Case description for C-Takes documenting:
Setting: Outpatient.
Specialty: Ob/Gyn. 
Note detail level (1-5): 4.
Level of abbreviation (Low/Medium/High): Medium.

Mrs. X is a 45 y/o G2P2 with LMP of 6Feb10 using BTL for contraception. She presents to the clinic for f/u of labial and perianal abscess for which she was seen last week. Patient was recently traveling in Brazil. Patient arrived in a hotel in Rio on 10Jan which she described as incredibly filthy. Within 2 weeks of arriving she developed an acute throat irritation ("Laryngitis" in her words) that persisted apprx 2 weeks during which time she felt feverish and short of breath with severe general malaise. Appx one month after arriving she noticed a cyst on her labia majora as well as around her anus and enlargement of the inguinal lymph nodes. When asked to hypothesize on what may have caused the infection, she feels it may have been the toilet seat in the hotel room. Cysts came and went as she popped them, some as large as "marbles" and one the size of a "golf ball". Patient saw provider in Rio who performed I&D of labial and perianal abscesses. The primary abscess was drained with approx 4cc of fluid being removed and she returned home to Austin. Today she states that she continues to feel some swelling in the area but it has overall improved. She continues to feel malaise and "not herself". She is currently in 3/10 pain and states that, currently, most of lesions are healed after a course of "something" that they gave her in Rio. Also of note and concern to the patient is a new onset rash in the right axilla as well as medial thigh. She denies any significant medical history or any similar occurences in the past. She reports that she is in a monogamous relationship but is amenable to STI testing. Denies sick contacts. Denies CP, SOB, VB/Discharge, fever/nv.

ROS: General malaise, otherwise unremarkable.
PMHx: Noncontrib.
PSHx: Breast augmentation, BTL.
Meds: Bactrim for abscess (obtained in Rio, read from pill bottle).
Allergies: NKDA.
OB: TSVD x 2, uncomplicated.
Gyn: Denies STIs and abnormal paps, BTL.
FamHx: Noncontrib.

Vit: BP 124/71 HR 70 RR 18 Tc 98.0
PE: Reveals a thin, well developed caucasian woman of stated age in no acute distress. 
Pelvic: Speculum exam: Two lesions on the patients right labia majora and one on the left. All three healing well at this time. No other lesions noted on the exterior. No lesions on the interior. Posterior cervix, medium sized, parous, not friable, no discharge. Palpable inguinal lymph nodes bilaterally approximately the size of large marbles, very prominent. 
CV: No m/r/g, rrr.
Pulm: CTAB.
Abd: Non-distended, symettrical, flat, well toned. Not tender to palpation. Normal bowel sounds auscultated. 
Skin: Silver dollar size erythematous lesions at approx the location of the right axilla as wel as the right medial thigh.

Lab/Ancillary:
Swabbed KOH/Wet prep, Gon/Chlam pending.

A/P:
Genital skin abscess: reveals a 45 y/o G2P2 with LMP appx 2 weeks ago using BTL for contraception with labial and perianal abscess. Abscess appears to be healing well w/o e/o further infection. Pt had concurrent inguinal lymphadenectomy, fever, chills, malaise and laryngitis and was traveling at the time. Considering these findings, will test for HIV, RPR and gc/chlamydia. Pt amenable to being tested for STIs. 1g azithromycin given prophylactic for LGV- if positive will continue with 2 additional weekly doses. Will refer to derm for eval of axillary/thigh skin lesions. Pt is to f/u in one week to review lab results. Return precautions discussed. Pt voiced understanding of plan, all questions answered.

