STDs

Question 1

States in which minors can provide consent for STD care

Answer 1

All of them

Question 2

Recommendations for routine annual screening for Neisseria gonorrheae

Answer 2

All sexually active females less than 25

Question 3

Routine annual screening for Chlamydia

Answer 3

Sexually active females less than 25 years old

Question 4

Yearly routine STD screening for MSM

Answer 4

Gonorrhea, chlamydia, syphilis

Question 5

Co-management of chlamydia in patients being treated for gonorrhea

Answer 5

For all, even if NAAT for C. Trachmotis is negative

Question 6

Test of cure and rescreening after treatment for gonorrhea

Answer 6

TOC at 14 days only if using cefixime; rescreen recommended at 3 months

Question 7

Incubation periods of gonorrhea, chlamydia, syphilis

Answer 7

Gonorrhea: 1-14 days
Chlamydia: 7-30 days
Syphilis (primary): 21 days

Question 8

Nontreponemal tests for syphilis

Answer 8

VDRL/RPR; Nontreponemal tests historically used for screening; antibody titers may correlate with disease activity and are used to follow response to treatment

Question 9

Treponemal tests for syphilis

Answer 9

Treponemal tests historically used to confirm infection i. T. pallidum enzyme immunoassay ii. Fluorescent treponemal antibody absorption (FTA-ABS)

Question 10

Stage with greatest risk of Jarisch-Herxheimer reaction

Answer 10

Primary syphilis (presumably higher organism burden)

Question 11

Follow-up testing in syphilis

Answer 11

Quantitative tests at 6 and 12 months after treatment for primary and secondary; fourfold reduction in titer considered adequate

Question 12

HSV initial infection characteristics

Answer 12

Incubation is 2–14 days. First-episode infection: Signs and symptoms i. Several painful pustular, vesicular, or ulcerative lesions on external genitalia; develop for 7–10 days and heal within 2–4 weeks

Question 13

Efficacy of prophylaxis in genital HSV

Answer 13

Reduces the frequency of recurrences by 70%–80% in patients who have common recurrences (defined variably as at least four to six episodes in 1 year or at least two episodes in 6 months), though it is also effective in individuals with less common recurrences

Question 14

Treatment options for genital warts

Answer 14

. Patient applied

i. Imiquimod 3.75% or 5% cream
ii. Podofilox 0.5% solution or gel
iii. Sinecatechins 15% ointment
Provider administered
i. Recommended treatment
(a) Cryotherapy
(b) Trichloroacetic or bichloracetic acid 80%–90%
(c) Surgical removal

Question 15

Pathogens in bacterial vaginosis

Answer 15

Caused by anaerobic bacteria (Prevotella sp. and Mobiluncus sp.), Gardnerella vaginalis,
Ureaplasma urealyticum, M. genitalium, and several fastidious anaerobic bacteria replacing
Lactobacillus

Question 16

Sexual partner treatment days cutoff

Answer 16

Generally 60 days (90 days for syphilis(

Question 17

Recurrent UTI definitions

Answer 17

Reinfections a. Infections occurring more than 14 days after the original UTI b. 80% of recurrent infections c. Recurrence of infection by organism different from that in the preceding infection, but potentially of the same genus and species

Question 18

Relapsing UTI definition

Answer 18

Within 14 days of original UTI; persistence of Sam organism

Question 19

Epidiymitis cause and treatment

Answer 19

Epididymitis (Domain 1, Tasks 3, 4, 5) 1. Clinical syndrome consisting of pain, swelling, and inflammation of the epididymis that lasts less than 6 weeks 2. Most likely caused by gonococcal and chlamydial infections (particularly in men younger than 35) a. Ceftriaxone 250 mg intramuscularly as a single dose plus doxycycline 100 mg orally twice daily for 10 days

Question 20

Conjunctivitis etiology

Answer 20

Viruses are the most common cause of infectious conjunctivitis (80%), particularly in the summer: Adenovirus, enterovirus, influenza 3. Bacteria are the second most common cause of infectious conjunctivitis, but they account for most cases in children and in the winter. Bacterial conjunctivitis is highly contagious. a. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis

Question 21

Classic symptoms of viral conjunctivitis

Answer 21

Pharyngoconjunctival fever: Abrupt onset of fever, pharyngitis, bilateral conjunctivitis, periauric-
ular lymph node enlargement

Question 22

Classic symptoms of bacterial conjunctivitis

Answer 22

Bacterial conjunctivitis

a. Mattering and adherence of the eyelids
b. Lack of itching
c. No history of conjunctivitis
d. Purulent or mucopurulent discharge

Question 23

Criteria for treatment of conjunctivitis

Answer 23

Children in day care or school
b. Health care workers
c. Hospitalized patients or patients living in health care facilities
d. Patients who are immunosuppressed, including those with uncontrolled diabetes or recent ocular
surgery
e. Patients who wear contact lenses
f. Patients presenting with purulent or mucopurulent discharge

Question 24

Antibiotic treatment principles and duration in conjunctivitis

Answer 24

All antibiotics are equally effective (see Table 2), so older, non-fluoroquinolones should be considered first because of concerns regarding emerging resistance and cost, except in patients who wear contact lenses (because the risk of Pseudomonas infection is high).

Usually, symptoms begin to resolve within first 24 hours of treatment

vii. Treatment duration (a) 10 days in children 2 years and younger or if severe symptoms (b) 7 days in children 2–5 years old and if mild to moderate symptoms (c) 5–7 days in children 6 years and older and if mild to moderate symptoms (d) 3 days if using ceftriaxone

Question 25

Topical antibiotics used for conjunctivitis

Answer 25

Gentamicin or tobramycin solution or ointment
Besifloxacin/Gatifloxacin/Levofloxacin/Moxifloxacin/Ofloxacin solution
Ciprofloxacin ointment
Erythromycin ointment
Azithromycin solution
Sulfacetamide ointment/solution
Bacitracin/polymyxin ointment
TMP/polymyxin solution