STD

Question 1

Infectious agent of gonorrhea

Answer 1

Neisseria gonorrheae

gram - intracellular diplococci

Question 2

Man presenting with yellow, creamy, profuse discharge from penis with burning

Answer 2

Gonorrhea

Question 3

Ways to dx gonorrhea

Answer 3

Gold Standard: culture
gram stain
can also do NAAT/PCR

-urine tests available, not as good

Question 4

Treatment for gonorrhea

Answer 4

Ceftriaxone 250mg IM once

+ Azithromycin 1g PO once

Question 5

If patient is allergic to traditional tx, what can be used for gonorrhea?

Answer 5

Azithromycin 2g PO once

Question 6

Infectious agent of chlamydia

Answer 6

C. trachomatis

Question 7

MC bacterial STD in men and women is

Answer 7

Chlamydia

Question 8

Man with dysuria and >5 WBCs on urine dipstick is suggestive of

Answer 8

Urethritis- likely chlamydia

Question 9

Pt with conjunctival redness, R knee arthritis, and dysuria

Answer 9

Reiter’s syndrome

linked to chlamydia

Question 10

What antibiotic specifically treats chlamydia

Answer 10

Azithromycin

Question 11

Risk factors for PID include

Answer 11

nulliparity
AA
multiple partners
douching
smoking
IUD

Question 12

Infectious agent of PID

Answer 12

Starts with GC/Chlamydia but is polymicrobial infection

Question 13

When is PID most common

Answer 13

around menses

-from disruption of natural barriers

Question 14

Unilateral adnexal pain, purulent cervical discharge, fever, chills, bleeding, post-coital bleeding, dyspareunia, dysuria
Chandelier sign

Answer 14

Pelvic Inflammatory Disease

Question 15

To dx PID

Answer 15

Its a clinical diagnosis
Pt has signs of STD and signs of inflammation

US- if concerned about ectopic pregnancy or abscess

Question 16

Treatment of outpatient PID

Answer 16

Ceftriaxone 250 IM once (gets gonorrhea)
Doxycycline 100mg PO BID x 14 days
+/- Flagyl 500mg PO BID x 14 days

Question 17

Treatment of TOA

Answer 17

requires surgical or transcutaneous debridement

follow up US to assess for resolution

Question 18

Infectious agent of syphilis

Answer 18

Treponema pallidum

Question 19

Risk of acquiring syphilis when contacted

Answer 19

50%

Question 20

Major sxs of secondary syphilis

Answer 20

Rash, “copper penny lesions”

Question 21

What are condyloma latas and when do they occur

Answer 21

Weeping papules in moist skin regions

During secondary syphillis

Question 22

Presentation of tertiary sphyillis

Answer 22

Gummas- granulomatous tumors of skin, liver, bone
Aortic aneurysms
CNS- dementia, psychosis, polyneuropathy,focal
*Argyl Robinson pupil

Question 23

An argyle robinson pupil does what

Answer 23

accommodates but doesn’t react

Question 24

Can dx syphilis via

Answer 24

Dark Field Microscopy
-useful early, not great on mouth
VDRL of RPR for SCREENING
-may be a lot of false (+)
-If + get FTA-ABS
FTA-ABS
-once positive, then + for life

Question 25

Neursyphilis dx

Answer 25

``` clinical findings + LP: -elevated protein -lymphocytic pleocytosis -CSF VDRL may be + -CSF FTA-ABS + ```

Question 26

Tx of primary, secondary, and early latent syphilis

Answer 26

Benzathine Penicillin G 2.4 million units IM once if unsure, will do it over 3 weeks

Question 27

Primary, secondary, and early latent syphilis treatment in PCN allergy pt

Answer 27

Doxycycline for ~ a month depending on the stage

Question 28

When is FU done for syphilis treatment

Answer 28

Serological testing done at 6 and 12m that include RDR titers

Question 29

Neurosyphilis tx

Answer 29

3 options: Aqueous PCN G 24mill units IV daily Procaine penicillin 2.4 mill units IM daily w/probenicid Ceftriaxone 2g IV daily - all for 2 weeks - f/u with LP for 6m

Question 30

What is Jarisch-Herxheimer reaction

Answer 30

complication of treatment of syphilis. Is self limiting. hypersensitivity reaction of host rapid destruction of syphilis bacteria and release of lipoproteins into serum leading to systemic hypersensitivity rxn -usually within first 24hrs tx -fevers, chills, HoTN

Question 31

How do you tx Jarisch-Herxheimer reaction

Answer 31

antipyretics | continue abx unless syphilitic laryngitis, auditory neuritis, or labryinthitis develops

Question 32

Syphilis in pregnancy treated with

Answer 32

PCN only - no doxycycline w/developing fetus - require desensitization if allergic

Question 33

what are rhagades

Answer 33

scars around mouth or nose seen in congenital syphilis

Question 34

what are Hutchinson teeth?

Answer 34

permanent upper incisor that are peg shaped with a central notch seen in congenital syphilis

Question 35

Influencing factors determining if pt gets genital herpes clinically

Answer 35

immune status, viral serotype, females more predisposed

Question 36

Gold standard to dx HSV

Answer 36

Tissue culture= Gold Standard Tzank Smear- multinucleated giant cells -More likely to get swab of sore and DFA test

Question 37

Characteristic sign HSV encephalitis

Answer 37

Temporal lobe enhancement on MRI

Question 38

When is antibody testing used for HSV diagnosis

Answer 38

To document seroconversion only! | Does not distinguish active or latent infection, or predict recurrences

Question 39

What HPV strains are most commonly associated with genital warts

Answer 39

6 & 11

Question 40

What HPV strains are most commonly associated with cervical cancer/neoplasia

Answer 40

16 & 18 | Also ( 31,33,35)

Question 41

What age group is indicated to receive HPV prevention Gardasil

Answer 41

Females and males 9-26yrs | males 22-26 immunocomp

Question 42

Causitive agent of chancroid

Answer 42

Haemophilus ducreyia

Question 43

Painful necrotizing genital ulcers with inguinal LAD

Answer 43

Chancroid

Question 44

Causative agent of lymphogranuloma venereum

Answer 44

C. trachomoatis | Serotypes L1,L2, L3

Question 45

Proctitis with bleeding, tenesmus, purulent discharge, rectal ulcers, and constitutional symptoms

Answer 45

LGV- lymphogranulma venereum

Question 46

To dx LVG

Answer 46

Clinical findings with NAAT for confirmation with genotyping for serotypes

Question 47

Causative agent of Molluscum

Answer 47

poxviurs

Question 48

Causative agent of Trichomonas

Answer 48

flagellated protozoal T. vaginalis

Question 49

Copious frothy green/yellow discharge with odor and pruritis | Strawberry cervix

Answer 49

Trichomonas

Question 50

Main way to dx Trichomonas

Answer 50

Wet Mount showing motile trichomonads

Question 51

Tx for Trichomonas

Answer 51

Flagyl 2 different length options 1 day or 7 days if unsure if BV, do 7 day dose

Question 52

Which type of hepatitis is likely to be transmitted as STD?

Answer 52

Hep B