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STI Flashcards
AIDS is defined by an absolute CD4 cell count of fewer than
200
CD4 levels that are healthy are
500-1400
s/s of aids includes
Signs and symptoms that suggest AIDS include those caused by AIDS-defining opportunistic infections such as oral candidiasis, tuberculosis (TB), Pneumocystis jirovecii pneumonia, central nervous system (CNS) toxoplasmosis, histoplasmosis, cryptosporidiosis, Kaposi’s sarcoma (purple to bluish-red bumps on the skin), and many others.
leading cause of opportunistic infection in patients with HIV.
P. jirovecii
Pneumocystis pneumonia (PCP) prophylaxis is advised when CD4 count is
<200
f STD symptoms with new onset of swollen red knee on side (or another joint), may be caused by
DGI - Disseminated Gonococcal Infection
most common STD in the US is
chlamydia. C trachomatis
lab test for both gonorrhea and chlamydia is
Nucleic acid amplification test (NAAT)
used for pregnant patients who have chlamydia.
azithromycin and test of cure needed 3 - 4 weeks after treatment
Treatment for chlamydia is
Doxycycline 100 mg BID × 7 days: preferred agent for nonpregnant individuals
Know first-episode treatment for genital herpes
(acyclovir [Zovirax] TID or valacyclovir [Valtrex] BID or famciclovir TID × 7 to 10 days).
flare-up treatment for genital herpes is
(acyclovir [Zovirax] or valacyclovir [Valtrex] or famciclovir [Famvir] × 2–5 days).
Diagnostic test: Herpes
viral culture or PCR assay for HSV-1 and HSV-2 RNA (more sensitive).
Tzanck smear shows
multinucleated giant cells with herpes virus infection (varicella, herpes simplex).
f a patient on ART has a CD4 count that increases (from CD4 200 to 400 copies/mL), it suggests that
the immune sx is getting better
With dapsone, first check patient for
glucose-6-phosphate dehydrogenase (G6PD) anemia due to risk of hemolysis (about 10% of African American males have G6PD).
f hairy leukoplakia of tongue, recurrent candidiasis, or thrush, rule out
HIV infection
first-line agent for the prophylaxis of PCP;Pneumocystis Pneumonia
Bactrim DS if allergic to sulfa use Dapsone
bactrim is also prophylatcti tx
Screening test to diagnose HIV infection.
HIV-1/HIV-2 antibody with p24 antigen with reflexes
If positive, lab will perform HIV-1/HIV-2 antibody differentiation immunoassay to confirm initial test.
Antibody-only tests; can be used as initial test to screen for HIV infection as early as 3 weeks after exposure to the virus.
ELISA positive follow up with HIV-1 and HIV-2 diff assay or HIV western blot
ests for HIV virus directly. Used for infants of HIV-positive mothers. Diagnoses acute HIV infection (window stage). Use if indeterminate result on antibody–antigen testing.
HIV RNA PCR
The HIV antibody/antigen test (fourth generation) can detect infection
18-45 days after exposure
condyloma acuminata
genital warts
condyloma lata
secondary syphillis
an immune-modulator treatment for genital warts, and patient can use at home.
imiquimod
HPV straints what are oncogenic/carcinogenic
16 and 18
treatments of genital wart in pregnancy that are no used are
podophyllotoxin and imiquimod
Treat uncomplicated gonorrhea with
ceftriaxone IM 500 mg × one dose. Cotreat for chlamydia only when chlamydial infection has not been excluded.
All patients with proctitis—treatment
for gonorrhea and chlamydial infection: Ceftriaxone 500 mg IM as a single dose (1 g if weight ≥150 kg) plus doxycycline 100 mg BID for 7 days
most sensitive physical exam finding for PID
adnexal tenderness
Sexually active young woman with acute onset of lower abdominal or pelvic pain that is one-sided or bilateral with new vaginal discharge and/or intermenstrual bleeding. Evidence of cervical motion, uterine, or adnexal tenderness on exam. Reports painful intercourse (dyspareunia). Inflammation of fallopian tubes (salpingitis). May walk in a shuffling gait to avoid jarring pelvis, which is painful. Jumping/running aggravates pelvic pain. Associated fever and chills may occur. Some develop perihepatitis (with right upper quadrant [RUQ] tenderness), peritonitis, and tubo-ovarian pelvic abscess.
