med surg STDs

Question 1

what are the 3 mandated to report STDs

Answer 1

-gonorrhea
-chlamydia
-syphilis
the bacterial infections

Question 2

what increase risk of STDs

Answer 2

-early reproductive maturity
-increased sexual lifespan
-inconsistent use of barrier methods
-medias increased emphasis on sexuality w/o teaching safe sex
-substance use
+ everything you expect

Question 3

what is the best form of protection against STIs

Answer 3

male condom (other than abstinence but we do not teach that)

Question 4

which is the most common bacterial STD

Answer 4

chlamydia

Question 5

chlamydia

Answer 5

-incubation period of 1 to 3 wks
-most common sites: urethra in males, cervix in women
-can be asym
-men: pain w/ urination and/or discharge
-women: mucopurulent discharge, bleeding, dysuria, pain w/ sex
rectum: pain, discharge, bleeding, pruritis, tenesmus, mucus coated stools

Question 6

complications of chlamydia

Answer 6

can result in infertility (rarely in men) and pelvic inflammatory disease

Question 7

PID

Answer 7

damages the fallopian tubes and increases risk for ectopic pregnancy, fertility comps and chronic pelvic pain

Question 8

dx and treatment of chlamydia

Answer 8

-H&P + nucleic acid amplification test (NAAT)
-screen regularly
-treated w/ azithromycin or doxycycline
return for testing 3 month after treatment

Question 9

if a patient test positive for chlamydia, what needs to be done

Answer 9

-all sexual contacts from prior 60 days should be notified/evaluated/treated
-abstain from sex for 7 days after treatment & until all partners have been tested/treated

Question 10

gonorrhea

Answer 10

-incubation period of 1-14 days
-prior infection does not prevent reinfection
-sites: urethra for men, cervical for women
-men: dysuria, purulent urethral discharge or epididmyitis
-women: asym or minor, dysuria, frequent urination, bleeding after sex, redness & swelling, purulent exudate
rectal: rectal discharge, bleeding, anorectal pain, pruritus, painful BM

Question 11

gonorrhea complications

Answer 11

men: infertility if not treated
women: bartholin’s glands inflamed causing reddened & enlarged labia, PID, pregnancy comps
gonorrhea can be passed to the neonate and cause conjunctivitis

Question 12

gonorrhea dx & treatment

Answer 12

-H&P, culture discharge
-can begin treatment w/o results
-high dose IM single -dose ceftriaxone

Question 13

if a patient test positive for gonorrhea, what needs to be done

Answer 13

-all sexual contacts from prior 60 days should be notified/evaluated/treated
-abstain from sexual contact at least 7 days after abx therapy completed

Question 14

what is the most common not viral STD

Answer 14

trichomoniasis (a parasite)

Question 15

trichomoniasis in men

Answer 15

mostly asym & often transient (spon resolution within 10 days)

Question 16

trichomoniasis

Answer 16

-incubation: 1wk-3mo
-screening only recommended for high risk women
-men: burning w/ urination/ejac, discharge
-women: painful urination, vaginal itching, painful sex w/ bleeding after, yellow/green discharge w/ foul odor, strawberry appearance of cervix

Question 17

complications to untreated trichomoniasis

Answer 17

more likely to get another STD, particularly HIV

Question 18

trichomoniasis dx & treatment

Answer 18

-NAAT (detects RNA)
-treat w/ antifungals (azoles)
-abstain from sex for 7 days post antifungal
-high rate of recurrence so get tested again in 2wk-3mo

Question 19

when is a person w/ herpes most contagious

Answer 19

when symptomatic but can be transmitted w/o apparent sx d/t asym viral shedding

Question 20

herpes manifestations: primary

Answer 20

-primary episode (incubation 2-12 days) -> genital infection usually no recognizable symptoms -> regional lymphadenopathy & flu like sx -> whole process can take ~ 3wks

Question 21

herpes manifestations: recurrent

Answer 21

occurs usually within the first year after primary episode, less severe & heals quicker -> decreased episodes over time

Question 22

triggers to recurrent herpes episodes

Answer 22

stress, fatigue, acute illness, sunburn, immunosuppression

Question 23

complications of herpes

Answer 23

blindness
encephalitis
aseptic meningitis
genital ulcer (inc risk for HIV)
can be transferred to baby
psychological impact of non curable disease

Question 24

dx & treatment of herpes

Answer 24

-DX: by sx & culture of active lesion to distinguish between HSV 1&2
-tx: acyclovir to shorten durations of outbreak & control lesions

Question 25

what is HPV highly linked w/

Answer 25

cancer so need more screenings

Question 26

syphilis

Answer 26

-transmitted by direct contact w/ syphilitic ulcer
-incubation period 10-90 days
-can be transmitted to baby during pregnancy

Question 27

syphilis: clinical stages

Answer 27

-early/primary: highly infectious, lesions appear
-secondary: highly infectious, 2-8 wks after primary, bacterial dissemination & starts to effect nerves (meningitis)
-early latent: asym, not contagious
-late: not infectious and rarely seen post abx treatment

Question 28

early syphilis complications

Answer 28

-early chancres increase HIV transmission
-people w/ syphilis & HIV are more likely to have CNS involvement

Question 29

neurosyphilis

Answer 29

permanent damage within the CNS, visual impairment, dementia

Question 30

cardiovascular syphilis

Answer 30

chest pain, dyspnea, murmur, cardiomegaly

Question 31

gummatous syphilis

Answer 31

unusual scarring on skin, changes in nasal septum & palate

Question 32

syphilis dx & tx

Answer 32

-dx: serologic/blood test (VDRL) then a confirmatory positive screening (treponemal antigens) bc false results can occur based on timing of infection
-tx: w/ penicillin G for all stages (doxycycline or tetracycline if cillin allergy)

Question 33

syphilis test precautions

Answer 33

-test for HIV
-follow up w/ sex partners from the last 90 days
-follow up care w/ HCP every 6 months for 2 years