Chapter 48 Flashcards by Daniel Choi

True or False: Providers are required to report many STI’s to the CDC

True

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What are two populations at increased risk for STI’s?

Adolescents, and homosexual/bisexual men

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What ethnicities have the highest risk for STI’s?

African Americans & Native Americans

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What complication can arise from a pregnant woman with syphilis?

Congenital syphilis: woman passes syphilis to the fetus which can result in abortion, low birth weight, prematurity, neurological problems, anemia, and even death

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Which STI is the most common cause of cervical cancer

Human Papillomavirus (HPV)

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What are the most common STI’s among adolescents?

HPV, Chlamydia & HSV-2

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What are the most common STI’s among homosexual/bisexual men?

Syphilis, HIV, gonorrhea

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Cervical cancer screening recommendations include:

21-29 y/o’s: cervical cytology screening q3years
30-65 y/o’s: either cervical cytology q3 years, high-risk HPV testing q5 years, or both

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These two subtypes of HPV tend to be correlated with lesions which progress to malignancies:

16 & 18

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Syphilis is spread by:

direct contact with mucosal tissue with infected lesions

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Drug of choice for treatment of syphilis for all stages is:

Benzathine Penicillin G (IM)

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What are the stages of syphilis?

Primary
Secondary
Early Latent
Late Latent

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What is the first line treatment for gonorrhea?

Ceftriaxone 250mg (IV or IM)

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What can you use to treat gonorrhea if the patient has cephalosporin allergy?

Gentamicin & Azithromycin

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If a patient has gonorrhea, and chlamydia has not been ruled out, a patient should be treated with:

Azithromycin 1g PO

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Common complications of gonorrheal infection in women:

Pelvic inflammatory disease, tubal scarring, infertility, ectopic pregnancy, salpingitis, disseminated gonococcal (GC) infection

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Patient education for gonorrhea:

Sexual partners require treatment even if asymptomatic
Retesting should occur 3-6 months after treatment per CDC guidelines
Abstain from intercourse until 7 days after completing therapy and until symptoms are absent

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Gold standard treatment for non-pregnant patients with Chlamydia:

Doxycycline 100mg PO

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Pregnant women with chlamydia can be treated with:

Azithromycin or Amoxicillin

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Treatment for chlamydia in children:
1. Less than 45kg:
2. More than 45kg but less than 8y/o:
3. Greater than 8y/o:

Erythromycin
Azithromycin
Doxycycline

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Patient education for chlamydia:

All sexual partners in the past 60 days should be tested and treated
Abstain from sex for 7-days after single dose therapy
Retest for chlamydia 3 months after treatment

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The CDC recommends using Test of Cure (NAAT) for Chlamydia in these patients:

Pregnant, high risk groups (adolescents, same-sex-sex), or those whose adherence is in question

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What is the first line-treatment for trichomoniasis?

Metronidazole PO (1-dose)

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Patient education regarding use of Metronidazole or Tinidazole:

Avoid alcohol consumption as it can cause disulfiram-type reaction

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Patient education for trichomoniasis:

1. Re-screen in 3 months 2. 1 month follow-up after treatment 3. Sexual partners should be treated 4. Abstain from intercourse until patient and partner are treated and asymptomatic

What is the primary treatment for Bacterial Vaginosis?

Metronidazole 500mg PO BID (7 days)

What is the gold standard for diagnosing Bacterial Vaginosis?

Gram stain

Bacterial vaginosis increases the risk of:

Contracting STI's, HIV & HSV-2

Pelvic inflammatory disease occurs due to:

A delay in treating STI's & bacterial vaginosis

Pelvic Inflammatory Disease is defined as:

Acute infection of the upper genital tract

The minimum criteria for a diagnosis of pelvic inflammatory disease are:

1. Uterine/adnexal tenderness 2. Cervical motion tenderness

Treatment for pelvic inflammatory disease:

2 Step treatment: 1. Doxycycline & Metronidazole 2. Ceftriaxone or Cefoxitin

How do you manage pregnant patients with pelvic inflammatory disease?

Hospitalization & IV antibiotics

Patients with pelvic inflammatory disease should also be screened for:

Gonorrhea, Syphilis, HIV, Chlamydia

Pelvic Inflammatory disease should start to resolve within __ days of starting treatment

3 days

True or False: Syphilis testing is required in the first prenatal visit

True

What are the three stages of syphilis? Excluding latent

1. Primary syphilis infection: Ulcer or chancre at site of infection 2. Secondary infection: Rash, mucocutaneous lesions, adenopathy, neurological complications 3. Tertiary infection: Cardiac, neurological, ophthalmic, auditory, gummatous lesions

Fetal exposure to an infected cervix with gonorrhea can lead to:

disseminated gonococcal infection

Herpes Simplex Virus has two stereotypes:

HSV-1 & HSV-2

What are the three treatment options for the first clinical episode of HSV-1 & HSV-2?

