Sexually transmitted diseases Flashcards
The median time between initial HIV infection and eight is how many years
10 years
AIDS is defined by an absolute CD4 count of less than how many cells
200
Signs and symptoms that suggest aids are
Oral candidiasis i.e. thrush, fever, weight loss, diarrhea, cough, so it’s a breath, purple to bluish-red bumps on the skin, and certain infections
What infection causes the most deaths in HIV
Pneumocystis jirovecii
And acute and brief illness that occurs in 50% to 80% of persons within a few weeks of exposure to the HIV virus
ACute retro viral syndrome
Is a cute retro viral syndrome infectious
Yes due to high viral load greater than 100,000 copies ML and high concentration of virus in general secretions. The initial immune response made me make mono nucleus low-grade fever, fatigue, generalized red rash, and lymphadenopathy.
What would an HIV anti-body test show with a cute retro viral syndrome
Negative possibly.
If strongly Suspect acute HIV infection, order
Polymerase chain reaction
What is the usual time to develop antibodies after HIV exposure
Three months
Is universal screening for HIV recommended
Yes
Screening test is An Elisa
HIV
Produces a malodorous vaginal discharge
BV
DNA probe is used for screening
Gonorrhea and chlamydia
RPR is used for screening
Syphilis
FTA-ABS, MHA-TP Are diagnostic test for this STI (treponema pallidum)
Syphilis
Treated with 2.4 million units of penicillin IM. This treatment is for early disease
Syphilis early
Treated with three doses of benzathine penicillin spaced out weekly intervals. Hint treatment for late or unknown duration of this disease
Syphilis later
Associated with positive whiff-amine test
BV
Confirmatory test is western blot
HIV
Treated with metronidazole 500 mg b.i.d. for seven days
BV and trichomonas
Etiologic agent is a virus
HIV, herpes and HPV
Clue cells present on saline wet mount
BV
This STD produces a discharge
HPV, gonorrhea, chlamydia, BV, herpes, trichomonas
Absent or decreased lactobacilli
BV
Wet prep used for diagnosis
Trichomonas, BV, and yeast
Treated with acyclovir, valacyclovir, and famciclovir with equal efficacy
Herpes
Trading with 2 g of metronidazole as a single dose
Trichomonas
May be associated with involuntary weight loss
HIV
Can produce rash on palms of the hands soles of feet
Syphilis
What STI is associated with a positive chandelier test
PID
What is a positive chandelier test
Tender cervical area
What STD produces a chanere
Syphilis
What STD produces vesicles on mucous membranes
Herpes type one
What are the screening test for HIV
EIA or ELISA
What is the confirmatory test for HIV
Western blot
When do you do an HIVRNA
If the screening tests are negative or if a cute retro viral syndrome is suspected
If you receive a patient that is HIV-positive what records do you need to request
Treatment history, prior drug resistance testing, virologic and immune responses to treatment
In HIV infected patients what disease progresses faster
Liver disease and it affects the choice of anti-retroviral therapy
What is a significant risk factor for reactivation of latent TB
HIV
What vaccines do HIV infected patients need annually
Pneumococcal, tetanus, hepatitis A and B, and flu
Do you administer alive or attenuated vaccine’s to HIV infected patients
No
How often do you obtain a CD4 count in an HIV infected patient
First CD4 count baseline then repeat once and usually every 3 to 4 months.
How often to check viral load and HIV infected patient
Need baseline and then every 3 to 4 months
If on ART, How long does it take for the viral load to be undetectable
Within 16 to 24 weeks of therapy
What other screening tests do HIV infected patients need
Hepatitis A, B and C, glucose and lipid panel, and STD assessment
If an HIV infected patient has a CD4 count of less than 200 what are they at risk for
Pneumocystis carinii
What is the prophylactic treatment for pneumocystis carinii with a CD4 count less than 200
TMP-SMX
What is the prophylactic treatment for pneumocystis carinii with a cd4 count less than 50
MAC
Azithromycin, clarithromycin once daily
A patient with new onset HIV would present with what symptoms
Fever, pharyngitis, nonpruritic macular skin rash, malaise, headache, lymphadenopathy
A 20-year-old male has suspected acute infection of HIV. How should he be screened?
What a western blot
Anemia, leukopenia, thrombocytopenia, involuntary weight loss, persistent diarrhea, severe chronic fatigue, dementia, peripheral neuropathy, herpes zoster, presence of opportunistic infections are all assessment findings for
Established HIV
Sexually active adult from high-risk population complains of petechial or pustular skin lesions of hands and soles, swollen, red, and tender joints in one joint such as the knee. Maybe accompanied by signs of STD i.e. cervicitis, urethritis.
