ID

Question 1

Chancroid: cause?

Answer 1

Haemophilus ducreyi

Question 2

Chancroid: Clinical presentation

Answer 2

Painful
Shallow, friable, nonindurated with ragged margins, granulomatous base, yellow or gray, necrotic purlent exudate

Question 3

Chancroid: associated symptoms

Answer 3

Painful inguinal adenopathy called “buboes” present

Question 4

Chancroid: diagnosis

Answer 4

Culture of lesion. not widely available)
CDC criteria for diagnosis:
1. >1 painful genital ulcer
2. No evidence of syphilis on dark-field or serologic test performed 7 days after onset of ulcer
3. Typical clinical presentation
4. Negative HSV test of ulcer

Question 5

Lymphogranuloma venereum: Cause?

Answer 5

L1 L2 or L3 forms fo C. trchomatis

Question 6

Lymphogranulmoa venerum: Clinical presentation?

Answer 6

Painless ulcer, small pustule at site of inoculation, can disappear rapidly

Question 7

lymphogranuloma venereum: Associated symptoms

Answer 7

First stage: small, painless ulcer
Second stage: constitutional illness, painful lymphadenopathy, “groove” sign pathognomonic
Third stage: proctocolitis

Question 8

Lymphogranuloma venereum: Diagnosis

Answer 8

Genital lesion swab lymph node aspirate tested using nucleic acid amplification tests

Question 9

Granuloma inguinale: cause?

Answer 9

Klebsiella granulomatis

Question 10

Granuloma inguinale: clinical presentation?

Answer 10

Painless, slowly progressive ulcerative lesion on genitals or perineum; bleeds easily on contact

Question 11

Grauloma inguinale: associated symptoms

Answer 11

Regional lymphaenopahty is uncommon

Question 12

Granuloma inguinale: diagnosis

Answer 12

Identification of Donovan bodies within histiocytes of granulation tissue smears or biopsy specimens

Question 13

Syphilis: cause/

Answer 13

Treponema pallidum

Question 14

Syphilis: clinical presentation

Answer 14

Painless ulcer with indurated hard, raised border and “punched-out” appearance

Question 15

Syphilis associated symptoms

Answer 15

regional lymphadenopathy may occur

Question 16

Syphilis: diagnosis

Answer 16

Screen: nontreponemal tests (RPR, VDRL)
Confirm: treponemal tests (FTA-ABS or TPPA)
Dark-field microscopy showing spirochetes

Question 17

Genital herpes: cause?

Answer 17

HSV1 or HSV2

Question 18

Genital herpes clinical presentation

Answer 18

Painful vesicular lesions developing into ulcer

Question 19

genital herpes associated symptoms

Answer 19

Constitutional symptoms present in primary infection

Question 20

Genital herpes diagnosis

Answer 20

Viral culture or PCR for HSV DNA (from lesion)

Question 21

Chlamydia trachomatis: recommended regimens?

Answer 21

Azithromycin 1g orally once
or
doxycycline 100 mg orally twice daily for 7 days

Question 22

Chlamydia trachomatis: alternative regimens and special consierations?

Answer 22

Pregnancy:
azithromycin 1g orally once
Alternative regimens:
Erythromycin base 500 mg orally four times a day for 7 days
or
Erythromycin ethylsuccinate 800mg orally four times a day for 7days
or
levofloxacin 500 mg orally once daily for 7 days
or ofloxacin 300mg orally twice a day for 7 days

Question 23

Neisseria gonorrhoeae (cervix, urethra, and rectum): Recommended regimens?

