STDs

Question 1

What is + whiff amine test?

Answer 1

For BV, presence of a fishy odor when 10 percent potassium hydroxide (KOH) is added to a sample of vaginal discharge.

Question 2

What physical exam findings suggest PID?

Answer 2

Cervical motion, uterine, or adnexal tenderness, Abnormal cervical or vaginal mucopurulent discharge

Question 3

Lady is diagnosed with gonorrhea by NAAT urine screen. How should she be treated?

Answer 3

Treat for both gonorrhea and chlamydia, as infection is commonly concomitant. 250 mg Ceftriaxone IM + 1g Azithromycin PO x 1

Question 4

When diagnosed with chlamydia, gonorrhea or trichomoniasia, should the sexual partner be treated in addition to patient?

Answer 4

YES

Question 5

Treatment of uncomplicated chlamydia?

Answer 5

1 g azithromycin single dose OR 100 mg doxycycline bid for 7 days

Question 6

Is doxycycline safe in pregnant women?

Answer 6

NO

Question 7

A pregnant women is diagnosed with uncomplicated chlamydia at point of antenatal screening. How should you treat?

Answer 7

Single dose azithromycin 1 g. Doxycycline is not an option during pregnancy.

Question 8

What is recommended screening for gonorrhea and chlamydia?

Answer 8

annual screening when < 24 and in high risk older adults

Question 9

A man presents with a painless ulcer. What test do you send?

Answer 9

RPR or VDRL as this is likely syphillis. If +, confirm with FTA-ABS.

Question 10

Does treatment of syphillis vary with stage?

Answer 10

NO. All treated with IV Penicillin G.

Question 11

Women comes in for abdominal pain. On physical exam she has mucopurulent drainage from cervical os and cervical motion tenderness. How should she be treated?

Answer 11

Presumptive treatment for PID, likely secondary to ascending gonorrhea and/or chlamydia infection. Tx is ceftriaxone 250 mg IM + doxycycline 100 mg PO bid for 14 days

Question 12

Strawberry cervix and frothy discharge are buzz words for which STI?

Answer 12

Trichomoniasis

Question 13

Treatment for trichomoniasis?

Answer 13

2g dose oral metronidazole

Question 14

Before microscopy, what quick test can help determine cause of vaginitis?

Answer 14

pH strip, if > 4.5 likely BV

Question 15

A patient has yellow-green discharge in vaginal vault. What diagnostic tests can you run?

Answer 15

1) wet mount to visualize trichomonid flagellates and many WBCs
2) pH should be < 4.5
3) Culture of swab

Question 16

Why use KOH prep of wet mount?

Answer 16

KOH kills cellular debris making it easier to visualize yeast buds and hyphae when suspect vaginal candidiasis

Question 17

What is the Whiff test?

Answer 17

Production of fishy odor when 10% KOH solution is added to discharge. Consistent with BV.

Question 18

You suspect BV. What can aid in diagnosis?

Answer 18

1) Wet mount for clue cells.
2) KOH whiff test
3) pH > 4.5
4) Thin white/grayish d/c on side of vaginal vault walls

Question 19

Patient presents for white d/c and itchiness. Vaginal area is erythematous with excoriations and d/c is curd like. Wet mount microscopy shows hyphae with KOH prep. How should you treat.

Answer 19

Classic picture for vaginal candidiasis. Treat with vaginal suppository or single oral dose of fluconazole 150 mg

Question 20

Patient has cervicitis with mucopurulent drainage from endocervical os but no tenderness on bimanual exam. Test comes back + for chlamydia. How to treat?

Answer 20

1g azithromycin PO single dose + 250mg Ceftriaxone IM

Question 21

Lady has abdominal pain and cervical motion tenderness. How to treat?

Answer 21

250 mg Ceftriaxone IM + 100 mg doxycycline bid for 14 days

Question 22

If you have gonorrhea infection, treat for chlamydia as well?

Answer 22

YES

Question 23

If chlamydia infection, treat for gonorrhea infection as well?

Answer 23

NO

Question 24

Are treatments for trichomoniasis, chlamydia and candida vaginitis all available in single dose preparations?

Answer 24

YES