PID
Treatment for PID is
Antibiotic regimen for outpatients: Ceftriaxone (Rocephin) 500 mg IM (or 1 g for individuals >150 kg) × one dose plus doxycycline 100 mg PO BID for 14 days plus metronidazole 500 mg PO BID for 14 days.
Follow-up: Evaluate for clinical improvement within 72 hours.
Inflammation of the liver capsule and peritoneal surfaces of the anterior RUQ; minimal stromal hepatic involvement. Manifests as a patchy purulent and fibrinous exudate (“violin strings” seen on laparoscopy). Characterized by RUQ abdominal pain and tenderness on palpation with a distinct pleuritic component. The liver function tests are usually normal or slightly elevated.
Fitz-Hugh–Curtis Syndrome (Perihepatitis)
STI caused by the
spirochete Treponema pallidum.
screening tests for syphilis.
RPR and VDRL
If positive RPR or VDRL (nontreponemal test), confirm with FTA-ABS (treponemal test). If reactive RPR and reactive FTA-ABS, this is diagnostic for syphilis in patients without a history of prior syphilis.
Treatment for syphillis is
Benzathine penicillin G 2.4 million units IM once per week × 3 consecutive weeks
If penicillin allergy, doxycycline 100 mg PO BID for 28 days or ceftriaxone 2 g IV or IM daily for 10 to 14 days
Gonorrhea can infect the
pharynx and conjunctiva
A patient reports a history of a painless lesion about a month ago. The patient now presents with a rash, fever, headache, malaise, and complains of anorexia. The patient reports a history of unprotected sexual encounters with multiple partners. The patient denies any allergies. Based on this presentation, which of the following is the appropriate treatment course?
A.Single dose of penicillin G benzathine 2.4 million units intramuscularly (IM)
B.Penicillin G benzathine 2.4 million units IM once weekly for 3 weeks
C.Penicillin G 3 to 4 million units intravenously (IV) every 4 hours for 10 to 14 days
D.Doxycycline 100 mg orally two times per day for 14 days
A. Single dose of penicillin G benzathine 2.4 million units intramuscularly (IM)
The patient is presenting with signs and symptoms consistent with secondary syphilis. Weeks to months after infection, untreated individuals will develop secondary syphilis with systemic symptoms including fever, rash, headache, malaise, fatigue, and lymphadenopathy. Treatment for early syphilis (primary, secondary, and early latent syphilis) includes a single dose of penicillin G benzathine 2.4 million units IM. Treatment for late latent syphilis or tertiary syphilis includes penicillin G benzathine 2.4 million units IM once weekly for 3 weeks. For patients with neurosyphilis, treatment includes penicillin G 3 to 4 million units IV every 4 hours for 10 to 14 days. If patients are allergic to penicillin, doxycycline is an appropriate treatment alternative.
Which of the following antigens is a component of the HIV 1/2 combination antibody/antigen testing?
A.p24
B.p20
C.p18
D.p14
Answer: A. p24
The p24 antigen appears early in HIV infection and enables earlier detection. The preferred test for HIV screening is the fourth-generation HIV 1/2 combination antibody with p24 antigen test. If there is a strong suspicion of HIV infection, also order the HIV RNA polymerase chain reaction (PCR) test, which detects the HIV virus directly. p20, p18, and p14 are not components of the HIV 1/2 combination antibody/antigen testing.
A patient with HIV presents for routine annual lab work. The CD4 count is 175 cells/mcL. The patient denies any allergies. Which of the following prophylactic antimicrobials is indicated based on this CD4 cell count?
A.Trimethoprim-sulfamethoxazole is indicated to prevent toxoplasmosis.
B.Metronidazole is indicated to prevent histoplasmosis.
C.Azithromycin is indicated to prevent cryptococcus.
D.Trimethoprim-sulfamethoxazole is indicated to prevent pneumocystis pneumonia.
