Chapter 27: Sexually Transmitted Infections

Question 1

What unique factor causes adolescent girls to have a high risk for sexually transmitted
infections (STIs)?
a. They are in an experimental phase with sexual intercourse and believe they are
resistant to developing STIs.
b. The adolescent cervix is immature and lacks immunity.
c. The length of the vaginal canal is short in adolescents, allowing a greater
concentration of microorganisms within the internal genitalia.
d. In adolescent girls, the anus to the vaginal introitus are in close proximity.

Answer 1

ANS: B
Partly, perhaps, because of risk-taking behavior (unprotected intercourse or selection of
high-risk partners), many adolescents have an increased risk for STI exposure and
infection. The unique factor for adolescent women is that they have a physiologically
increased susceptibility to infection because of increased cervical immaturity and lack of
immunity. The remaining options are not considered legitimate risk factors for STIs.
PTS: 1 REF: Pages 918-919

Question 2

How is gonorrhea transmitted from a pregnant woman to her fetus?
a. Unbound in the blood via the placenta
b. Attached to immunoglobulin G (IgG) via the placenta
c. Across amniotic membranes by the direct inoculation with the fetal scalp
electrodes during labor monitoring
d. Predominately through infected cervical and secretions during the birth process

Answer 2

ANS: D
A pregnant woman can transmit gonorrhea to her fetus during the birth process. The
infection passes from mother to child predominately through infected cervical and vaginal
secretions. The transmission is not associated with the other options.
PTS: 1 REF: Page 920

Question 3

Which statement is false about the factors that facilitate the ascent of gonococci into the
uterus and fallopian tubes?
a. Ascent of gonococci is facilitated because the cervical plug disintegrates during
menstruation.
b. Ascent of gonococci is facilitated because the vaginal pH decreases to 2 or 3.
c. Ascent of gonococci is facilitated because the uterine contractions may cause
retrograde menstruation into the fallopian tubes.
d. Ascent of gonococci is facilitated because the bacteria may adhere to sperm and be
transported to the fallopian tubes.

Answer 3

ANS: B
Several factors can facilitate the ascent of gonococci into the uterus and the fallopian
tubes, where they cause pelvic inflammatory disease (PID). Among these factors are (1)
disintegration of the cervical mucous plug and (2) a rise in vaginal pH greater than 4.5
during menstruation. The other options are accurate statements.
PTS: 1 REF: Page 921

Question 4

In women, what is the usual site of original gonococcal infection?

a. Endocervical canal
c. Fallopian tube
b. Vagina
d. Labia major

Answer 4

ANS: A
In women, the endocervical canal (inner portion of the cervix) is the usual site of original
gonococcal infection, although urethral colonization and infection of Skene or Bartholin
glands also are common. The other options are not usually associated with gonococcal
infections.
PTS: 1 REF: Page 921

Question 5

What is the primary site for uncomplicated local gonococci infections in men?

a. Epididymis
c. Urethra
b. Lymph nodes
d. Prostate

Answer 5

ANS: C
Uncomplicated local infections are observed primarily as urethral infections in men.
PTS: 1 REF: Page 921

Question 6

What local complication of a gonococcal infection is diagnosed in approximately 10% of
affected women?
a. Acute salpingitis 
c. Vaginitis
b. Cystitis 
d. Cervicitis

Answer 6

ANS: A
Acute salpingitis, or pelvic inflammatory disease (PID), is the most common local
complication in women. Approximately 10% of women with untreated cervical gonorrhea
develop PID.
PTS: 1 REF: Page 921

Question 7

Which laboratory test is considered adequate for an accurate and reliable diagnosis of
gonococcal urethritis in a symptomatic man?
a. Ligase chain reaction (LCR)
c. Polymerase chain reaction (PCR)
b. Gram-stain technique
d. DNA testing

Answer 7

ANS: B
Microscopic evaluation of Gram-stained slides of clinical specimens is deemed positive
for Neisseria gonorrhoeae if gram-negative diplococci with the typical “kidney bean”
morphologic appearance are found inside polymorphonuclear leukocytes. Such a finding is
considered adequate for the diagnosis of gonococcal urethritis in a symptomatic man. The
other options are not relevant to the diagnosis of this condition.

