Any lesion should be reported to the doctor. This can indicate a herpes lesion. Clients with open lesions related to herpes are delivered by Cesarean section because there is a possibility of transmission of the infection to the fetus with direct contact to lesions. During pregnancy there is a higher risk of perinatal transmission with primary HSV infection than with recurrent infection. If a primary HSV outbreak is diagnosed in pregnancy, oral antiviral treatment may be administered to help reduce the duration and severity of symptoms and viral shedding.

Option A: It is not enough to document the finding. Viral or serologic testing should be performed to confirm suspected HSV infections; the basic groups of tests used are viral and antibody detection techniques. For viral detection, the primary testing techniques are viral culture and HSV antigen detection by polymerase chain reaction.
Option C: The physician must make the decision to perform a C-section. Cesarean delivery is recommended to prevent perinatal HSV transmission in women with active genital lesions or prodromal symptoms, but it is not recommended for women with HSV lesions found only on nongenital areas, such as the back, thigh, or buttock.
Option D: It is not enough to continue primary care. Antiviral agents commonly used to treat HSV infections are acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex), which are all U.S. Food and Drug Administration pregnancy category B medications. For patients with more severe HSV infection, oral treatment can be used for more than 10 days if the lesions have not healed completely.

The client with HPV is at higher risk for cervical and vaginal cancer related to this STI. The Human Papillomavirus (HPV) is the initiating force behind multiple epithelial lesions and cancers, predominantly of cutaneous and mucosal surfaces. Today, HPV has been implicated as a cause of laryngeal, oral, lung and anogenital cancer. Subtypes 6 and 11 are low risk and usually present with the formation of condylomata and low-grade precancerous lesions. HPV subtypes 16 and 18 are high risk and are responsible for high-grade intraepithelial lesions that progress to malignancies.

Option A: It is important to understand that HPV alone does not cause cancer but requires triggers like smoking, folate deficiency, exposure to UV light, immunosuppression, and pregnancy. Long-term follow-up is essential as recurrence of warts is common. In addition, all treatments for warts have side effects that need to be monitored.
Option C: The prognosis after an HPV infection is good but recurrences are common. Even though there are many treatments for warts, none works well and most patients require repeated treatments. The HPV infection can also result in vulvar intraepithelial dysplasia, cervical dysplasia, and cervical cancer.
Option D: Some women remain at high risk for developing vaginal and anal cancer. The risk of malignant transformation is highest in immunocompromised individuals. Finally, when a patient has been diagnosed with HPV infection, there is a 5-20% risk of also having other STDs like gonorrhea and/or chlamydia.

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.

Fluorescent treponemal antibody (FTA) is the test for treponema pallidum. The fluorescent treponemal antibody absorption (FTA-ABS) test is a blood test that checks for the presence of antibodies to Treponema pallidum bacteria. These bacteria cause syphilis. Syphilis is a sexually transmitted infection (STI) that’s spread through direct contact with syphilitic sores.

Option A: The venereal disease research laboratory (VDRL) test is designed to assess whether you have syphilis, a sexually transmitted infection (STI). Syphilis is caused by the bacterium Treponema pallidum. The bacterium infects by penetrating into the lining of the mouth or genital area. The VDRL test doesn’t look for the bacteria that cause syphilis. Instead, it checks for the antibodies your body makes in response to antigens produced by cells damaged by the bacteria. Antibodies are a type of protein produced by your immune system to fight off invaders like bacteria or toxins. Testing for these antibodies can let your doctors know whether you have syphilis.
Option B: The rapid plasma reagin (RPR) test is a blood test that looks for antibodies to syphilis. Syphilis is a sexually transmitted infection (STI) that first causes symptoms seen with many other illnesses. Early symptoms include rash, fever, swollen glands, muscle aches, and sore throat. The RPR test looks for antibodies that react to syphilis in the blood. This means the test doesn’t detect the actual bacteria that cause syphilis. Instead, it looks for antibodies against substances given off by cells that have been harmed by the bacteria.
Option D: The Thayer-Martin culture is done for gonorrhea. It is used for culturing and primarily isolating pathogenic Neisseria bacteria, including Neisseria gonorrhoeae and Neisseria meningitidis, as the medium inhibits the growth of most other microorganisms.

The criteria for HELLP is hemolysis, elevated liver enzymes, and low platelet count. The syndrome of hemolysis, elevated liver enzymes, and low platelets, otherwise referred to as HELLP syndrome, has historically been classified as a complication or progression of severe preeclampsia. Genetic analysis of the inheritability of predisposition for preeclampsia and/or HELLP syndrome in pregnancy has also been explored. Results show both genetic and immunological factors that play a role in pathogenesis.

Option A: An elevated blood glucose level is not associated with HELLP. One of the features of HELLP syndrome is microangiopathic hemolytic anemia. Schistocytes or helmet cells, present on a peripheral blood smear is diagnostic of microangiopathic hemolytic anemia, making peripheral smears useful in the workup for HELLP syndrome.
Option B: Platelets are decreased, not elevated, in HELLP syndrome. The coagulation cascade is activated by adhesion of platelets on the activated and damaged endothelium. Platelets release thromboxane A and serotonin, causing vasospasm, platelet aggregation, and further endothelial damage. The cascade only terminates with the delivery of the fetus. This causes the usage of platelets and hence, thrombocytopenia.
Option C: The creatinine levels are elevated in renal disease and are not associated with HELLP syndrome. In the liver, intravascular fibrin deposits give rise to sinusoidal obstruction, intrahepatic vascular congestion, increased hepatic pressures leading to hepatic necrosis. This may eventually result in intraparenchymal or subcapsular hemorrhage and capsular rupture.