Trimethoprim-sulfamethoxazole is indicated to prevent pneumocystis pneumonia.
Antimicrobial therapy is indicated in certain patients with HIV to prevent an opportunistic infection. Trimethoprim-sulfamethoxazole is indicated to prevent pneumocystis pneumonia in patients with a CD4 count ≤200 cells/mcL. Alternative agents include dapsone, atovaquone suspension, or aerosolized pentamidine. For patients with a CD4 count ≤150 cells/mcL, antifungal prophylaxis is not indicated to prevent infection with histoplasmosis due to limited evidence. For patients with CD4 counts ≤100 cells/mcL, trimethoprim-sulfamethoxazole is indicated to prevent reactivation of Toxoplasma gondii and a positive T. gondii IgG serology. Preventive therapy for cryptococcal disease is not recommended; however, screening may be useful in certain patients.
Which of the following is the specimen of choice when screening male patients using the nucleic acid amplification test (NAAT)?
A.Urethral swab
B.First-catch urine
C.Meatal swab
D.Rectal swab
First clean catch
A sexually active 16-year-old patient with cervicitis is tested for gonorrhea and chlamydia. The nucleic acid amplification test (NAAT) result shows that the patient is positive for gonorrhea. Which of the following is appropriate treatment for this patient?
A.Cephalosporin
B.Cephalosporin and macrolide
C.Tetracycline
D.Tetracycline and sulfonamide
Answer: A. Cephalosporin
As of December 2020, the Centers for Disease Control and Prevention recommends that patients with gonorrhea-positive testing be treated with a higher dose of cephalosporin than previously recommended. Additionally, the recommendation for cotreatment of chlamydia with positive gonorrhea has been removed, provided chlamydia status is confirmed negative. The first-line treatment for gonorrhea-positive culture is ceftriaxone 500 mg intramuscularly (IM) for patients who weigh ≤150 kg and 1 gram IM for patients who weigh ≥150 kg. If the patient has a cephalosporin allergy, the recommended alternative is 240 mg IM plus azithromycin 2 g orally. Screening for gonorrhea again in 3 months is recommended due to the high rates of reinfection.
Which human papillomavirus (HPV) strains are oncogenic and cause the majority of cervical cancer cases?
A. HPV 6 and HPV 11
B. HPV 16 and HPV 18
C. HPV 2 and HPV 4
D. HPV 40 and HPV 51
Answer: B. HPV 16 and HPV 18
Most cases of cervical cancer are caused by HPV. HPV 16 and HPV 18 cause 70% of cervical cancer cases in the United States. There are more than 150 HPV types. HPV can also cause cancer of the vulva, vagina, penis, and anus, as well as oropharyngeal cancers.
xA patient presents with a painless chancre; this is most characteristic of which stage of syphilis disease?
A.Late
B.Primary
C.Secondary
D.Tertiary
Primary
The Jarisch-Herxheimer reaction is a response to treatment of which of the following organisms?
A.Neisseria gonorrhoeae
B.Chlamydia trachomatis
C.Treponema pallidum
D.Rickettsia rickettsii
Answer: C. Treponema pallidum
The Jarisch-Herxheimer reaction is an immune reaction caused by treatment of the spirochete T. pallidum (syphilis) with benzathine penicillin G, given by intramuscular injection. When large amounts of treponema are killed, it releases foreign antigens that the body responds to with symptoms such as fever, chills, headache, myalgia, tachycardia, and increased respiratory rate, all of which occur in the first few hours after treatment and peak in 6 to 8 hours. It is a self-limited reaction. Treatment is corticosteroids, antipyretics, and general supportive measures. Other spirochete bacteria that may elicit this reaction are Borrelia burgdorferi (Lyme disease) and Leptospira leptospirosis, also known as Weil’s disease or swamp fever.
A 30-year-old male patient with a history of HIV infection has been on antiretroviral therapy (ART) since diagnosis at age 28 years. Which of the following indicates that the patient’s immune system is responding to ART?
A.HIV viral load is higher compared with the previous test.
B.CD4 count is higher compared with the previous test.
