Infections/STDs part 2

Question 1

what HPV types are MC associated w anogenital warts

Answer 1

types 6 and 11

Question 2

tubo-ovarian abscess (TOA)

Answer 2

an inflammatory mass involving the fallopian tubes, ovaries, or occasionally other pelvic organs

most occur as a complication to PID

typically polymicrobial with mixtures of aerobic and anaerobic organisms

Question 3

sx TOA

Answer 3

acute lower abdominal pain, vaginal discharge, and systemic symptoms, such as fever and chills

similar to PID

Question 4

when is TOA thought to have ruptured

Answer 4

it is leaking contents into the abdominal cavity. Most patients with a ruptured TOA present with an acute abdomen and sepsis, which requires immediate surgical exploration.

Question 5

dx TOA

Answer 5

made clinically based on hx and an exam suggestive of PID and the presence of an inflammatory adnexal mass on pelvic imaging

Question 6

MC imaging modality for TOA

Answer 6

TVUS

Question 7

Tx TOA

Answer 7

admit for IV abx - Cefoxitin and doxy or cefotetan and doxy

Question 8

what pts w TOA should be treated initially w abx ALONE

Answer 8

hemodynamically stable, no signs of an acute abdomen, abscess size < 7 cm in diameter, and premenopausal status

Question 9

Postmenopausal women w TOA

Answer 9

higher risk for malignancy –> surgical intervention is recommended for dx and therapeutic purposes

Question 10

sx vulvovaginal atrophy

Answer 10

vulvovaginal dryness, burning, and irritation; urinary symptoms, such as dysuria, urinary frequency, and recurrent urinary tract infections; and reduced lubrication during sexual intercourse causing dyspareunia

Question 11

PE vulvovaginal atrophy

Answer 11

tissue fragility or fissures, vulvovaginal pallor, vulvovaginal erythema, loss of vaginal rugae, and decreased vulvovaginal secretions

Question 12

initial tx vulvovaginal atrophy

Answer 12

vaginal moisturizers (two or three times per week) and lubricants (during intercourse)

Question 13

C/I vaginal estrogen

Answer 13

prior or current estrogen-dependent tumors

Question 14

How does the normal vaginal pH compare to the vaginal pH in postmenopausal women?

Answer 14

Postmenopausal pH is more basic. The normal pH in reproductive-aged women is 3.5–5.0, and the pH in postmenopausal women is often 5.5–6.8

Question 15

how long should ppl abstain from sexual activities for gonorrhea

Answer 15

abstain from sexual activities until at least 7 days after the initiation of therapy and they no longer have symptoms

Question 16

cardiovascular syphilis

Answer 16

develops 10 years after primary

causes aneurysm formation in the aorta

Question 17

neurosyphilis

Answer 17

damage to brain and spinal cord at any stage of disease causing gait abnormalities, disruption in pain and temp sensations, memory and speech impairment, psychosis and progressive dementia

Question 18

nontreponemal testing for syphilis

Answer 18

venereal disease research laboratory (VDRL)
rapid plasma reagin (RPR)
Toluidine Red Unheated Serum Test (TRUST)

Question 19

treponema test for syphilis

Answer 19

fluorescent treponema antibody absorption (FTA-ABS)
Microhemagglutination test for antibodies to T pallidum (MHA-TP)
T pallidum particle agglutination assay (TPPA)
T pallidum enzyme immunoassay (TP-EIA)
chemiluminescence immunoassay (CIA)

Question 20

How often should ppl w syphilis be monitored

Answer 20

repeat RPR or VDRL at 6 and 12 month intervals to ensure treatment success

Question 21

What is the nickname for syphilis?

Answer 21

the great imposter

Question 22

strawberry cervix int rich is also called

Answer 22

colpitis macular (punctate macular hemorrhages on the cervix)

Question 23

dx trich

Answer 23

wet mount is MC used

Question 24

wet mount for trich

Answer 24

flagellated protozoa moving in corkscrew patterns, shaking, or rotating

Question 25

if wet mount is negative but still suspicious of trich, what next

Answer 25

nucleic acid amplification testing

Question 26

tx trich

Answer 26

oral metronidazole 500 mg by mouth twice a day for 7 days

all sexual partners should receive tx as well

Question 27

repeat testing for trich

Answer 27

repeat testing should be performed 2 weeks to 3 months after abx completion to ensure curative therapy

sexual abstinence is strongly encouraged during this time

Question 28

complications women trich

Answer 28

urethritis
cystitis
PID
infertility

Question 29

complications men trich

Answer 29

prostatitis
epididymitis
infertility
prostate CA

Question 30

sx Vulvovaginal candidiasis

Answer 30

most common symptom is vulvar pruritus and other common symptoms include vulvar burning, soreness, or irritation. Patients may have dysuria or dyspareunia

Question 31

PE vulvovaginal candidiasis

Answer 31

erythema, excoriations, or fissures of the vulva and the vagina

may have discharge - white, thick, and clumpy discharge

sx may be worse the week prior to menses

Question 32

dx vulvovaginal candidiasis

Answer 32

detecting Candida on a wet mount, Gram stain, or culture of vaginal discharge

dx should not be made solely based on clinical findings

Question 33

tx vulvovaginal candidiasis

Answer 33

asx - no tx
sx - oral fluconazole administered as a single oral dose

if vulvovaginal candidiasis and uncontrolled diabetes mellitus = complicated; tx = two doses of oral fluconazole administered as oral doses 3 days apart

Question 34

Vulvovaginal candidiasis is caused by an overgrowth of

Answer 34

C. albicans (MC)
C. glabrata

Question 35

challenge of C. glabrata

Answer 35

resistance to azole therapy

Question 36

what lesions are common w vulvovaginal candidiasis infxn

Answer 36

Satellite lesions (small, erythematous, well-demarcated patches with scalloped edges)

Question 37

does discharge have an odor in vulvovaginal candidiasis

Answer 37

no

Question 38

is pH abnormal in vulvovaginal candidiasis

Answer 38

no

Question 39

The microscopic evaluation of a vaginal sample using either saline or potassium hydroxide for vulvovaginal candidiasis

Answer 39

hyphae and spores

sometimes referred to as spaghetti and meatballs for the shape and distribution of the fungal components.

Question 40

tx chlamydia

Answer 40

azithromycin 1 gram PO as a single dose, doxycycline 100 mg PO twice daily for 7 days plus ceftriaxone 500 mg IM as a single dose, or cefixime 400 mg PO as a single dose

Question 41

tx chlamydia in pregnancy

Answer 41

amoxicillin 500 mg PO three times per day for 7 days with repeat testing 3–4 weeks after therapy