Gonorrhea
Poly microbial clinical syndrome resulting from the replacement of the normal vaginal flora with high concentrations of anaerobic bacteria. Associated with multiple sex partners, new partners, douching, IUCs. Sexually associated not sexually transmitted
BV
What is the condition you are at Increased risk of acquiring STDs, UTIs, post gynecologic surgery infection, and preterm labor
Bacterial vaginosis
What are the causes of organisms of bacterial vaginosis
Prevotella, Mobiluncus, G. vaginalis, atopobium, and others
Asymptomatic in about 50% of women, profuse grayish white malodorous vaginal discharge, unpleasant, fishy, or musty vaginal odor, increased odor after intercourse, pruritus and burning of Vulvo vaginal area
Bacterial vaginosis
Homogeneous, white, discharge coating vulva/vagina, vaginal pH of greater than 4.7, fishy odor of vaginal discharge before or after addition of KOH, clue cells on Micro scopic exam, one or more epithelial cells coated with bacteria, obscuring borders
BV
How should BV this be treated
Screen for other STDs, metronidazole 500 mg b.i.d. for seven days. Avoid Sexual intercourse until after treatment. Condom use increases cure rates. Avoid douching to prevent reoccurrences. Treat symptomatic patients including pregnant patients
What medication should be avoided in pregnancy
Tinidazole As it is category C
When taking metronidazole or tinidazole what precautions need to be taken
No alcohol until 24 hours after her last dose
With recurrent bacterial vaginosis what must be ruled out
HIV
What is the most frequently reported infectious disease in the United States
Chlamydia
At what age is chlamydia most common
Less than 25 years old
What can cause PID, ectopic pregnancy, infertility, and pelvic pain
Chlamydia
Mucopurulent cervicitis, edematous, congested, friable cervix, vaginal discharge, cervical motion tenderness, dysuria/urethritis, salpingitis, proctitis, epididymitis, abnormal vaginal bleeding, pelvic pain, prostatitis are all assessment findings of
Chlamydia
How do you diagnose chlamydia
NAAT, DNA probe, culture, urine testing
Who should be screened for chlamydia and how often
Screen all sexually active females less than 25 years of age and all pregnant women. Re-screen in three months after treatment due to higher rates of reinfection. Follow up in one month if pregnant and symptoms persist they can cause reinfection
How do you treat chlamydia In a pregnant patient
Azithromycin 1 g or early times one Or amoxicillin 500 mg orally TID times seven
How do you treat a non-pregnant patient for chlamydia
Doxycycline 100 mg b.i.d. for seven days
When treating a male for chlamydia and epididymitis is involved how do you treat
Doxycycline times 10 to 14 days
When being treated for chlamydia what measures should be taken
Refrain from intercourse for seven days after treatment is completed. Referral sexual contacts in last 60 days.
A sexually-transmitted infection producing a purulent inflammation of mucous membranes. Underdiagnosed in US. Uncommon among monogamous heterosexual populations. Risks are men having sex with men, IV drug use and other high-risk behaviors
Gonorrhea
In males a finding of purulent urethral discharge, dysuria, testicular pain and some asymptomatic symptoms are assessment findings of
Gonorrhea
In females findings of asymptomatic symptoms, endocervical discharge, dysuria, Bartholin’s gland abscess, abnormal vaginal bleeding, abdominal pelvic pain, adnexal tenderness, and cervical motion tenderness are all assessment findings of
Gonorrhea
What are the diagnostic studies for gonorrhea
Gram stain of exudate, DNA probe, NAAT, culture of exudate or joint aspirate on Thayer-Martin agar (chocolate agar)
How do you treat gonorrhea
Ceftriaxone i.e. Rocephin 250 mg or Cefixime. Test of cure required two weeks. Plus azithromycin 1 mg oral or doxycycline 100 mg oral b.i.d. for seven days and this is for dual purpose of the chlamydia and gonorrhea
Does a minor require parental consent for STD care
No
Red colored bumpy surface that emerges out of the cervical os
Cervical ectropion
Epididymitis and prostatitis are possible sides of which type of infection
Chlamydia
What STD causes Reiters syndrome in males
Chlamydia
How do you collect a urine sample for chlamydia test
Collect the first part of the urine stream 15 to 20 ML
What antibiotic is associated with nausea, G.I. upset, photosensitivity, and stains growing tooth enamel in fetuses
Doxycycline
Is doxycycline safe to use in pregnancy
No category D
A gram-negative bacterium that infects the urinary and general tracts, rectum, and pharynx. Unlike chlamydia this disease can become systemic or disseminated if left untreated
Gonorrhea
If a patient is positive for gonorrhea what must they be co-treated for
Chlamydia
Sexually active teenage to young adult female complains of purulent green colored vaginal discharge. Speculum examination reveals purulent discharge on the cervix, which may be friable. Males will have penile discharge and dysuria and may report staining of underwear with purulent discharge. History of new partner or multiple sex partners. In consistent condom use.
