unless lesions become
larger, patients may experience bleeding, discharge, itching, and pain (Dains, Baumann
& Scheibel, 2016).
Herpes simplex virus infection: Genital herpes is a common sexually transmitted
disease. Affected patients often do not experience any symptoms or very mild
symptoms. Herpes sores appear as one or more blisters on or around the genital,
rectum, or mouth which are often mistaken as ingrowing hair or pimples (Center for
Disease Control and Prevention, 2017).
Gonorrhea: Patients with this sexually-transmitted disease experience purulent
discharge, dysuria, and pain during urination, painful intercourse and/or abdominal pain
(Mayo Clinic, 2018). More detailed sexual history and symptoms must be detected in
the health interview to determine if the patient is at risk for this type of STD.
Contact Dermatitis: A genital rash is referred to a spread of lesions or bumps.
Symptoms may include sores, bumps, blister, and lesions, irritation or inflammation,
itching or burning, discharge genitals, and pelvic pain (Ball, Baumann & Scheibel,
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2016). Furthermore, allergic irritants such lubricants and condoms may cause to
develop genital lesions.
Diagnostic Testing
The case study reveals that only a Herpes Simplex Virus sample was obtained.
To confirm the primary diagnosis, healthcare providers must collect a syphilis serologic
blood test to confirm the presence of antibodies. The diagnostic of syphilis also includes
a detailed health assessment interview including the onset of the chancre and the
examination of the chancre. It is common in syphilis to experience painless ulcerations
in the anogenital area which typically appears 9 to 90 days after exposure (Epocrates,
2018). Gonorrhea is detected with a recommended (Epocrates, 2018). Nucleic acid
amplification test (NAAT) Since the sexual history reveals multiple sexual partners and
no barrier protection, healthcare providers may want to utilize a speculum exam of the
cervix and vagina while collecting a clinician vaginal and endocervical swab along with a
urine sample to detect gonorrhea. Genital herpes can be detected with an HSV test
which was already obtained. Furthermore, type-specific serologic testing may be the
best diagnostic approach to detect HSV (Epocrates, 2018). To confirm a human
papilloma virus infection provider will collect a pap smear sample and DNA test for
laboratory testing (Mayo Clinic, 2018). Acute genital dermatitis is manifested by itching,
genital redness, and burning sensation. Diagnosis is made by history, physical exam,
and patch testing to detect irritants and contact sensitivity such as reaction to latex
condoms (Ljubojević et al., 2009).
References
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Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s
guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Center for Disease Control and Prevention. (2017). Chlamydia – CDC Fact Sheet.
Retrieved from https://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm
Centers for Disease Control and Prevention. (2017). Genital Herpes – CDC Fact Sheet.
Retrieved from https://www.cdc.gov/std/herpes/stdfact-herpes.htm
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and
clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Epocrates Online. (2018). Gonorrhea Infection – Diagnostic Approach. Retrieved from
https://online.epocrates.com/diseases/5131/Gonorrhea-infection/Diagnostic-
Approach
Epocrates Online. (2018). Chlamydia Infection – Diagnostic Approach. Retrieved from
https://online.epocrates.com/diseases/5231/Genital-tract-chlamydia-
infection/Diagnostic-Approach
Epocrates Online. (2018). Syphilis Infection – Diagnostic Approach. Retrieved from
https://online.epocrates.com/diseases/5031/Syphilis-infection/Diagnostic-
Approach
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Ljubojević, S., Lipozencić, J., Celić, D. & Turcić, P. (2009). Genital contact allergy. Acta
Dermatovenerol Croatia (ADC), 17 (4), 285-8. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/20021983
Mayo Clinic. (2018). HPV Infection. Retrieved from
https://www.mayoclinic.org/diseases-conditions/hpv-infection/diagnosis-
treatment/drc-20351602
Mayo Clinic. (2018). Gonorrhea. Retrieved from https://www.mayoclinic.org/diseases-
conditions/gonorrhea/symptoms-causes/syc-20351774
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