7 - STD's

Question 1

What is the most common STD in Western countries?

Answer 1

Chlamydia trachomatis (CT) is 3-5 x more common than gonorrhea

Question 2

True or False: GC (gonorrhea), CT, and syphilis all have routes of transmission that include both sexual contact and perinatal.

Answer 2

true

Question 3

CT usually manifests as what 3 problems in men?

Answer 3

1) urethritis
2) proctitis
3) epididymitis
(true for GC as well)

Question 4

CT usually manifests as what 5 problems in women?

Answer 4

1) urethritis
2) endocervicitis
3) proctitis
4) PID
5) perihepatitis (shoe string adhesions)
(true for GC as well)

Question 5

What tests will you typically run to dx CT?

Answer 5

1) clinical exam (yellow discharge)

2) PCR/NAAT

Question 6

What is the drug of choice to tx CT?

Answer 6

Azithromycin 1000mg single dose

Question 7

If your patient comes to you for a severe sore throat that seems to be resistant to treatment, what might you want to consider?

Answer 7

gonorrhea (GC)

Question 8

What should you consider in your DDx for joint infections that occur in sexually active patients?

Answer 8

disseminated gonorrhea

Question 9

Disseminated gonorrhea can commonly present as arthritis or ________________

Answer 9

dermatitis

Question 10

How will you dx GC?

Answer 10

1) clinical exam

2) PCR/NAAT

Question 11

What is the treatment of choice for gonorrhea?

Answer 11

Ceftriaxone + Azithromycin

Question 12

If GC goes untreated, what are the long term consequences?

Answer 12

infertility, ectopic, chronic pelvic pain

Question 13

What STD has the highest prevalence in urban blacks and Hispanics and includes primary, secondary, latent, and tertiary stages?

Answer 13

syphilis

Question 14

What is the pathogen responsible for syphilis?

Answer 14

treponema pallidum

Question 15

What is the screening lab test for syphilis?

Answer 15

VDRL or RPR (basically same thing)

and retest after 6 mo to get baseline

Question 16

What is characteristic of primary syphilis?

Answer 16

painless chancre (genitalia or cervix)

Question 17

What is characteristic of secondary syphilis?

Answer 17

condyloma latum, flat plaques

Question 18

What is characteristic of late/tertiary syphilis?

Answer 18

destructive gummas, aortic valve problems and CNS manifestations

Question 19

What are the CNS manifestations of tertiary syphilis?

Answer 19

dementia, foot slapping (tabes dorsalis), pupil abnormalities (Argyle Robertson)

Question 20

In what stage of syphilis is a diagnosis usually made?

Answer 20

Latent stage as part of a screening test.

Question 21

How can syphilis affect a fetus?

Answer 21

1) death
2) growth restriction
3) multiple anomalies which can be immediately apparent at birth or delayed

Question 22

What is the tx of choice for syphilis?

Answer 22

1) PCN!! Especially when pregnant

2) Doxy, Tetra, Cetriaxone also used…but if patient is pregnant USE PCN, even in presence of an allergy.

Question 23

True or False: You cannot get HSV 2 on/around the mouth, as it is the genital strain of herpes.

Answer 23

False. Both types can occur and be transmitted at both oral and genital sites

Question 24

How do you dx HSV?

Answer 24

1) clinical exam

2) PCR

Question 25

If you need to collect a specimen from a lesion you suspect is HSV, what kind of lesion would yield the best test results?

Answer 25

a vesicular lesion with clear fluid, once “unroofed” will be most virulent.

(start as raised red bumps, then vesicular, then pustular, then ulcers, finally scabs)

Question 26

How can you tell the difference between HSV and primary syphilis?

Answer 26

HSV is painful and syphilis chancre is not

Question 27

What is the drug of choice for HSV?

Answer 27

Acyclovir (or Valacyclovir…but more expensive)

Question 28

Can women with active HSV lesions proceed with a vaginal birth?

Answer 28

No. C-section

Question 29

Which of the following STD’s cannot use the PCR as a diagnostic test?

a) chlamydia
b) gonorrhea
c) syphilis
d) HSV

Answer 29

c) syphilis – VCRL/RPR

Question 30

Azithromycin alone is used to treat ___________

Answer 30

chlamydia

Question 31

Penicillin is used to treat _____________-

Answer 31

syphilis

Question 32

Acyclovir is used to treat ______________

Answer 32

HSV

Question 33

Azithromycin and _____________ are used to treat gonorrhea

Answer 33

ceftriaxone IM