std

Question 1

what are the 5ps when educating for stds?

Answer 1

partners, practices, prevention IUP, protection STDs, past hx STds

Question 2

what diseases are on DDX if pt presents w genital, oral, vaginal lesions?

Answer 2

Chancroid, LGV, donovanosis, herpes, syphilis

Question 3

what should be on your DDX if pt presents w discharge?

Answer 3

Trich, BV, candida, gonorrhea, chlamydia

Question 4

what should be on your DDX if have constitutional sx?

Answer 4

HIV/AIDS, syphilis, herpes

Question 5

what is the PE of cervicitis?

Answer 5

red/ friable cervix with mucopurulent discharge

Question 6

how is the cervicitis diagnosed?

Answer 6

Gram stain >100 WBC per high power field and wet prep

Question 7

what are the 2 cervicitis?

Answer 7

Gc and chlamydia

Question 8

how is Chlamydia diagnosed?

Answer 8

Endocervical / vaginal swab for DNA culture; NAAT; and liquid based cytology

Question 9

What is the 1st line tx with Chlaymdia?

Answer 9

Azithromycin 1gm PO - single dose!

Question 10

How far back do sexual partners need to be test for Chlamydia?

Answer 10

Back 60 days need to be tested

Question 11

What are some complications of Chlamydia and Gc?

Answer 11

PID, sequelae, infertility, ectopic

Question 12

What are the PE findings of neisseria gonorrhoeae?

Answer 12

Friable cervix with mucopurulent discharge from rectum, pharynx, cervix, and eye

Question 13

How is Gc diagnosed?

Answer 13

endocervical/ vaginal swab for DNA culture; NAAT; liquid based cytology

Question 14

What is 1st line tx for cervical, rectal, or pharyngeal gc?

Answer 14

Ceftriaxone 250 mg IV PLUS Azithromycin 1 g PO - single dose

Question 15

What is 1st line tx for conjunctiva gc?

Answer 15

Ceftriaxone 1 g IV PLUS Azithromycin 1g PO

Question 16

How long does one need to abstain from sex after gc or Chlamydia?

Answer 16

Abstain 7 days after completion of Rx for both partner and patient.

Question 17

Is TOC needed for gc?

Answer 17

Not needed if uncomplicated rectal or urogenital w/ 1st line tx; UNLESS persistent sx, pregnancy, or suspected reinfection

Question 18

What is PID?

Answer 18

Upper genital tract spectrum inflammatory disorder

Question 19

What are some causes of PID?

Answer 19

N. gon, C. trach, vaginal anaerobes, G. vag, H. influ, gram neg rods

Question 20

What are some PE findings on PID?

Answer 20

uterine, cervical, adenexal tenderness plus 1 or more : > 101 fever, mucopurulent discharge +/ friable cervix, abundant WBC in vaginal fluid, elevated SED rate + / c reactive protein, + rapid test for gc or chlamydia

Question 21

How is PID diagnosed?

Answer 21

clinic, TVUS and laproscopy PRN

Question 22

Can tx of PID reverse damage?

Answer 22

No, only prevent future damage.

Question 23

What is FIRST LINE for OUTPATIENT tx for PID?

Answer 23

Ceftriazone IM PLUS doxycycline , +/- metronidazole bid

Question 24

What are C/I for outpt PID tx?

Answer 24

Vomit, febrile, pregnant, septic, surgical abdomen not present.

Question 25

What is the FIRST LINE tx for IN PATIENT PID?

Answer 25

IV Cephalosporin + IV doxycycline both q 12 hours

Question 26

When would inpatient tx for PID begin?

Answer 26

1. Failure to respond to outpt. tx in 24-72 hours 2. Do not tolerate out pt meds 3. Suspect tubal-ovarian abscess 4. Pregnancy 5. Unreliable patient

Question 27

What are the oncogenic high risk HPV strains? Low risk?

Answer 27

16 and 18 | 6 and 11

Question 28

How can the oncogenic HPVs be prevented?

Answer 28

Quadrivalent vaccine - 16,18,11 ,6 Bivalent - 16, 18 Nonavalent - the rest

Question 29

How is HPV transmitted

Answer 29

1. Genital skin to skin contact 2. Oral Genital skin to oral skin contact 3. Anal sex

Question 30

What will be visible on the PE if pt is HPV positive??

Answer 30

Condyloma acuminata

Question 31

Which HPV types are anogential warts related to?

Answer 31

90% 6,11

Question 32

How is it diagnosed (anogen warts)?

