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clin med ii - exam 5 > Schoenwald - STIs > Flashcards

Schoenwald - STIs Flashcards

1
Q

5 p’s of the STI medical interview

A

partners

practices

protection from std’s

past hx std’s

pregnancy intention

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2
Q

3 pre exposure vaccines

A

hep B

hep A

HPV

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3
Q

who should get the hep B preexposure vaccine

A

all sexually active patients

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4
Q

who should get the hep A vaccine

A

MSM

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5
Q

who should get the HPV vaccine

A

9-26 yo male and female

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6
Q

male condoms are most effective in preventing

A

mucosal surface contact infxns

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7
Q

what are mucosal surface contact infxns (4)

A

GC

CT

trichomonas

HIV

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8
Q

what are skin-skin contact infxns

A

HSV

HPV

syphilis

chancroid

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9
Q

con of non latex condoms

A

higher breakage/slippage rate

lambskin: larger pores → infxn

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10
Q

are female condoms an effective barrier to viruses

A

yes

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11
Q

are spermicides effective in preventing STIs

A

no

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12
Q

what is N-9

A

vaginal spermicide

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13
Q

t/f: N-9 can be used as a microbicide or lubricant during anal sex

A

f!

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14
Q

annual STI screenings for at risk MSM (7)

A

HIV

syphilis

GC

CT

HPV

HBsAG

Hep C Ab

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15
Q

preferred screening test for GC/CT

A

NAAT

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16
Q

HPV test for MSM

A

anal pap smear

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17
Q

screening tests for WSW (5)

A

HPV

HIV

GC

CT

trichomonas and BV

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18
Q

what is PrEP

A

pre exposure prophylaxis for HIV

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19
Q

what is opt out HIV testing

A

notify pt that HIV test will be performed unless they decline

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20
Q

all __ women should be tested for HIV

A

pregnant

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21
Q

what is expedited partner therapy

A

treating partner of STI pt

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22
Q

what 3 STIs does expedited partner therapy make you think of

A

syphilis

GC

CT

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23
Q

t/f: in CO, expedited partner therapy is sanctioned

A

T!

also recommended by CDC and CDPHE

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24
Q

what are STIs of concern

A

trick question!

they all are

just needed to toss a softball in here :)

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25
Q

STIs involving ulcers

A

syphilis

genital herpes

also (uncommon):

lymphogranuloma venereum

chancroid

granuloma inguinale

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26
Q

mc cause of ulcers in young women in the US

A

HSV

syphilis

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27
Q

5 sources of non infectious ulcers

A

carcinoma

trauma

psoriasis

fixed drug eruption

yeast

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28
Q

STI ulcers are often classified into

A

painful vs painless

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29
Q

painful STI ulcers (2)

A

chancroid

genital herpes simplex

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30
Q

2 STI strains of HSV

A

HSV 1 and 2

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31
Q

painless STI ulcers (3)

A

syphilis

lymphogranuloma venereum

granuloma inguinale

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32
Q

6 STIs w. drip/discharge

A

gonorrhea

chlamydia

nongonococcal urethritis/mucopurulent cervicitis

trichomonas vaginitis/urethritis

vulvovaginal candidiasis

HPV 16 and 18

also cervical ca

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33
Q

what do you think when you see: multiple painful vesicles on erythematous base lasting 7-10 days

A

HSV

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34
Q

mc infectious etiology of genital ulcerations

A

hsv 1 and 2

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35
Q

mc cause of genital herpes/recurrent herpes

A

hsv 2

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36
Q

prodrome of HSV involves

A

tingling/burning 18-36 hr prior to lesions

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37
Q

primary (first presentation) of HSV lesions are associated w.

A

fever

bilateral LAD

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38
Q

recurrent HSV does not involve

A

fever

LAD

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39
Q

in terms of detecting HSV, the majority of infxns are __

A

undiagnosed

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40
Q

in women, HSV symptoms often occur

A

during menstrual cycle

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41
Q

what is wrong w. serologic HSV testing

A

high rate of false positives

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42
Q

__ is the gs dx testing for HSV

but it lacks __

A

Tzank smear

sensitivity

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43
Q

preferred testing for HSV

A

culture and PCR

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44
Q

positive findings of Tzanc smear

A

presence of multinucleated giant cells

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45
Q

tx for first clinical episode of HSV

A

acyclovir 400 mg tid

OR

famciclovir 250 mg tid

OR

valacyclovir 1000 mg bid

7-10 days for all agents

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46
Q

pharm for HSV is most effective w.in __ hr of lesions

A

72

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47
Q

tx for episodic HSV

A

acyclovir

famciclovir

valacyclovir

don’t need to know dosing for this one

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48
Q

tx for daily suppression of HSV

A

acyclovir 400 mg bid

famciclovir 250 mg bid

valacyclovir 500-1,000 mg qd

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49
Q

t/f: suppression tx for HSV reduces frequency of recurrence by 70-80%

A

t!