C.Complete blood count (CBC) shows an increase in leukocyte count.
D.Genetic testing of the patient’s HIV strain shows that it is sensitive to current HIV regimen.
Answer: B. CD4 count is higher compared with the previous test.
One of the best indicators that the patient is responding to the ART regimen is an increase in the CD4 count. Another indicator is a decrease in the viral load. An increased leukocyte count seen on the CBC may indicate worsening infection, inflammation, or injury. Genetic testing is not used to assess treatment response.
A female patient presents with cauliflower-shaped, pedunculated, flesh-colored warts that vary in size and are generalized in the vulva and perineum area. The patient reports a history of unprotected sexual activity; a pregnancy test is positive, and the patient indicates an interest in continuing the pregnancy. Based on this presentation, which of the following is the preferred treatment option for this patient?
A.Imiquimod cream
B.Podophyllin cream
C.Sinecatchins ointment
D.Trichloroacetic acid
Answer: D. Trichloroacetic acid
The patient is presenting with clinical manifestations suggestive of condylomata acuminata (anogenital warts). The preferred medical treatment for pregnant patients is trichloroacetic acid because it has no systemic absorption or known fetal effects. Cryoablation is also considered safe and effective for pregnant patients. Podophyllin, podophyllotoxin, and interferons are contraindicated due to the potential for fetal harm. Imiquimod and sinecatechins are not recommended due to limited evidence and potential for fetal harm.
Which information will the nurse practitioner include when providing education to a male patient who has been prescribed treatment for uncomplicated rectal gonorrhea?
A.“Return to the clinic in 6 months for repeat testing for HIV infection.”
B.“Any sexual partners you have within 30 days of being diagnosed with the infection will need to be evaluated for treatment.”
C.“Abstain from sexual contact for 7 days after you finish the treatment and your symptoms resolve.”
D.“Return to the clinic 14 days after completing your prescribed treatment for repeat testing.”
Solution: C
“Abstain from sexual contact for 7 days after you finish the treatment and your symptoms resolve.”
To prevent reinfection the nurse practitioner will inform the patient to abstain from sexual contact for 7 days after the resolution of symptoms and treatment. It is recommended that all patients diagnosed with gonorrhea be tested for other sexually transmitted infections, including HIV; however, HIV testing would be repeated only if there were unrelated concerns. Any of the patient’s sexual partners, within 60 days of the patient’s symptoms or diagnosed infection, will require evaluation for treatment. Only patients with pharyngeal gonorrhea who are treated with an alternative regimen will be instructed to return for a test of cure 14 days after treatment. The Centers for Disease Control and Prevention (CDC) recommends that all patients treated for gonorrhea be retested 3 months after treatment.
Which of the following is the most common pathogen associated with sexually acquired reactive arthritis?
A.Neisseria gonorrhoeae
B.Chlamydia trachomatis
C.Treponema pallidum
D.Escherichia coli
Answer: B. Chlamydia trachomatis
Reactive arthritis is a rare disease that can occur following a sexually transmitted infection; C. trachomatis appears to be the most common pathogen associated with sexually acquired reactive arthritis. Other inciting pathogens include Campylobacter, Salmonella, and Shigella.
Which of the following is a risk factor for pelvic inflammatory disease (PID)?
A.Choice of contraceptive method
B.Female patient age 40 years
C.Multiple sexual partners
D.Family history of PID
Answer: C. Multiple sexual partners
Risk factors for PID include sex (primary risk factor); multiple sexual partners; sexually transmitted infection in the sexual partner; age (highest frequency among those age 15 to 25 years; incidence in female patients older than 35 years is only one seventh that in younger female patients); a personal previous episode of PID; and other conditions (e.g., complete disruption of the vaginal ecosystem). The choice of contraceptive method does not clearly affect the risk of PID; however, consistent and correct condom use has been found to reduce the risk significantly.
A patient with HIV presents for routine annual lab work. The CD4 count is 175 cells/mcL. The patient denies any allergies. Which of the following prophylactic antimicrobials is indicated based on this CD4 cell count?