Question 8

How does an established gonococcal infection usually express itself in newborns?

a. Generalized skin rash 4 to 6 days after birth
b. Systemic infection with fever
c. Bilateral corneal ulceration
d. Yellow vaginal or penile discharge approximately 10 days after birth

Answer 8

ANS: C
Established infection causes bilateral corneal ulceration. The other options are not usual
sites for such an infection.
PTS: 1 REF: Page 922

Question 9

What is the major concern regarding the treatment of gonococci infections?

a. Development of antibiotic resistance
c. Changes in pathogenicity
b. Changes in virulence
d. Mutations into different strains

Answer 9

ANS: A
Several types of drug-resistant strains have been identified; they are
penicillinase-producing Neisseria gonorrhoeae (PPNG), which is resistant to penicillin;
tetracycline-resistant N. gonorrhoeae (TRNG), which is resistant to tetracycline;
chromosomal control of mechanisms of resistance of N. gonorrhoeae (CMRNG), which is
resistant to penicillin and tetracycline; and increasingly a fluoroquinolone-resistant N.
gonorrhoeae (QRNG). The other options are not major concerns.
PTS: 1 REF: Page 922

Question 10

Which sexually transmitted infection frequently coexists with gonorrhea?

a. Syphilis
c. Chlamydia
b. Herpes simplex virus
d. Chancroid

Answer 10

ANS: C
The coexistence of chlamydial infection with gonorrhea frequently occurs. No coexistence
exists with the other options.
PTS: 1 REF: Page 922

Question 11

During which stage of syphilis do bloodborne bacteria spread to all the major organ
systems?
a. Primary 
c. Latent
b. Secondary 
d. Tertiary

Answer 11

ANS: B
Bloodborne bacteria spread to all major organ systems during only stage II, secondary
syphilis (see Box 26-2).
PTS: 1 REF: Page 923

Question 12

In which stage of syphilis would the following clinical manifestations be found:
destructive skin, bone and soft tissue lesions, aneurysms, heart failure, and neurosyphilis?
a. Primary
c. Latent
b. Secondary
d. Tertiary

Answer 12

ANS: D
Stage IV, tertiary syphilis, is the only stage during which significant morbidity and
mortality occur, including destructive skin, bone, and soft-tissue lesions (see Box 26-2).
PTS: 1 REF: Page 924

Question 13

Which organism is responsible for the development of syphilis?

a. Neisseria syphilis
c. Haemophilus ducreyi
b. Treponema pallidum
d. Chlamydia trachomatis

Answer 13

ANS: B
T. pallidum is the only cause of syphilis.
PTS: 1 REF: Page 923

Question 14

Which is a characteristic lesion of secondary syphilis?

a. Condylomata lata
c. Chancroid
b. Gummas
d. Donovan bodies

Answer 14

ANS: A
The only secondary syphilis lesion is the condylomata lata.
PTS: 1 REF: Pages 924-925

Question 15

By which method is the organism that causes syphilis best identified?

a. Acid-fast stain
c. In vitro culture
b. Gram-stained slide
d. Darkfield microscopy

Answer 15

ANS: D
Because Treponema pallidum cannot be cultured in vitro, early definitive diagnosis of
primary or secondary syphilis depends on darkfield microscopy of a specimen taken from
a chancre, regional lymph node, or other lesion. The remaining options are not relevant.
PTS: 1 REF: Page 925

Question 16

When a patient has small, vesicular lesions that last between 10 and 20 days, which
sexually transmitted infection is suspected?
a. Genital herpes
c. Syphilis
b. Chancroid
d. Chlamydia

Answer 16

ANS: A
If symptoms occur, the individual may have small (1 to 2 mm), multiple, vesicular lesions
that are generally located on the labia minora, fourchette, or penis. They may also appear
on the cervix, buttocks, and thighs and are often painful and pruritic. These lesions usually
last approximately 10 to 20 days. The other options do not demonstrate these symptoms.
PTS: 1 REF: Page 933

Question 17

Which statement is false regarding the risk of transmission of the herpes simplex virus
(HSV) from mother to fetus?
a. Neonatal infection of HSV rarely occurs in the intrapartum or postpartum period.
b. The risk is higher in women who have a primary HSV infection.
c. The risk is higher in women who experience ruptured membranes more than 6
hours before delivery.
d. The risk is higher when internal fetal monitoring devices are used.

