Problem
Feng is a 22 year old Chinese American who identifies as gay male and has had multiple male partners over the two years. He recently graduated from college and has found a position as an engineer in a prestigious firm. He has been experiencing flu-like symptoms for several weeks and upon the urging of his friends, has visited a clinic outside of his community.
HPI
He reports flu like symptoms for several weeks which include general sense of not feeling well, fatigue, body aches, and low energy. He denies chills or fever. He reports a + appetite without nausea/vomiting. He denies any sleep disturbances or insomnia. He has not taken any medication to improve his symptoms.
Medical history: He denies any diseases including asthma, seizures, hypertension, cancers, or heart disease. He is up to date on vaccinations.
Family history: His father has hypertension at age 62; his mother is alive & well at age 57. He has one sister who is 28 and is alive & well.
ROS
Constitutional: Denies weight loss. Reports + fatigue, +malaise.
Pulmonary: Denies shortness of breath or cough.
Cardiovascular: Denies chest pain, irregular heart rate, or palpitations.
Gastrointestinal: Denies anorexia, nausea, vomiting, constipation, and diarrhea.
Neurologic: Denies weakness, numbness, tremor, and neuropathy.
Immune: Denies fever, chills, night sweats. He has a history of chlamydia in 2017.
Skin: Reports a skin lesion near his anus that he noticed yesterday. The lesion is tender.
GU: Denies dysuria, urethral discharge, or scrotal pain. He reports one episode of rectal bleeding yesterday.
Task
1) Based on this information, what differential diagnoses should be considered at this time?
2) What other considerations would you include in the care of this patient?