GU 2

Question 1

PID

Answer 1

complication of lower genital tract infections affecting upper female genital tract (uterus, fallopian tubes, ovaries, pelvic structures)

Question 2

complication of lower genital tract infections affecting upper female genital tract (uterus, fallopian tubes, ovaries, pelvic structures)

Answer 2

PID

Question 3

STI - may c/o
8

Answer 3

1. genital lesions
2. vaginal/urethral discharge
3. vaginal itching/irritation
4. dysuria
5. pelvic pain (females)
6. testicular or perineal pain (males)
7. pharyngitis
8. conjunctivitis

Question 4

PID - may c/o
2

Answer 4

1. pelvic tenderness
2. vaginal discharge

Question 5

PID - speculum and bimanual PE findings may include
5

Answer 5

1. cervical motion tenderness
2. adnexal tenderness
3. uterine compression tenderness
4. RUQ tenderness on abd exam (Fitz-Hugh-Curtis syndrome or perihepatitis
5. peritonitis

Question 6

PID - fever

Answer 6

not usually present

Question 7

STI - PE findings may include (male)
2

Answer 7

1. testicular pain (orchitis)
2. pain w/ palpation of the epididmysis or perineum (epididymitis or prostatitis)

Question 8

STI - vesicles

Answer 8

HSV

Question 9

STI - painless ulceration

Answer 9

Chancre in primary syphilis

Question 10

STI - painful ulceration

Answer 10

Chancroid -highly contagious yet curable sexually transmitted disease (STD) caused by the bacteria Haemophilus ducreyi

Question 11

STI - verrucous lesions

Answer 11

genital warts

Question 12

STI - umbilicated papules

Answer 12

Molluscum contagiosum -viral skin infection that can be considered a sexually transmitted infection (STI) in adults. It’s characterized by small, smooth, round, pearly bumps with a central core

Question 13

PID/STI - in females, first img/test

Answer 13

pregnancy test

Question 14

chlamydia and gonorrhea test (if available) - male/female

Answer 14

men - first catch urine or urethral swab
women - endocervical swab (req if sending cx for gonorrhea), or vaginal swab, or first catch urine (NAAT)

Question 15

male urethral swab instructions -

Answer 15

clean urethral opening, insert swab 2/3” into urethra and turn 10 times in one direction, pull out

Question 16

chlamydia test in women
2

Answer 16

1. urine in cup
2. but more sensitive test is vaginal swab - insert into vaginal canal and swab insides

Question 17

gonorrhea test in women

Answer 17

urine or vaginal swab - same as chlamydia

Question 18

what STIs can be tested in blood

Answer 18

genital herpes,
HIV,
syphilis
hepatitis B
chlamydia (but not preferred bc it’s not as accurate)

Question 19

what STIs can be tested in urine sample
3

Answer 19

chlamydia
gonorrhea
trichomoniasis

Question 20

what STIs can be tested w/ a swab
5

Answer 20

chlamydia
gonorrhea
trich
herpes if lesions present
HPV - pap smear

Question 21

trichomoniasis test - women, men

Answer 21

women - vaginal, endocervical or urine specimen
male - urethral swab, urine sediment, or semen

Question 22

syphilis test

Answer 22

non-treponemal test (RPR or VDRL), also known as a screening test, is a blood test that detects antibodies that are not specific to the bacteria that causes syphilis

Question 23

syphilis - reactive non treponemal test

Answer 23

supports dx but does not confirm - need subsequent test

Question 24

syphilis - non reactive non treponemal test

Answer 24

does not definitvely r/o syphilis

Question 25

herpes simplex virus test 1

Answer 25

viral culture

Question 26

order urgent US for pain where 2

Answer 26

1. unilateral pelvic pain in the setting of PID - concern for tubo ovarian abscess 2. testicular pain when dx is unclear

Question 27

gonorrhea tx from CDC

Answer 27

Ceftriaxone 500 mg* IM in a single dose for persons weighing <150 kg If chlamydial infection has not been excluded, treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days. * For persons weighing ≥150 kg, 1 g ceftriaxone should be administered.

Question 28

gonorrhea tx education 3

Answer 28

1. symptoms usually start to improve within a few days but can take up to two weeks 2. all partners in the last 60 days should be treated 3. need f/u testing to ensure clearance in three months - try to schedule at initial visit

Question 29

chlamydia tx from CDC 3

Answer 29

1st line - Doxycycline 100 mg orally 2 times/day for 7 days alternatives include - Azithromycin 1 g orally in a single dose OR Levofloxacin 500 mg orally once daily for 7 days

Question 30

trich tx CDC - female/male

Answer 30

female - Metronidazole 500 mg 2 times/day for 7 days male - Metronidazole 2 g orally in a single dose

Question 31

does partner need to be treated for chlamydia

Answer 31

yes, in the last 60 days

Question 32

does partner need to be treated for trich

Answer 32

yes, in the last 60 days

Question 33

trich, gonorrhea, chlamydia - when can you resume sex

Answer 33

7 days after sx resolve

Question 34

syphilis tx

Answer 34

benzathine penicillin G 2.4 million units IM once

Question 35

genital warts tx

Answer 35

imiquimod cream 5% apply to lesions 3 x week at bedtime up to 16 weeks

Question 36

genital herpes tx

Answer 36

acyclovir 400 mg PO q8h for 7-10 days

Question 37

PID - empirically treat if

Answer 37

CMT present, uterine or adnexal tenderness present

Question 38

PID tx

Answer 38

ceftriaxone 500 mg IM once + doxy 100 mg PO BID for 14 days

Question 39

what are reportable STIs in the U.S. 5

Answer 39

1. HIV 2. syphilis 3. chancroid 4. chlamydia 5. gonorrhea

Question 40

which need f/u in three months

Answer 40

HIV syphilis chlamydia gonorrhea chancroid??

Question 41

STI - consider what partner therapy

Answer 41

expedited partner therapy EPT

Question 42

PID/STI - when to refer to ER 4

Answer 42

1. uncertain dx and additional img needed - 10-25% of those thought to have PID actually have appendicitis 2. s/sx of severe illness 3. PID w/ concurrent pregnancy 4. concern for tubo-ovarian abscess