A.Trimethoprim-sulfamethoxazole is indicated to prevent toxoplasmosis.
B.Metronidazole is indicated to prevent histoplasmosis.
C.Azithromycin is indicated to prevent cryptococcus.
D.Trimethoprim-sulfamethoxazole is indicated to prevent pneumocystis pneumonia.
Answer: D. Trimethoprim-sulfamethoxazole is indicated to prevent pneumocystis pneumonia.
Antimicrobial therapy is indicated in certain patients with HIV to prevent an opportunistic infection. Trimethoprim-sulfamethoxazole is indicated to prevent pneumocystis pneumonia in patients with a CD4 count ≤200 cells/mcL. Alternative agents include dapsone, atovaquone suspension, or aerosolized pentamidine. For patients with a CD4 count ≤150 cells/mcL, antifungal prophylaxis is not indicated to prevent infection with histoplasmosis due to limited evidence. For patients with CD4 counts ≤100 cells/mcL, trimethoprim-sulfamethoxazole is indicated to prevent reactivation of Toxoplasma gondii and a positive T. gondii IgG serology. Preventive therapy for cryptococcal disease is not recommended; however, screening may be useful in certain patients.
Which of the following is the specimen of choice when screening male patients using the nucleic acid amplification test (NAAT)?
A.Urethral swab
B.First-catch urine
C.Meatal swab
D.Rectal swab
Answer: B. First-catch urine
Although NAAT can be performed on urethral, meatal, and rectal swabs, first-catch urine is the specimen of choice when screening male patients for Chlamydia trachomatis and Neisseria gonorrhoeae infections. The vaginal swab is the specimen of choice for female patients.
A female patient presents with cauliflower-shaped, pedunculated, flesh-colored warts that vary in size and are generalized in the vulva and perineum area. The patient reports a history of unprotected sexual activity; a pregnancy test is positive, and the patient indicates an interest in continuing the pregnancy. Based on this presentation, which of the following is the preferred treatment option for this patient?
A.Imiquimod cream
B.Podophyllin cream
C.Sinecatchins ointment
D.Trichloroacetic acid
Answer: D. Trichloroacetic acid
The patient is presenting with clinical manifestations suggestive of condylomata acuminata (anogenital warts). The preferred medical treatment for pregnant patients is trichloroacetic acid because it has no systemic absorption or known fetal effects. Cryoablation is also considered safe and effective for pregnant patients. Podophyllin, podophyllotoxin, and interferons are contraindicated due to the potential for fetal harm. Imiquimod and sinecatechins are not recommended due to limited evidence and potential for fetal harm.
A patient presents with a fever and lower abdominal pain with pelvic discomfort. Acute cervical motion, uterine, and adnexal tenderness is noted on bimanual pelvic examination. The patient denies dysuria or other urinary symptoms. Which of the following tests is a priority to obtain for this patient?
A.Pregnancy test
B.Hepatitis panel
C.Urinalysis
D.C-reactive protein
Answer: A. Pregnancy test
The findings are presumptive of a clinical diagnosis of pelvic inflammatory disease (PID). For all female patients suspected of having PID, the following tests should be obtained: pregnancy test (to rule out ectopic pregnancy and complications of intrauterine pregnancy); microscopy of vaginal discharge (to assess for increased white blood cells); nucleic acid amplification tests (NAATs) for Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium; HIV screening; and serologic testing for syphilis (to rule out sexually transmitted infections that share similar risk factors with PID). While an erythrocyte sedimentation rate and C-reactive protein can often be obtained to assess severity, these tests have poor sensitivity and specificity for the diagnosis of PID. A urinalysis should be checked in female patients with urinary symptoms. Hepatitis virus testing may be indicated depending on the patient’s risk history, but it is not a priority at this time.
Which of the following is the most common pathogen associated with sexually acquired reactive arthritis?
A.Neisseria gonorrhoeae
B.Chlamydia trachomatis
C.Treponema pallidum
D.Escherichia coli
Answer: B. Chlamydia trachomatis
Reactive arthritis is a rare disease that can occur following a sexually transmitted infection; C. trachomatis appears to be the most common pathogen associated with sexually acquired reactive arthritis. Other inciting pathogens include Campylobacter, Salmonella, and Shigella.