Gonorrhea
Treat male partners of women with PID if sexual contact during How many days preceding the patient’s symptoms
60 days and avoid sex until both finished treatment and no longer have symptoms
What may reduce the risk of PID
Oral contraceptives
Chlamydia and/or gonococcal and infection of the liver capsule resulting in expensive scarring between the liver capsule and abdominal contents. Scars look like a violin strings. A complication of disseminated gonorrhea or PID
Fitz-Hugh-Curtis Syndrome (perihepatitis)
Sexually active female with symptoms of PID complains of right upper quadrant abdominal pain and tenderness on palpation. The liver function test is normal.
Fitz-Hugh-Curtis Syndrone
How do you treat Fitz-Hugh-Curtis syndrome
Treated as a complicated got a real/chlamydial infection for 14 days
Acute febrile reaction that can occur during the first 24 hours after treatment. More likely to occur after treatment for early syphilis. Look for fever, chills, headache, myalgias. And immune mediated reaction that usually resolves spontaneously. Treatment is supportive.
Jarisch-Herxheimer Reaction
More common in males. And immune mediated reaction secondary to infection with certain bacteria i.e. chlamydia that spontaneously resolved. Treatment is supportive i.e. NSAIDs
Reiters syndrome
A male with current history of chlamydia genital infection i.e. urethritis complains of red and swollen joints that come and go and ulcers on the skin of the glans penis
Reiters syndrome
Mneumonic. I can’t to see, Pee, or climb up a tree
Reiters syndrome
If a patient has chlamydia do you treat for gonorrhea
No
What drug is used for patients that are pregnant who have chlamydia
Azithromycin and test of cure after treatment
When do you use a GenProbe
Only for cervix or urethral chlamydia or gonorrhea symptoms
If STD symptoms with new onset of swollen red knee on side, maybe caused by
Disseminated gonorrheal infection
Is PID a clinical diagnosis
Yes i.e. cervical motion tenderness. Even if gonorrhea and chlamydia test are negative treat a sexually active patient who has signs and symptoms of PID
After treating a patient for PID when should the patient follow up
2 to 3 days and perform vaginal bimanual examination. Symptoms should be improve within 2 to 3 days
For STDs that are treated with azithromycin such as chlamydia or syphilis what must the patient be instructed
Patient and partner are not to have sex for at least seven days afterwards
Sexually transmitted disease which can infect vagina, Skene’s ducts, and lower GU tract in women and lower GU tract in men
Trichomonas
Asymptomatic sometimes for decades, that will discharge frothy, yellow green, vulvar irritation, dysuria, cervical petechiae i.e. strawberry cervix
Trichomonas
Asymptomatic, urethral discharge, dysuria, epididymitis, prostatitis are all assessment findings in males for
Trichomonas in males
Wet prep Showing trichomonads as flagellated, motile cells slightly larger than white blood cells and polymorphonuclear cells. Vaginal pH is greater than 4.6. These are diagnostic studies for
Trichomonas
Affirm and Osom are POC testing for
Trichomonas
How do you treat Trichomonas
Metronidazole i.e. Flagyl 2 grams single-dose orally which is OK and in all trimesters of pregnancy or Tinidazole 2 grams single-dose orally category C for pregnancy or metronidazole 500 mg oral b.i.d. for seven days for HIV-positive. Abstinence until treated completed. Treat sexual partners. Abstain from drinking alcohol 72 hours post RX
Sexually transmitted disease characterized by sequential stages and involving multiple system. Stages are primary secondary Latent and teritiary
Syphilis
Chancre at site of inoculation begins as papule then also ulcerates with a hard edge and clean yellow base, indurated and painless usually located on the genitalia, maybe solitary or multiple. Persists 1 to 5 weeks and heals spontaneously. Chancre may go unnoticed in females. And regional lymphadenopathy
Primary syphilis
Rash that is bilaterally symmetrical, polymorphic, nonpruritic, frequently on soles and palms, and usually persists for 2 to 6 weeks then spontaneously resolved. Condyloma lata moist, pink, peripheral warty lesions present on glans, perianal, vulvar areas, and intertriginous areas.