Answer 17

ANS: A
Neonatal infections can occur in utero or, more commonly, during the intrapartum or
postpartum period. The other options are accurate statements.
PTS: 1 REF: Page 933

Question 18

During the latent period of a herpes virus infection, where in the host cell is the genome of
the virus maintained?
a. Mitochondria 
c. Nucleus
b. Lysosomes 
d. Cytoplasm

Answer 18

ANS: C
During the latent period, the genome for the virus is maintained in the host cell nucleus
without causing the death of the cell.
PTS: 1 REF: Page 933

Question 19

During reactivation (release from latency), herpes virus genomes are transported through
which nerves to the dermal surface?
a. Somatic 
c. Autonomic
b. Peripheral sensory 
d. Peripheral motor

Answer 19

ANS: B
Only during reactivation are the viral genomes transported through the peripheral sensory
nerves back to the dermal surface.
PTS: 1 REF: Page 933

Question 20

Which statement provides the most accurate information regarding the transmission of
herpes simplex virus (HSV)?
a. HSV is transmitted only when vesicles are present.
b. HSV is transmitted only while lesions are present.
c. The use of condoms prevents the transmission of HSV.
d. The risk of transmission is present even during latent periods.

Answer 20

ANS: D
Latent infections can become reactivated and cause a recurrent infection with similar
manifestations. The other options are not accurate statements regarding the transmission of
HSV.
PTS: 1 REF: Pages 933-934

Question 21

Which drug may be prescribed orally for outbreak management of herpes simplex viral
(HSV) infections?
a. Acyclovir (Zovirax) c. Zidovudine (AZT) (Retrovir)
b. 5-Fluorouracil (5-FU) d. Bichloroacetic acid (BCA)

Answer 21

ANS: A
Although no curative treatment for HSV infection is known, only oral acyclovir,
valacyclovir, penciclovir, and famciclovir are used for primary and periodic outbreaks and
to prevent recurrences.
PTS: 1 REF: Page 934

Question 22

Which of the following causes condylomata acuminata or genital warts?

a. Chlamydia
c. Human papillomavirus (HPV)
b. Adenovirus
d. Herpes simplex virus 1 (HSV-1)

Answer 22

ANS: C
Genital warts are quite contagious and are a result of only HPV.
PTS: 1 REF: Pages 934-935

Question 23

Which treatment is used for trichomoniasis?

a. Topical application of 5-Fluorouracil (5-FU)
b. Topical application of acyclovir
c. Systemic metronidazole
d. Systemic tetracycline

Answer 23

ANS: A
The treatment of choice for trichomoniasis is a single 2-gram dose of metronidazole
(Flagyl) or tinidazole. The other options are not applicable.
PTS: 1 REF: Page 938

Question 24

A woman diagnosed with trichomoniasis asks if her sexual partner should be treated as
well. What is the appropriate response?
a. Sexual partners should be treated only if symptoms are present.
b. Sexual partners should be treated even if they are asymptomatic.
c. Infections in men are self-limiting; therefore a male sexual partner does not require
treatment.
d. Sexual partners should be treated to prevent infection

Answer 24

ANS: B
Sexual partners, even if asymptomatic, are also treated and examined for coexisting
sexually transmitted infections.
PTS: 1 REF: Page 938

Question 25

Which microorganism is sexually transmitted, primarily by homosexual men, through
infected feces?
a. Shigellosis 
c. Giardia lamblia
b. Cytomegalovirus (CMV) 
d. Entamoeba histolytica

Answer 25

ANS: A
Only the Shigella infection, termed shigellosis, is transmitted by contact with infected
feces particularly among homosexual men.
PTS: 1 REF: Page 940 | Table 26-3

Question 26

Which hepatitis virus is known to be sexually transmitted?

a. A
c. C
b. B
d. D

Answer 26

ANS: B
Only hepatitis B virus (HBV) is known to be sexually transmitted.
PTS: 1 REF: Page 940

Question 27

Which sexually transmitted disease occasionally causes clinical manifestations of scant
intermittent penile discharge, slight pruritus, and mild dysuria?
a. Campylobacter enteritis
c. Cytomegalovirus enteritis
b. Shigellosis
d. Trichomoniasis

Answer 27

ANS: D
Most men with trichomoniasis are asymptomatic but may have scant intermittent
discharge, slight pruritus, and mild dysuria. The other options do not demonstration these
symptoms.
PTS: 1 REF: Page 937

Question 28

Which statements are true regarding the hepatitis B infection? (Select all that apply.)

a. Hepatitis B poses a significant risk for chronic liver disease.
b. Hepatocellular cancer is a common comorbid condition.
c. Universal vaccination of infants and children is recommended.
d. The preventive method of choice is immunization.
e. Universal vaccination of sexually active adults is recommended.