Which of the following is a risk factor for pelvic inflammatory disease (PID)?
A.Choice of contraceptive method
B.Female patient age 40 years
C.Multiple sexual partners
D.Family history of PID
Answer: C. Multiple sexual partners
Risk factors for PID include sex (primary risk factor); multiple sexual partners; sexually transmitted infection in the sexual partner; age (highest frequency among those age 15 to 25 years; incidence in female patients older than 35 years is only one seventh that in younger female patients); a personal previous episode of PID; and other conditions (e.g., complete disruption of the vaginal ecosystem). The choice of contraceptive method does not clearly affect the risk of PID; however, consistent and correct condom use has been found to reduce the risk significantly.
A patient reports a history of a painless lesion about a month ago. The patient now presents with a rash, fever, headache, malaise, and complains of anorexia. The patient reports a history of unprotected sexual encounters with multiple partners. The patient denies any allergies. Based on this presentation, which of the following is the appropriate treatment course?
A.Single dose of penicillin G benzathine 2.4 million units intramuscularly (IM)
B.Penicillin G benzathine 2.4 million units IM once weekly for 3 weeks
C.Penicillin G 3 to 4 million units intravenously (IV) every 4 hours for 10 to 14 days
D.Doxycycline 100 mg orally two times per day for 14 days
Answer: A. Single dose of penicillin G benzathine 2.4 million units intramuscularly (IM)
The patient is presenting with signs and symptoms consistent with secondary syphilis. Weeks to months after infection, untreated individuals will develop secondary syphilis with systemic symptoms including fever, rash, headache, malaise, fatigue, and lymphadenopathy. Treatment for early syphilis (primary, secondary, and early latent syphilis) includes a single dose of penicillin G benzathine 2.4 million units IM. Treatment for late latent syphilis or tertiary syphilis includes penicillin G benzathine 2.4 million units IM once weekly for 3 weeks. For patients with neurosyphilis, treatment includes penicillin G 3 to 4 million units IV every 4 hours for 10 to 14 days. If patients are allergic to penicillin, doxycycline is an appropriate treatment alternative
The Jarisch-Herxheimer reaction is a response to treatment of which of the following organisms?
A.Neisseria gonorrhoeae
B.Chlamydia trachomatis
C.Treponema pallidum
D.Rickettsia rickettsi
Answer: C. Treponema pallidum
The Jarisch-Herxheimer reaction is an immune reaction caused by treatment of the spirochete T. pallidum (syphilis) with benzathine penicillin G, given by intramuscular injection. When large amounts of treponema are killed, it releases foreign antigens that the body responds to with symptoms such as fever, chills, headache, myalgia, tachycardia, and increased respiratory rate, all of which occur in the first few hours after treatment and peak in 6 to 8 hours. It is a self-limited reaction. Treatment is corticosteroids, antipyretics, and general supportive measures. Other spirochete bacteria that may elicit this reaction are Borrelia burgdorferi (Lyme disease) and Leptospira leptospirosis, also known as Weil’s disease or swamp fever.
A patient presents with painful genital ulcers and generalized symptoms of fever, headache, and fatigue. Upon physical examination, the vesicles are 2 to 4 mm with underlying erythema and are progressing to erosions and ulcerations. The patient denies a history of genital lesions and reports that this is the first occurrence. Based on this presentation, which of the following is the appropriate therapy?