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50
Q

tx for first episode of HSV in pregnant pt

A

acyclovir

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51
Q

there is a high rate of transmission of HSV to neonate if HSV is transmitted to MOC

A

near delivery

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52
Q

t/f: pregnant pt can deliver vaginally if asymptomatic

A

t!

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53
Q

painless papule that ulcerates

A

chancre → syphilis

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54
Q

incidence of syphilis is high and increasing in what 3 pt populations

A

HIV

MSM

IVDU

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55
Q

what pathogen causes syphilis

A

treponema pallidum

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56
Q

active syphilis infxn is classified into (3)

A

primary

secondary

tertiary

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57
Q

primary presentation of syphilis

A

chancre/ulcer

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58
Q

describe early chancre

A

macule/papule → erodes

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59
Q

describe late chancre

A

clean based

painless

indurated

smooth, firm borders

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60
Q

t/f: syphilis chancre is generally asymptomatic

A

F! it is HIGHLY infectious

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61
Q

syphilis chancre usually resolves in

A

1-5 weeks

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62
Q

secondary presentation of syphilis (6)

A

whole body skin rash (including palms/soles)

LAD

mucous patches

condylomata lata

constitutional sx

neuro sx

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63
Q

flesh colored/hypopigmented macerated papules or plaques

A

condylomata lata

genitals/anus

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64
Q

which sx of secondary syphilis is highly contagious

A

condylomata lata

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65
Q

secondary syphilis usually resolves w.in

A

2-10 weeks

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66
Q

3 neuro sx associated w. secondary syphilis

A

AMS

stroke

meningitis

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67
Q

tertiary presentation of syphilis

A

gummatous lesions

cardiovascular syphilis

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68
Q

soft, tumor like growth of tissues

A

gumma

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69
Q

staging of syphilis

A

early latent

late latent

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70
Q

define early latent syphilis

A

reactive testing w.in 1 year of infxn

no sx

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71
Q

define late latent syphilis

A

reactive testing > 1 year after onset of infxn

OR

timing can not be determined

no sx

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72
Q

gs dx test for syphilis

A

darkfield examination of exudate/tissue

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73
Q

2 types of serologic tests for syphilis

A

nontreponemal

treponemal

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74
Q

nontreponemal serologic tests for syphilis

A

RPR (rapid plasma reagin)

VDRL (veneral dz research lab test)

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75
Q

2 treponemal serologic tests for syphilis

A

fluorescent trepenemal ab (FTA-AB)

T-pallidum passive particle agglutination (TP-PA)

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76
Q

reactivity of non treponemal tests __,

treponemal tests __

A

fades over time

stay positive

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77
Q

for serologic testing for syphilis you need to do both __

and __ tests

A

treponemal

nontreponemal

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78
Q

dx test for neurosyphilis

A

CSF

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79
Q

3 complications of neurosyphilis

A

eye dz

uveitis

optic neuritis

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80
Q

maternal rf for syphilis

A

multiple partners

drug use

transactional sex

late entry to prenatal care

no prenatal care

meth/heroin

incarceration

unstable housing/homeless

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81
Q

tx for primary, secondary, and early latent syphilis

A

benzathine pen g 2.4 million doses IM x 1 dose

6-12 mo f.u for repeat RPR tx

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82
Q

tx for primary, secondary, and early latent syphilis for pt w. PCN allergy

A

doxycycline 100 mg bid x 14 days

OR

ceftriaxone

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83
Q

tx for late latent syphilis

A

benzathine pen g 2.4 million units IM 1 dose weekly x 3 weeks

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84
Q

tx for tertiary syphilis

A

pen g 2.4 million units IM q week x 3 weeks (bicillin LA)

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85
Q

acute febrile rxn w. HA and myalgia that occurs w.in 24 hr of initiation of tx for neurosyphilis

A

jarisch-herxheimer rxn

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86
Q

jarisch-herxheimer rxn is associated w. __ syphilis

A

neurosyphilis

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87
Q

jarisch-herxheimer rxn is usually controlled w. __

but can be life threatening

A

antipyretics

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88
Q

do you typically treat sex partner of syphilis positive pt

A

yes!