Answer 23

Ceftriaxone 250 mg IM in a isngle dose
or
single-dose injectable cephalosporin
plus
azithromycin 1g orally once

Question 24

Neisseria gonorrhoeae (cervix, urethra, and rectum): alternative regimens and special considerations

Answer 24

Alternative if unable to offer IM: cefixime 400 mg orally in a single dose
plus
azithromycin 1 orally once
If azithromycin is not available or if patient is allergic to azithromycin, doxycycline 100 mg orally twice daily for 7 days may be substituted for azithromycin as the second antimicrobial
Severe cephalosporin allergy: contact infectious disease specialist

Question 25

N. gonorrhoeae (pharynx): Recommended regimens

Answer 25

Ceftriaxone 250 mg IM in a single dose plus azithromycin 1g orally once

Question 26

N. gonorrhoeae (pharynx): alternative regimens and special considerations

Answer 26

No alternative therapy available Patients treated with an alternative regimen should return 14 days after treatment for a test of cure using either culture or NAAT. If the NAAT is positive, every effort should be made to perform a confirmatory culture.

Question 27

Treponema pallidum (primary and secondary syphilis or early latent syphilis, i.e, infection <12 months): Recommended regimens?

Answer 27

Benzathine penicillin G 2.4 million units IM in 1 dose

Question 28

Treponema pallidum (primary and secondary syphilis or early latent syphilis, i.e, infection <12 months): alternative regimens and special considerations

Answer 28

Penicillin allergy: doxycycline 100 mg orally twice daily for 14 days. Limited data suggest ceftriaxone 1-2g daily either IM or V for 10-14 days

Question 29

Treponema pallidum (late latent syphilis or syphilis of unknown duration): recommended regimens

Answer 29

Benzathine penicillin G 7.2 million units total, administered as three doses of 2.4 million units IM each at 1-week intervals

Question 30

Treponema pallidum (late latent syphilis or syphilis of unknown duration): alternative regimens and special considerations?

Answer 30

Penicillin allergy: doxycycline 100 mg orally twice daily for 28 days with close serologic and clinical follow-up

Question 31

Haemophilus ducreyi (chancroid: genital ulcers, lymphadenopathy): recommended regimens

Answer 31

Azithromycin 1g orally in a single dose or ceftriaxone 250 mg IM in single dose or ciprofloxacin 500 mg orally twice a day for 3 days or erythromycin base 500 mg orally 3 times a day for 7 days

Question 32

Haemophilus ducreyi (chancroid: genital ulcers, lymphadenopathy): Alternative regimens and special considerations?

Answer 32

NA

Question 33

C. trachomatis serovars L1, L2 or L3 (lymphogranuloma venereum): Recommended regimens?

Answer 33

Doxycycline 100 mg orally twice daily for 21 days

Question 34

C. trachomatis serovars L1, L2 or L3 (lymphogranuloma venereum): alternative regimens and special considerations

Answer 34

Alternative: erythromycin base 500 mg orally four times a day for 21 days or azithromycin 1g orally once a week for 3 weeks

Question 35

Bacterial vaginosis: Organism?

Answer 35

Replacement of normal vaginal flora (Lactobacillus sp) with anaerobes

Question 36

Bacterial vaginosis: type of organism?

Answer 36

Bacteria

Question 37

Bacterial vaginosis: discharge?

Answer 37

thin, gray-white, foul-smelling; adheres to vaginal walls

Question 38

Bacterial vaginosis: diagnostic features?

Answer 38

"Clue cells" on wet prep, vaginal pH > 4.5, + whiff test (KOH reveals "fishy odor")

Question 39

Trichomoniasis: organism?

Answer 39

Trichomonas vaginalis

Question 40

Trichomoniasis: Type of organism?

Answer 40

protozoan

Question 41

Trichomoniasis: discharge?

Answer 41

Green-yellow, malodorous, frothy

Question 42

Trichomoniasis: diagnosti features

Answer 42

Motile trichomonads on wet mount, culture, PCR; can alsocause ervicitis with red, punctuate "strawberry" cervix

Question 43

Vulvovaginal candidiasis organism?

Answer 43

Candida

Question 44

Vulvovaginal candidiasis: type of organism?

Answer 44

Fungus (yeast)

Question 45

Vulvovaginal candidiasis: discharge?

Answer 45

White "cottage cheese" discharge

Question 46

Vulvovaginal candidiasis: diagnostic features

Answer 46

Fungal elements on wet prep, vaginal pH <4.5