Answer 32

1. Visual of warts | 2. HPV test with cervical cytology or colposcopy

Question 33

Treatment of macroscopic warts?

Answer 33

1st line: imiquimod, wash areas 6-10 hours post application | 2. 1st line HCP - cryotherapy w/ liquid nitrogen r cryoprobe

Question 34

What are the side effects of imiquimod?

Answer 34

Local erythema, erosions, irritation, induration

Question 35

What are the side effects of cryotherapy?

Answer 35

Pain, blistering, necrosis

Question 36

How does HSV 1 manifest?

Answer 36

oral cold sores

Question 37

What will a first episode of Herpes present as?

Answer 37

Constitutional + adenopathy + lesion or lesions | Recurrent; prodrome + lesions

Question 38

How is Herpes diagnosed?

Answer 38

Cell culture and PCR

Question 39

What is being looked at in serology of Herpes?

Answer 39

HSV glycoproteins - G1 AND G2 , + results indicate anogenital infection

Question 40

What is FIRST LINE tx for Herpes?

Answer 40

ANTIVIRALS

Question 41

What is initial first line tx for Herpes?

Answer 41

antiviral - acylovir TID 7-10 x day

Question 42

What is the tx for established or recurrent Herpes?

Answer 42

Acyclovir TID, and acyclovir BID

Question 43

What is the tx for partner in Herpes?

Answer 43

Valacyclovir

Question 44

What is neurosyphilis?

Answer 44

Invasion of CNS by T. pallidum

Question 45

What are the early changes in neurosyphilis?

Answer 45

CN issues, meningitis, CVA, altered MS, eye/ear issues

Question 46

What is the primary stage of syphilis?

Answer 46

Chancre : 10-60 days post infected. Painless punched out ulcer Resolves on own 3-6 weeks +/- regional adenopathy

Question 47

When does the secondary stage of syphilis start ? When does it resolve?

Answer 47

4-8 weeks post chancre | On own in 3-12 weeks

Question 48

What are the sx of secondary syphilis?

Answer 48

Great imitator - generalized non-pruritic maculopapular rash (palms and soles) , fever, HA , malaise sore throat, condyloma lata : moist flat and grey

Question 49

When is the tertiary stage of syphilis?

Answer 49

10 -30 years post infection

Question 50

What are the PE findings in the tertiary stage of syphilis?

Answer 50

1. Gumma - necrotic/ nodular granulomatous lesion cutaneous - arciform, erythematous, eroded plaques with central scarring or cardiac CNS changes - late stage neurosyphilis

Question 51

What are the signs and sx of latent syphilis?

Answer 51

None

Question 52

What is the difference between early and late latent syphilis?

Answer 52

Acquired infection within preceding year vs. unknown duration or > 1 year

Question 53

How is syphilis diagnosed?

Answer 53

Dark field- definitive microscopy --> Serum, chancre, tissue, CSF serology- non-treponemal and trep

Question 54

What is non-trep?

Answer 54

VDRL - venereal dz research lab | RPR - rapid plasma reagin

Question 55

What is the trep test?

Answer 55

TP-PA = t. pallidum passice particle agglutination assay FTA- ABS = fluorescent trep antibody absorbed

Question 56

Qualified vs. Quantified serology results for syph?

Answer 56

Quant - 1:4, 1:8, 1:16, etc | Qual - FTA or TP-PA infection is reactive

Question 57

What is FIRST LINE tx for syphilis?

Answer 57

Benzathine PCN G IM

Question 58

How many doses of PCN do syphs pt need for primary, secondary, and early latent?

Answer 58

SINGLE DOSE of Benzanthine PCN G IM

Question 59

How many doses of PCN do syph pt need for late latent or unknown duration?

Answer 59

Weekly x 3 weeks of Benzanthine PCN G IM

Question 60

When do syph pts need to have clinical follow up?

Answer 60

6 and 12 months minimum

Question 61

What is Jarisch-Herxheimer rxn?

Answer 61

NOT a PCN rxn, Happens when all the organisms die off--> HA , fever within 24 hours of infection

Question 62

What is HIV/AIDS?

Answer 62

RNA retrovirus

Question 63

How is HIV/ AIDS diagnosed?

Answer 63

Rapid tests: prelim diagnosis w/in 30 minutes, if + get confirmed test - Serology : Antibody differentiation HIV 1 & HIV 2; HIV antigens, RNA assay - Serology : Combination HIV-1/HIV-2 antigen-antibody immunoassay & if positive: antibody differentiation HIV 1 & HIV 2