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89
Q

syphilis screening for pregnant pt

A

1st prenatal visit

AND

at 28 weeks before delivery if high risk

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90
Q

congenital syphilis is associated w. (4)

A

fetal demise

cleft palates

mental retardation

nerve damage → vision/hearing

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91
Q

t/f: congenital syphilis is rarely seen

A

f! → 291% increase from 2015-2019

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92
Q

what test should you order for newly diagnosed syphilis pt and vice versa

A

HIV

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93
Q

what do you think when you see: painful ulcer + tender inguinal adenopathy

A

chancroid

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94
Q

chancre is __

and a chancroid is __

A

painless

painful

really, we couldn’t think of a different name for one of these??

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95
Q

what pathogen causes chancroid

A

haemophilus ducreyi

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96
Q

chancroids are difficult to test and must be cultured w.in __

A

1 hour

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97
Q

culture for chancroid have __% sensitivity

A

80

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98
Q

tx for chancroid

A

azithromycin 1 gm orally

OR

ceftriaxone

OR

cipro

99
Q

2 other tx considerations for chancroid

A

re-exam 3-7 days after tx

LAD may need drainage

100
Q

2 factors that reduce effectiveness of tx for chancroid

A

uncircumcised

HIV

101
Q

what determines healing time for chancroid

A

size of the ulcer

102
Q

tx for partner of pt w. chancroid

A

treat partner even if asymptomatic if contact was 10 or fewer days prior to onset

103
Q

chancroids are a rf for __ transmission

A

HIV

104
Q

2 other tx considerations for chancroid

A

re-exam 3-7 days after tx

LAD may need drainage

105
Q

what abx for chancroid is contraindicated in pregnancy

A

cipro

106
Q

what STI do you think of when you see lymphogranuloma venereum

A

chlamydia trachomatis

107
Q

painless papule, vesicle or ulcer PLUS tender regional, unilateral LAD

A

lymphogranuloma venereum

108
Q

what do you think when you see genital elephantiasis

A

chronic lymphogranuloma venereum in females

109
Q

tx for lymphogranuloma venereum

A

doxycycline 100 mg bid x 21 days

OR

azithromycin 1 gm po q week x 3 weeks

110
Q

painless papule that ulcerates, NO lymph node involvement

A

granuloma inguinale

111
Q

granuloma inguinale is same-same

A

donovanosis

112
Q

what pathogen is associated w. granuloma inguinale

A

klebsiella (calymmatobacterium) granulomatis

113
Q

dx for granuloma inguinale (donovanosis)

A

wound exudate culture

114
Q

what do you think when you see: donovan bodies (WBC inclusions)

A

wound exudate findings of granuloma inguinale/donovanosis

115
Q

tx for granuloma inguinale (donovanosis)

A

doxycycline 100 mg twice weekly x 3 weeks

OR

azithromycin 1 gm once weekly x 3 weeks

116
Q

minimum tx duration for granuloma inguinale

A

3 weeks

117
Q

what are condyloma acuminatum

A

genital warts

118
Q

what STI do you think of when you see condyloma acuminatum

A

HPV

119
Q

t/f: h&p exam for genital ulcers is super accurate

A

f!

120
Q

evaluation of genital ulcers:

syphilis: __

HSV: __

chancroid: __

A

syphilis: serologic

HSV: culture/antigen

chancroid: haemophilus ducreyi culture

121
Q

what other test may be useful in evaluation of genital ulcers

A

biopsy

122
Q

moving on to STIs that cause “drips”/ discharge

A

gonorrhea

nongonococcal urethritis → chlamydia, mycoplasma genitalium

mucopurulent cervicitis

trichomonas vaginitis and urethritis

candidiasis

123
Q

2nd mc reported STI yearly

A

gonorrhea

124
Q

in males, gonorrhea is associated w. (2)