Acyclovir (1st line) OR Valacyclovir OR Famciclovir

Recurrent episodes of HSV-2 can be treated episodically or continually. Episodic treatment consists of:

Acyclovir & Famciclovir

Recurrent episodes of HSV-2 can be treated episodically or continually. Continuous treatment consists of:

Acyclovir, Valacyclovir & Famciclovir

Episodic treatment of HSV is effective if started within 24 hours of first symptoms, therefore providers should:

Provide patient with renewable prescription to keep on hand for when symptoms begin

Management of pregnant patients with HSV:

1. Daily dosing indicated at 36 weeks of gestation to prevent perinatal transmission 2. Oral acyclovir is safe during all stages of pregnancy and breastfeeding 3.Cesarean birth decrease risk of HSV neonatal infection

Patient applied treatment of Human Papillomavirus (HPV):

1. Podofilx 0.5% solution/gel (1st line) 2. Imiquimod 3.75% or 5% cream 3. Sinecathechins 15% ointment

Provider management of HPV:

1. Cryotherapy with liquid nitrogen or TCA (trichloroacetic acid) or BCA (bichloroacetic acid) 2. Intralesion interferon or laser surgery

Describe a chancroid lesion:

A small papule that rapidly becomes pustular and eventually ulcerates. The ulcer enlarges, develops uneven borders, and is surrounded by erythematous rim

HPV (Human Papillomavirus) can also be referred to as:

Genital warts

Treatment for chancroid include:

Azithromycin, Ceftriaxone, Ciprofloxacin, Erythromycin

When treating chancroid, providers should avoid using this medication in patients under 18 years old, and those who are pregnant and/or lactating:

Ciprofloxacin

Follow-up testing for chancroid:

1. 3-7 days after starting treatment to assess healing 2. Test for HIV & Syphilis at 3 month intervals even if initial results are negative

HIV testing is important in a chancroid diagnosis because:

Chancroid is a cofactor for HIV transmission

Sexual partners of a patient witch chancroid should be:

Examined and treated if they had sex with infected person 10 days preceding diagnosis

Describe lesions/ulcers in Donovanosis:

Beefy-red ulcers of the genitals or perinium which are painless, slow-progressing, and highly vascular

1st line treatment for Donovanosis:

Azithromycin

Alternative treatments for Donovanosis:

Doxycycline OR Erythromycin OR Trimethoprim-Sulfamethoxazole

Recommended treatment for pregnant or breastfeeding patients infected with Donovanosis:

Erythromycin

Management/Patient education in Donovanosis:

1. Patients should be followed during 3 week course or treatment (or until lesions heal) 2. sex partners within past 60 days should be evaluated and offered treatment

Treatment of Lymphogranuloma Venereum in non-pregnant patients:

Doxycycline

Treatment of Lymphogranuloma Venereum in pregnant patients:

Erythromycin or Azithromycin with a test of cure NAAT, 4 weeks after treatment

Management of Lymphogranuloma Venereum:

1. Testing to rule out other STI’s 2. Test & treat partners who had contact with patient 60 days before diagnosis

Lymphogranuloma Venereum (LGV) is characterized by:

Initial presentation: pain, constipation, fever, tenesmus Men: proctocolitis Women: perianal inflammation

1st line treatment for Pediculosis Pubis (Pubic Lice) is:

1. Permethrin 1% cream applied to affected areas OR 2. Pyrhetrin with piperonyl butoxide

2nd line treatment for pubic lice is:

Ivermectin

Ivermectin is contraindicated in:

pregnancy, lactation, and children

Management of pubic lice:

1. Retreatment in 1 week recommended for symptomatic individuals 2. Sexual partners within the previous month should be treated 3. Pubic lice cannot live away from body for more than 72 hours so fumigating home is unnecessary

Primary treatment for scabies:

Permethrin cream 5% applied to all areas of body from neck down & washed off 8-14 hours after application

How is scabies spread?

Direct contact such as contact with infected linens or via sexual contact

The primary treatment for scabies is permethrin cream 5%. This should not be used in:

children younger than 2 month

2nd line treatment for scabies:

1. Ivermectin 2. Lindane 1% cream applied to affected areas and washed off after 8 hours

Lindane 1% cream is used to treat scabies. What are some considerations when using this medication?

1. Risk of toxicity and seizures 2. Should not be used in women who are pregnant/lactating, or in children <2 years of age

When treating scabies a provider should educate the patient on:

1. Decontaminating/isolating bedding and clothing for 72 hours 2. Rash and pruritus can persist for up to 2 weeks after treatment 3. Encouraging close contacts to be treated

Hepatitis A can be transmitted via:

Fecal-oral route: consumption of contaminated food or water OR sexual activity (fecal contact during anal sex)

Hepatitis B is mostly transmitted via:

sexual intercourse

Hepatitis B increases risk for:

Premature death from cirrhosis or hepatocellular carcinoma

Hepatitis B transmission occurs via:

Direct exposure to infected blood

Vaccines are available for which two types of Hepatitis?

A & B

Prevention of HIV includes the use of:

Pre-exposure prophylaxis (PrEP) reduces risk of HIV from sex by 99% Truvada & Descovy

Management of HIV exposure includes:

Post-exposure prophylaxis (PEP): antiretroviral drugs stop HIV seroconversion in individuals exposed

Management of STI's in sexual assault victims:

1. Testing of all penetration sites recommended 2. HIV, Hepatitis, and syphilis testing should also be considered 3. Pregnancy test, and emergency contraception should be offered 4. Empirical treatment is recommended

Chapter 48 Flashcards

Week 2