Secondary syphilis
In this stage of this STD the patient is asymptomatic
Latent syphilis
And this stage of this STD patient presents with cardiac manifestations such as aortic valve disease, aneurysms, neurological manifestations such as meningitis, encephalitis, dementia and integumentary manifestations such as gummas and orthopedic manifestation such as Charcot joints and osteomyelitis
Tertiary syphilis
What is the screening test for syphilis
RPR or VDRL
For patients with syphilis prophylaxis for all sexual contacts should be given in the last how many days
90
What is the treatment for syphilis
Benzathine penicillin G 2.4 million units IM in adults and children 50,000 units per kilogram IM
What is the treatment for neurosyphilis
Aqueous Crystaline penicillin G IV or procaine penicillin with probenecid IM
What is the treatment for congenital syphilis
Aqueous Crystaline penicillin G IV or procaine penicillin IM
If Syphilis patient is allergic to penicillin and compliance or follow what is uncertain what is recommended
Desensitization
When should you scream A patient for syphilis
Screen for syphilis if HIV infection, men who have sex with men, presence of any general ulcer, previous STD, pregnancy, IV drug use or a high-risk
Treponema infection is associated with
Syphilis
What is gumma in syphillis
Soft tissue tumors
What is the diagnostic test for syphilis
Fluorescent antibody absorption antibody (FTA-ABS) Directs fluorescent antibody testing i.e. DFA – TP, dark field microscopy
What is the order of screening test for syphilis
First order screening test is RPR or VDRL. If reactive, next step is to confirm with FTA – ABS.
If both the RPR and FTA-ABS or positive
This is diagnostic for syphilis
When do you recheck the RPR or VDRL after treatment
At six and 12 months
How do you treat patients with Latent and teritiary Syphillis
Referral to infectious disease specialist
RPR and VDRL are screening tests for
Syphilis
If RPR or VDRL a positive how do you confirm
FTA – ABS (treponemal test)
RPR or VDRL shows how much of a decrease in titers if patient is responding to treatment
Fourfold or higher
All patients with syphilis or men having sex with men must be tested for
HIB
maculopapular rash on the palms and soles or signs and symptoms of
Secondary syphilis
Condyloma Lata is associated with
Secondary syphilis
False positive RPR can be caused by
Autoimmune diseases, chronic or acute disease
The most common criterion collection is used to diagnose PID is
Cervical motion tenderness
In the United States what type of HIV is most common and what type of HIV is most common in Africa
In the United States it’s HIV-1 and in Africa is HIV 2
Number of HIV RNA copies in one ML of plasma. Test measures actively replicating HIV virus, progression of disease and response to anti-retroviral treatment
Viral load
Used to stage HIV infection and to determine when to start prophylaxis. Check at the same time of the day using the same laboratory each time
CD4 T cells counts
What is the screening test for HIV
ELISA Enzyme Linked Immunosorbent Assay
What is the confirmatory test for HIV
Western blot
What antibodies are detected by the Western blot and ELISA
IgG antibodies
If the EL I S a and western blot tests are both positive what is the next test to order
HIV PCR – HIVRNA
PCP prophylaxis one CD4 is less 200 is
Bactrim P.O. daily
Went a CD4 count is less than 100 Cells what kind of cause
Toxoplasma Gondii infections (Protozoa)
Causes brain abscesses. Avoid cleaning cat litter boxes and eating undercooked meats
When a patient is on HAART and ART how should their viral load be monitored
Check every 1 to 2 months until viral load is undetectable then every 3 to 4 months
What are the recommended vaccines for HIV and AIDS patients
HIV and AIDS patients can receive inactivated vaccines such as hepatitis A, hepatitis B, annual flu vaccine, pneumococcal vaccine, TD/TDAp
Can HIV patients receive some live vaccines
Yes but if CD4 count is less than 200, It is contra indicated.
What live virus vaccines are recommended for asymptomatic HIV patients
MMR vaccine is recommended for asymptomatic HIV infected children when the CD4 count of greater than 200 and varicella vaccine is recommended for seronegative children and adults if CD4 is greater than 200
What is some HIV education teaching points
Do not handle cat litter or eat uncooked lamb, beef, or pork as this is a risk for toxoplasmosis. Avoid Bird stool, turtles and other amphibians, and use gloves or avoid gardening.