A

urethritis

dysuria

125
Q

main presentation of gonorrhea in females

A

asymptomatic

126
Q

if gonorrhea is symptomatic in females, what are the symptoms

A

vaginal discharte

dysuria

labial pain/swelling

abd pain

127
Q

gs test for gonorrhea

A

gram stain → gram negative diplococci intracellular

128
Q

preferred testing for gonorrhea

A

NAAT

129
Q

what do you think when you see bartholian’s abscess

A

gonorrhea

130
Q

primary site of gonorrhea

A

endocervical canal → gonorrhea cervicitis

also urethra

131
Q

sign of disseminated gonorrhea

A

skin lesions

132
Q

tx for gonorrhea for pt’s < 150 lb

A

ceftriaxone 500 mg IM single dose

alternate: gentamicin

133
Q

tx for gonorrhea for pt’s > 150 lb

A

ceftriaxone 1 gm

134
Q

tx for disseminated gonorrhea

A

ceftriaxone 1 gm IM or IV q 24 hr x 7 days

135
Q

mc pathogen associated w. nongonococcal urethritis

A

c. trachomatis

also genital mycoplasmas

136
Q

2 sx associated w. nongonococcal urethritis

A

mild dysuria

mucoid d.c

137
Q

gonorrhea has developed resistance to __

and __

A

penicillins

tetracyclines

138
Q

dx for nongonococcal urethritis (3)

A

urethral smear

urine microscopic

139
Q

diagnosis on urethral smear for nongonococcal urethritis is __ or more PMNs,

but PMNs are usually > or higher

A

5

15

140
Q

2 findings of microscopic eval of nongonococcal urethritis

A

PMNs 10 or higher

leukocyte esterase (+)

141
Q

tx for nongonococcal urethritis

A

doxycycline 100 mg bid x 7 days

OR

azithromycin 1 gm in a single dose

142
Q

mc reported STI in the US

A

chlamydia trachomatis

143
Q

mc presentation of chlamydia

A

asymptomatic

144
Q

sx of chlamydia if symptomatic (5)

A

cervicitis

urethritis

proctitis

lymphgranuloma venereum

PID

145
Q

2 sx associated w. neonate chlamydia

A

conjunctivitis

PNA

146
Q

dx for chlamydia (2)

A

urine NAAT

cervical/urethral swabs (NA probe)

147
Q

what do you think when you see Gen-Probe Pace-2

A

dx test for chlamydia

148
Q

tx for chlamydia

A

doxycycline 100 mg bid x 7 days

149
Q

tx for chlamydia in pregnant pt

A

azithromycin 1 gm single dose

150
Q

women < __ yo should be screened for chlamydia

A

25

151
Q

what women > 25 yo should be screened for chlamydia

A

sexually active

risk factors

152
Q

10-20% of women w. __ develop PID

A

gonorrhea

153
Q

minimal dx criteria for PID

A

uterine adnexal tenderness

cervical motion tenderness

154
Q

other diagnostic criteria for PID

A

oral temp > 101

elevated ESR/CRP

cervical CT or GC

WBC/saline microscopy

cervical d.c

155
Q

sx of PID

A

endocervical d.c

fever

lower abd pai

156
Q

3 complications of PID

A

infertility

ectopic pregnancy

chronic pelvic pain

157
Q

indications for hospitalization for PID (5)

A

pregnancy

failure of oral abx or antimicrobials

inability to follow oral regimen

severe illnes → n/v, high fever

tubo-ovarian abscess

158
Q

inpatient tx for PID

A

ceftriaxone 1 gm IV q 24 hr

PLUS

doxycycline 100 mg po or IV q 12 hr

PLUS

metronidazole 500 mg po OR IV q 12 hr

159
Q

oral (outpatient) tx for PID

A

ceftriaxone 250 mg IM in a single dose

PLUS

doxycycline 100 mg bid x 14 days

PLUS

metronidazole 500 mg bid x 14 days

160
Q

tx for male sexual partner of PID pt

A

empiric abx w.in 60 days of onset of sz

161
Q

epididymitis is chronic if it lasts >

A

3 months

162
Q

mc cause of epididymitis in sexually active men < 35 yo (2)

A

gonorrhea

chlamydia

163
Q

mc cause of epididymitis in men > 35 yo

A

enteric organisms →

e.coli

164
Q

cardinal sx of epididymitis

A

unilateral testicular pain

165
Q

tx for epididymitis

A

ceftriaxone 500 mg IM x 1

PLUS

doxycycline 100 mg bid x 10 days

166
Q

tx for epididymitis in men who practice insertive anal sex

A

ceftriaxone 500 mg IM x 1 dose

PLUS

levofloxacin 500 mg po x 10 days

167
Q

tx for epididymitis if enteric organism is involved

A

levofloxacin 500 mg po q day x 10 days

168
Q

prostatitis has the same etiology as

A

epididymitis

2/2 to infxn

169
Q

is prostatitis part of the STI tx guidelines

A

no!