A.Valacyclovir 1,000 mg orally twice a day for 7 to 10 days
B.Intravenous acyclovir 5 mg/kg every 8 hours for 5 days
C.Famciclovir 250 mg orally twice a day for an extended duration with required follow-up
D.Topical acyclovir applied to the lesions twice a day
Answer: A. Valacyclovir 1,000 mg orally twice a day for 7 to 10 days
This patient is presenting with clinical manifestations consistent with genital herpes simplex virus (HSV) infection; the characteristic lesions of HSV begin as grouped 2- to 4-mm vesicles with underlying erythema that progress to vesicles, pustules, erosions, and ulcerations. Vesicles and pustules may have an umbilicated appearance due to central depression. Systemic symptoms may occur during the first episode, such as fever, headache, malaise, and myalgias. Antiviral therapy is indicated for most patients experiencing a first episode of genital HSV; treatment should be started within 72 hours of lesion appearance. For a first episode, valacyclovir 1,000 mg orally twice daily for 7 to 10 days is recommended along with acyclovir 400 mg three times daily and famciclovir 250 mg three times daily. Parenteral therapy is indicated in patients with a complicated infection (e.g., central nervous system involvement, end-organ disease, disseminated HSV). Chronic suppressive therapy may be indicated for patients with severe or frequent recurrence or for immunocompetent patients. Topical antiviral therapy is not recommended in the treatment of genital herpes.
A young adult patient presents with fever, lower abdominal tenderness, and pelvic discomfort. The patient reports being sexually active. A recent pregnancy test was negative. The physical assessment reveals acute cervical motion, uterine, and adnexal tenderness on bimanual pelvic examination, and mucopurulent vaginal discharge. The patient denies a history of dysuria or urinary frequency. These findings are suggestive of which diagnosis?
A.Ectopic pregnancy
B.Cystitis
C.Pelvic inflammatory disease
D.Appendicitis
Answer: C. Pelvic inflammatory disease
A clinical diagnosis of pelvic inflammatory disease is highly suggested in sexually active young female patients who are at risk for sexually transmitted infections. Often, patient presentation includes pelvic or lower abdominal pain and evidence of cervical motion, uterine, or adnexal tenderness. Additional supportive findings include fever, mucopurulent discharge or cervical friability, presence of white blood cells on microscopy of vaginal secretions, and detection of genital infection with Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium. While cervical motion tenderness may be found in other conditions, such as appendicitis and ectopic pregnancy, the patient’s pain is not localized to the right iliac fossa, and the patient does not have a positive pregnancy test. Cystitis is also less likely because the patient denies a history of urinary frequency and/or dysuria.
Which human papillomavirus (HPV) strains are oncogenic and cause the majority of cervical cancer cases?
A. HPV 6 and HPV 11
B. HPV 16 and HPV 18
C. HPV 2 and HPV 4
D. HPV 40 and HPV 51
Answer: B. HPV 16 and HPV 18
Most cases of cervical cancer are caused by HPV. HPV 16 and HPV 18 cause 70% of cervical cancer cases in the United States. There are more than 150 HPV types. HPV can also cause cancer of the vulva, vagina, penis, and anus, as well as oropharyngeal cancers.
A 30-year-old male patient with a history of HIV infection has been on antiretroviral therapy (ART) since diagnosis at age 28 years. Which of the following indicates that the patient’s immune system is responding to ART?
A.HIV viral load is higher compared with the previous test.
B.CD4 count is higher compared with the previous test.
C.Complete blood count (CBC) shows an increase in leukocyte count.
D.Genetic testing of the patient’s HIV strain shows that it is sensitive to current HIV regimen.
Answer: B. CD4 count is higher compared with the previous test.
One of the best indicators that the patient is responding to the ART regimen is an increase in the CD4 count. Another indicator is a decrease in the viral load. An increased leukocyte count seen on the CBC may indicate worsening infection, inflammation, or injury. Genetic testing is not used to assess treatment response.
During a community education session on sexually transmitted infections, the nurse practitioner advises the group that gonorrhea can infect the: (Select all that apply.)
A.Sinuses
B.Pharynx
C.Conjunctiva
D.Lungs
E.Small intestines
Solution: B and C
Pharynx and Conjunctiva.
Neisseria gonorrhoeae is a gram-negative bacteria that causes a gonorrhea infection. In addition to typical genitourinary sites, gonorrhea infections can also occur in the prostate, pharynx, and anorectum areas. Gonococcal ophthalmia neonatorum is a conjunctival gonorrhea infection that primarily affects newborns. The sinuses, lungs, and small intestines are not potential sites for infection.
Which information will the nurse practitioner include when providing education to a male patient who has been prescribed treatment for uncomplicated rectal gonorrhea?