When is PCP prophylaxis initiated in HIV patients
CD4 less than 200
If a patient with HIV is allergic to sulfa what drug should be used for PCP prophylaxis
Dapsone 100 mg PO daily
What is used for both prophylaxis and treatment of PCP
Bactrim DS
When do HIV infected pregnant women start treatment
Start AZT in the second trimester
If a patient presents with hairy leukoplakia on the tongue, recurrent candidiasis thrush what must be ruled out
HIV
What is the safest drug for HIV patients that are pregnant
Zidovudine (Retrovir ZDV AZT)
Can patients with HIV breast-feed
No
When do newborns start HIV medications
Newborns start treatment with zidovudine AZT within the first 6 to 12 hours of delivery
What is another name for genital warts
Condyloma acuminata
Do HIV positive women need more frequent pap testing
Yes every six months to monitor
Specialize microscope for evaluating and treating cervix
Colposcopy
What is the gold standard in diagnosing cervical cancer
Biopsy of cervical tissue
The majority of general HPV external warts are caused by which HPV strain
HPV 6 or 11
How are genital warts treated
Imiquimod (Alfara), cryo-procedures, or podofilox (Condylox) contraindicated in pregnancy
Asymptomatic shedding also occurs intermittently and patient is still contagious
Herpes simplex
What are prodrome herpes simplex symptoms
Itching, burning, and tingling
Sudden onset of groups of small vesicles sitting on an erythematous base. Easily ruptures and it’s painful. Primary episode more severe and can last from 2 to 4 weeks. Vesicle fluid and crust are contagious.
Herpes simplex
What is the diagnostic test for herpes
Herpes virus culture or RPR assay for HSV one and HSV-2 DNA (more sensitive)
What is an older test for herpes diagnosis
Tzanck Smear
For all cases of genital ulcers always rule out
Syphilis and HSV infection
What is the first episode treatment for herpes
Zovirax five times a day or Valtrex three times a day or famvir b.i.d. for 7 to 10 days
How do you treat episodic or herpes flareups
Zovirax or Valtrex or Famvir BID for five days
How do you use Imiquimod for genital warts
Apply a thin layer three times a week at bedtime for up to 16 weeks. Do not cover with dressing. Leave cream on skin for 6 to 10 hours. Wash off skin with soap and water after. Side effects include irritation, ulceration, erosions, and hypo pigmentation
What HPV strains are carcinogenic
16 and 18
How do you Evaluate a patient after sexual assault
Prophylactic postexposure treatment if refused then screen
NAATS for gonorrhea, chlamydia.
Wet mount and culture for trich, BV, Candida.
Serum HIV, hepatitis B and C, syphilis, consider HSV type 2 i.e. IgG
What is the appropriate follow-up care for a patient after sexual assault
1 to 2 weeks repeat the swab and wet mount.
Repeat the serology at six weeks, three and six months
What is the appropriate aftercare for A Sexual assault patient
Hepatitis B immunization, HPV vaccination.
Empiric treatment for chlamydia, gonorrhea, trichomonas, and BV.
Consider pep for HIV with zidovudine.
Emergency contraception i.e. pregnancy test
What medication should be given to patients after sexual assault or exposure
Ceftriaxone 250 mg IM plus metronidazole 2 grams oral plus azithromycin 1 g oral or doxycycline 100 mg b.i.d. for seven days
How long should a patient be treated with antibiotics if he has prostatitis secondary to an STD
14 days or longer
According to the CDC recommendations for non-occupational HIV exposure, a screening interval of how many weeks is recommended following initial negative testing
4-6 weeks
What Risk factor has the highest impact on HIV transmission
Viral load
A 32 year-old female was exposed to HIV after sexual intercourse. When do the majority of patients seroconvert if they are going to do so
Within three months
Chancroid is considered a cofactor for transmission of
HIV
HPV infection of the larynx has been associated with
Laryngeal Neoplasma
Complication of having pelvic inflammatory disease that was caused by vaginal infection such as gonorrhea or chlamydia
Fitz-Hugh-Curtis
How do you reveal subclinical lesions on the penile skin of a patient that presents with HPV infection
Apply acetic Acid to the penile shaft and look for Ace to white changes
The diagnosis of human papilloma virus infection in males is usually made by
Clinical appearance
An appropriate initial treatment for external genital warts caused by HPV in a non-pregnant patient is
Topical trichloroacetic acid (TCA)