170
Q

4 sx of prostatitis

A

dysuria

pain w. erection

f/v

low back pain

171
Q

dx for prostatitis

A

UA culture

pre/post prostate exam

172
Q

tx for prostatitis

A

same as epididymitis:

ceftriaxone PLUS doxy

but longer duration

173
Q

mc cause of vaginal d.c worldwide

A

BV

174
Q

what pt population is rarely affected by BV

A

not sexually active

175
Q

what bacteria makes up 95% of vaginal flora

A

lactobacillus

176
Q

known rf for bv (7)

A

new sex partner

douching

decrease in normal flora

absence of barrier methods

copper IUD

uncircumcised partner

WSE

177
Q

BV is mc caused by

A

gardnerella vaginosis

178
Q

__ criteria is used for BV dx

A

amsel

179
Q

amsel criteria

A

at least 3 of the following:

homogeneous, thin white d.c

wet prep → clue cells

positive whiff test → fishy odor

pH > 4.5

180
Q

__ tests have higher sensitivity than amsel criteria

A

NAAT

181
Q

why do we need to tx BV

A

risks for:

fetal complications

PID

postsurgical infxn

cervical ca

mucopurulent cervicitis

HIV/other STIs

182
Q

tx for BV

A

metronidazole 500 mg bid x 7 days

OR

metronidazole gel 0.75%, 5 g intravaginally x 5 days

OR

clindamycin cream

183
Q

should pregnant women be treated for BV

A

yes!

184
Q

tx for BV in pregnant pt

A

metronidazole 500 mg po bid x 7 days

same as for non pregnant

185
Q

is it recommended to tx partner of pt w. BV

A

no!

186
Q

only infxn so far w. no rec to tx partner

A

BV

187
Q

vulvovaginal candidiasis is mc caused by

A

candida albicans

188
Q

d.c associated w. vulvovaginal candidiasis

A

white

curdy

189
Q

what do you think when you see: pruritis, vaginal soreness, dyspareunia, external dysuria, and white curdy d.c

A

vulvovaginal candidiasis (VVC)

190
Q

dx for vulvovaginal candidiasis

A

clinical

KOH

culture

191
Q

is PCR testing used for vulvovaginal candidiasis

A

no! → not FDA approved

192
Q

4 indications of uncomplicated VVC

A

sporadic/infrequent

mild-moderate sx

c albicans

nonimmune compromised

193
Q

4 indications of complicated VVC

A

recurrent

severe sx

non c albicans

DM/immunocompromised

194
Q

recurrent VVC is defined as

A

3 or more episodes < 1 year

195
Q

what agents can be used to tx VVC

A
  • azoles
  • this will be my sacrificial lamb if she expects us to memorize all of these*
196
Q

what dx test is useful to confirm dx and identify unusual species (non c. albicans) for recurrent VVC

A

vaginal culture

197
Q

initial tx for recurrent VVC:

maintenance tx for VVC:

A

initial: topical azole OR fluconazole 150 mg x 7-14 days
maintenance: -zoles

198
Q

tx for non-albicans (complicated)

A

longer duration of non -azole agent

199
Q

are there recommendations to tx partner of VVC pt

A

no!

200
Q

what VVC tx is recommended in pregnancy

A

only topical intravaginal x 7 days

201
Q

what do you think when you see, diffuse, malodorous yellow to green d.c

A

trichomonas vaginalis

202
Q

__ infxn is associated w. 1.5 x risk of HIV

and increased risk for PID

A

trichomonas vaginalis

203
Q

__ is the gs dx for trichomonas vaginalis,

but __ is more sensitive

A

wet prep

NAAT

204
Q

what do you think when you see strawberry cervix

A

trichomoniasis

205
Q

tx for trichomoniasis

women:

men:

A

women: metronidazole 500 po bid x days
men: metronidazole 2 gm orally in a single dose

206
Q

recs for partner of trichomoniasis pt

A

partner should be treated

no sexy time until tx is done

207
Q

oncogenic strains of hpv

A

16

18

208
Q

nononcogenic hpv strains

A

6

11

209
Q

nononcogenic hpv (6, 11) are associated w.