A.“Return to the clinic in 6 months for repeat testing for HIV infection.”
B.“Any sexual partners you have within 30 days of being diagnosed with the infection will need to be evaluated for treatment.”
C.“Abstain from sexual contact for 7 days after you finish the treatment and your symptoms resolve.”
D.“Return to the clinic 14 days after completing your prescribed treatment for repeat testing.”
Abstain from sexual contact for 7 days after you finish the treatment and your symptoms resolve.”
To prevent reinfection the nurse practitioner will inform the patient to abstain from sexual contact for 7 days after the resolution of symptoms and treatment. It is recommended that all patients diagnosed with gonorrhea be tested for other sexually transmitted infections, including HIV; however, HIV testing would be repeated only if there were unrelated concerns. Any of the patient’s sexual partners, within 60 days of the patient’s symptoms or diagnosed infection, will require evaluation for treatment. Only patients with pharyngeal gonorrhea who are treated with an alternative regimen will be instructed to return for a test of cure 14 days after treatment. The Centers for Disease Control and Prevention (CDC) recommends that all patients treated for gonorrhea be retested 3 months after treatment.
Which of the following includes appropriate screening guidelines for sexually transmitted infections (STIs), according to the Centers for Disease Control and Prevention (CDC)?
A.Screening for chlamydia is not required for men who have sex with men if they practice consistent condom use.
B.All pregnant patients should be screened for herpes simplex virus-2 (HSV-2) at their first prenatal visit.
C.A heterosexual 20-year-old male patient who is in a monogamous relationship should be screened for gonorrhea annually.
D.A sexually active female patient who is 35 years old and has a history of gonorrhea should be screened for chlamydia.
Answer: D. A sexually active female patient who is 35 years old and has a history of gonorrhea should be screened for chlamydia.
According to the CDC, all sexually active female patients who are 25 years old should be screened for chlamydia and gonorrhea. Screen sexually active women older than 25 years if they are at increased risk (e.g., previous or coexisting STI, history of exchanging money or drugs for sex). Men who have sex with men should be screened at least annually for chlamydia, gonorrhea, and syphilis regardless of condom use. All pregnant patients younger than 25 years should be screened for chlamydia, gonorrhea, and syphilis; those older than 25 years at increased risk should be screened as well. Routine HSV-2 serologic screening among pregnant patients who are asymptomatic is not recommended. There is insufficient evidence for screening heterosexual men at low risk of infection for chlamydia and gonorrhea.
Which of the following antigens is a component of the HIV 1/2 combination antibody/antigen testing?
A.p24
B.p20
C.p18
D.p14
Answer: A. p24
The p24 antigen appears early in HIV infection and enables earlier detection. The preferred test for HIV screening is the fourth-generation HIV 1/2 combination antibody with p24 antigen test. If there is a strong suspicion of HIV infection, also order the HIV RNA polymerase chain reaction (PCR) test, which detects the HIV virus directly. p20, p18, and p14 are not components of the HIV 1/2 combination antibody/antigen testing.
A sexually active 16-year-old patient with cervicitis is tested for gonorrhea and chlamydia. The nucleic acid amplification test (NAAT) result shows that the patient is positive for gonorrhea. Which of the following is appropriate treatment for this patient?
A.Cephalosporin
B.Cephalosporin and macrolide
C.Tetracycline
D.Tetracycline and sulfonamide
Answer: A. Cephalosporin
As of December 2020, the Centers for Disease Control and Prevention recommends that patients with gonorrhea-positive testing be treated with a higher dose of cephalosporin than previously recommended. Additionally, the recommendation for cotreatment of chlamydia with positive gonorrhea has been removed, provided chlamydia status is confirmed negative. The first-line treatment for gonorrhea-positive culture is ceftriaxone 500 mg intramuscularly (IM) for patients who weigh ≤150 kg and 1 gram IM for patients who weigh ≥150 kg. If the patient has a cephalosporin allergy, the recommended alternative is 240 mg IM plus azithromycin 2 g orally. Screening for gonorrhea again in 3 months is recommended due to the high rates of reinfection.