Answer 28

ANS: A, B, C, D
Hepatitis B infection poses significant health risks including chronic liver disease and
hepatocellular cancer. Immunization against hepatitis B is the most effective means of
preventing transmission. Universal vaccination of infants and children is recommended, as
well as vaccination of high-risk adults.
PTS: 1 REF: Page 941

Question 29

What are the common modes of transmission for the hepatitis B virus (HBV)? (Select all
that apply.)
a. Needle punctures
b. Blood transfusions
c. Contact with infected body fluids
d. Skin cuts
e. Ingestion of infected substances

Answer 29

ANS: A, B, C, D
Transmission of HBV can occur through needle puncture, blood transfusion, cuts in the
skin, and contact with infected body fluids. Ingestion is not a recognized transmission
mode.
PTS: 1 REF: Page 941

Question 30

Which statements are true regarding the parasitic infection referred to as scabies? (Select
all that apply.)
a. Scabies is spread through skin-to-skin contact.
b. The crab lice, Phthirus pubis, cause scabies.
c. Severe pruritus is its major clinical manifestation.
d. Symptoms worsen at night.
e. Treatment is provided through oral medication therapy.

Answer 30

ANS: A, C, D
Scabies is a common parasitic infection that can be spread by skin-to-skin contact and
sexual contact. The scabies mite burrows through the skin, depositing two or three large
eggs per day. Intense pruritus, especially at night, is the most pronounced clinical
manifestation. Treatment consists of topical application of a pediculicide. Pediculosis
pubis (crabs) is commonly transmitted sexually and is caused by the crab louse, P. pubis.
PTS: 1 REF: Pages 938-939

Question 31

Which statements are true concerning the sexually transmitted infection (STI)
lymphogranuloma venereum? (Select all that apply.)
a. Lymphogranuloma venereum is an STI commonly diagnosed in the United States.
b. It begins as a skin infection.
c. Lymphogranuloma venereum spreads to lymph tissues.
d. Primary and secondary lesions are apparent with this STI.
e. A 60-day course of oral erythromycin is the recommended treatme

Answer 31

ANS: B, C, D
Lymphogranuloma venereum is a chronic STI uncommon in the United States. The lesion
begins as a skin infection and spreads to the lymph tissue, causing inflammation, necrosis,
buboes, and abscesses of the inguinal lymph nodes. Primary lesions appear on the penis
and scrotum in men and on the cervix, vaginal wall, and labia in women. Secondary
lesions involve inflammation and swelling of the lymph nodes with the formation of large
blue buboes that rupture and form draining ulcerative lesions. A 21-day or longer course of
oral doxycycline or erythromycin is needed for treatment. Treatment of sexual partners is
recommended.
PTS: 1 REF: Pages 931-932

Question 32

Match the disease with the corresponding causative organism.
\_\_\_\_\_\_A. Trichomoniasis
\_\_\_\_\_\_B. Granuloma inguinale
\_\_\_\_\_\_C. Amebiasis
\_\_\_\_\_\_D. Syphilis
\_\_\_\_\_\_E. Chancroid

32. Treponema pallidum
33. Haemophilus ducreyi
34. Calymmatobacterium granulomatis
35. Entamoeba histolytica
36. Trichomonas vaginalis

Answer 32

32. ANS: D PTS: 1 REF: Page 923
    MSC: T. pallidum is the cause of syphilis.
33. ANS: E PTS: 1 REF: Page 925
    MSC: H. ducreyi, a gram-negative bacillus, causes chancroid.
34. ANS: B PTS: 1 REF: Page 929
    MSC: Granuloma inguinale (donovanosis) is a chronic, progressively destructive bacterial
    infection caused by Calymmatobacterium granulomatis.
35. ANS: C PTS: 1 REF: Page 919 | Table 26-1
    MSC: E. histolytica is the cause of amebiasis.
36. ANS: A PTS: 1 REF: Page 937
    MSC: Trichomoniasis is a result of infection caused by T. vaginalis