A

warts

condyloma acuminata

210
Q

HPV infxn is detected in 99% of __ cancers

and is also causally associated w.

A

cervical

other anogenital ca (anal, penile, vulvar, vaginal)

211
Q

lab markers for HPV

A

trick question dummy!

there are none

jk, we aren’t dummies

212
Q

3 possible tx for HPV/warts

A

podofilox 0.5% solution or gel

OR

imiquimod 5% cream

OR

sinecatechins 15% ointment

213
Q

what strains of hpv cause respiratory papillomavirus in infants.children

A

6

11

214
Q

what agents are contraindicated for hpv in pregnancy

A

imiquimod

pdophylllin

podoflox

sinecatechins

215
Q

HPV vaccine is recommended for m and f aged __,

and is FDA approved up to age __

A

9-26

45

216
Q

t/f: both gardasil quadravalent and gardasil 9 cover HPV 16 and 18

A

T!

217
Q

what do you think when you see: intense itching, contagious, mite

A

scabies

218
Q

what parasite is associated w. scabies

A

sarcoptes scabiei

219
Q

tx for scabies

A

permethrin 5% cream to all areas of the body

OR

ivermectin 200 ug/kg po → repeat in 2 weeks

220
Q

what is persistent scabies

A

rash and pruritis > 2 weeks

221
Q

in persistent scabies, you should check the __ of the pt,

tx close contacts __,

and instruct the pt to __

A

fingernails

empirically

wash all linens, bedding, clothing

222
Q

crusted scabies is same-same

A

norweigan scabies

223
Q

what pt pop is usually affected by crusted scabies

A

immunodeficient

debilitated

malnourished

organ transplant

hematologic malignancies

224
Q

t/f: crusted scabies is more contagious than regular scabies

A

T!

225
Q

tx for crusted scabies

A

combo:

topical scabicide PLUS ivermectin

OR

repeated tx w. ivermectin

226
Q

pruritis or lice/nits on pubic hair

A

pediculosis pubis

227
Q

tx for pediculosis pubis

A

permethrin 1%

pyrethrin w. piperonyl butoxide

applied to affected are and washed off after 10 min

228
Q

tx for partner of pt w. pediculosis pubis

A

tx sex partners w.in the last month

229
Q

vaccine preventable STDs

A

hep A

hep B

HPV

230
Q

high risk population for hep A

A

MSM

IVDU

chronic liver dz

hep B/C infxn

231
Q

high risk pops for hep B

A

hx of STI

multiple sex partners

MSM

IVDU

household member/sex contact of Hep B person

hemodialysis

occupational exposure

232
Q

what 2 HPV vaccines are available

A

quadrivalent

Gardasil 9

233
Q

what are the oncogenic/wart associated strains of HPV

A

6

11

234
Q

mc bloodborne infxn

A

hep C

235
Q

is hep C commonly sexually transmitted

A

no

236
Q

hep C pt is commonly co-infected w.

A

HIV

237
Q

is a hep C vaccine available

A

no!

238
Q

what STIs are associated w. assault/abuse

A

GC

CT

trichomonas

candida/BV

HIV

HBV

syphilis

239
Q

recommended empiric tx regimen for adolescent and adult female sexual assault survivors

A

ceftriaxone 500 mg IM single dose

PLUS

doxycycline 100 mg po bid x 7 days

metronidazole 500 mg po bid x 7 days

240
Q

recommended empiric regimen for adolescent and adult male sexual assault survivors

A

ceftriaxone 500 mg IM in a single dose

PLUS

doxycycline 100 mg po bid x 7 days

same as for female minus metronidazole

241
Q

tx for post HIV exposure prophylaxis

A

HIV PEP

case by case basis

referral to specialty care

242
Q

HIV PEP is only recommended w.in < __ hours of substantial exposure risk

A

< 72 hr

243
Q

is HIV PEP recommended for negligible exposure risk

A

no!

clin med ii - exam 5 (23 decks)

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