Sexually transmitted diseases LECT (Unrein)

Question 1

A 19 y/o male college student presents with a generalized macular rash, patchy hair loss, generalized lymphadenopathy and flat grey white lesions in the perianal area. In order to diagnose his disease, you should order which test first? He relates having unprotected sex two months ago.

A) Culture in a high CO2 environment
B) PCR for HPV types 6 and 11 
C) Urethral DNA probe
D) RPR
E) Gram stain

Answer 1

RPR

the patient has secondary syphilis (2 month incubation period)

disseminated maculopapular rash

can start out as a vesicle and quickly breaks down into painless chancre (smooth round border)

Question 2

incubation time for neisseria gonorrhea

Answer 2

acutely (2-6 days)

Question 3

culture in a high CO2 environment

Answer 3

Neisseria gonorrhoea

Question 4

Urethral DNA probe used to diagnose what

Answer 4

Neisseria gonorrhea and chlamydia trachomatis

Question 5

RPR used to diagnose what

Answer 5

rapid plasma reagin

antibody screenings for suspected syphilis

this is a blood test

very non specific and can be positive in things like pregnancy

confirm with fluorescent treponemal antibody testing

Question 6

gram stain made for diagnosis of what

Answer 6

neisseria gonorrhea and would identify gram negative diplococci intracellular organisms bean shaped organism

Question 7

A 26 y/o female presents with right lower quadrant tenderness equivocal for rebound tenderness, a low grade fever, normal bowel sounds, and exudative and tender cervical examination. Her white blood cell count is 15,000 (4,000-10,000/L). You suspect which organisms?

A) GI tract coliforms
B) Treponema pallidum
C) Human papillomavirus
D) Human Immunodeficiency Virus
E) Chlamydia trachomatis

Answer 7

chlamydia trachomatis

cervix has purulent exudative tender findings

Question 8

what is the treatment for syphilis

Answer 8

IM Penicillin

one dose for having it for less than 1 year

Question 9

GI Tract coliforms

Answer 9

acute appendicitis

Question 10

treponema pallidum

Answer 10

causative agent for syphilis

Question 11

HPV

Answer 11

causes condyloma acuminata and cervical cancer

usually asymptomatic early in the disease

Question 12

when evaluating and treating chlamydia trachomatis what other diseases must be considered

Answer 12

gonorrhea

Hep B and C

Syphilis

HIV

CMV

Trichomonas

Question 13

treatment for chlamydia trachomatis

Answer 13

macrolides–> erythromycin (these work on the ribosome 50S)

AND
tetracycline (work at the 30S ribosome)

NOT penicillin or cephalosporin
-Chlamydia doesn’t have a cell wall and these drugs treat bugs with cell wall

Question 14

A 35 y/o female presents with a thin gray vaginal discharge and vulvovaginal discomfort. She relates four current male sexual partners. None of her partners have any symptoms and have all been checked recently for sexually transmitted illness: all partners are negative. Pelvic exam notes normal appearing cervix that is non-tender. There is no unusual odor. Wet mount notes large numbers of leukocytes and motile organisms. You suspect the etiology to be:

A) Candida albicans
B) Gardnerella vaginalis
C) Trichomonas vaginalis
D) Chlamydia trachomatis
E) Neisseria gonorrhoeae

Answer 14

Trichomonas Vaginalis

perform wet mount in clinic and you will see motile organisms

STD and non STD

large numbers of leukocytes

men are often asymptomatic

Question 15

treatment for gonorrhea

Answer 15

ceftriaxone

Question 16

gardnerella vaginalis

Answer 16

not an STD

usually associated with fishy vaginal odor

few leukocytes on wet mount

Question 17

treatment for trichomonas vaginalis

Answer 17

metrondiazole

DON’T DRINK WITH THIS

Question 18

A 22y/o male presents with multiple painful vesicles on the glans of his penis. He relates a new unprotected sexual encounter after a concert one week ago. He has no discharge, but has bilateral swollen lymph nodes in the groin. You suspect the following most likely etiology:

A) Chlamydia trachomatis
B) Treponema pallidum
C) Haemophilus ducreyi
D) Herpes Simplex-2
E) Klebsiella granulomatis

Answer 18

vesicles !!! —> herpes simplex 2

lymph nodes in the groin

Question 19

haemophilus ducreyi

Answer 19

disease of third world countries

causes the disease chancroid

presents initially as a vesicular pustule but progresses to a painful genital ulcer

irregular border and a gray necrotic exudate at its base

unilateral LAD is common

associated with sex workers/ injection drug workers

Question 20

Klebsiella granulomatis

Answer 20

make this flashy

Question 21

A 24 y/o male presents to the community health center with an eight-day history of sore throat, generalized aches, fever and anorexia. Today he developed a trunk and abdominal rash. He has had multiple male and female sexual contacts and uses condoms variably. His last sexual encounter was four weeks ago. You are most suspicious of which infection:

A) Hepatitis B
B) Human papillomavirus
C) Herpes Simplex-1
D) Human Immunodeficiency Virus
E) Primary Treponema pallidum

Answer 21

HIV

nonspecific viral syndrome with a fever, sore throat, swollen lymph nodes

Question 22

how do you confirm the diagnosis of haemophilus ducreyi

Answer 22

Chocolate agar plate

Question 23

treatment of haemophilus ducreyi

Answer 23

Ceftriaxone
azithromycin
either one as a single dose

Question 24

how do you confirm the diagnosis of klebsiella granulomatis

Answer 24

tissue biopsy

Question 25

treatment of klebsiella granulomatis

Answer 25

erythromycin or tetracycline for 3 weeks

ampicillin for 12 weeks

this is a more deep seeded infection

Question 26

how do you confirm diagnosis herpes simplex 2

Answer 26

viral culture (vesilces) and serology - PCR

Tzanck smear (old test and operator dependent)

Question 27

treatment for herpes simplex 2

Answer 27

Acyclovir, famciclovir, valacyclovir

Question 28

A 20 y/o female presents to the emergency department with a new onset of a rash, fever, and joint pain. Initially the pain began in her right knee but has progressed to her right ankle and hip. Her rash is represented by scattered painful lesion on the hands and feet.

The suspected cause of this disorder is:
A) Chlamydia trachomatis
B) Treponema pallidum
C) Neisseria gonorrhoeae
D) Herpes Simplex-2
E) Human Immunodeficiency Virus

Answer 28

neisseria gonorrhea

disseminated gonorrhea occurs weeks after the primary infection

migratory polyarthritis (septic arthritis of muliple joints)

sparsely distributed necrotic pustules

common for women to present in the above fashion without GU complaints

Question 29

19 y/o female presents to you with a painless papule on her lip and cervical lymphadenopathy. You suspect which disorder? She relates a new unprotected sexual encounter 1 month ago.

A) Haemophilus ducreyi 
B) Neisseria gonorrhoeae
C) Treponema pallidum
D) Herpes Simplex-2
E) Human Immunodeficiency Virus

Answer 29

treponema pallidum

singular lesion
lymphadenopathy

Question 30

genital ulcers are caused by what

Answer 30

syphilis
herpes simplex
chancroid
lymphogranuloma venereum

Question 31

urethritis and cervicitis are caused by what

Answer 31

what?

make this

Question 32

genital warts are caused by what?

Answer 32

HPV

confusion with secondary syphilis