STI

Question 1

Most common STI in U.S.? Most commonly reported STI?

Answer 1

HPV

Chlamydia

Question 2

Symptoms of HPV in females

Answer 2

genital warts that cause dyspareunia, pruritus, burning

Question 3

Pap smear cytology results of HPV

Answer 3

cervical cell changes present:
LSIL - all subtypes
HSIL - 16 > 18

Question 4

> 90% of ________ associated with HPV.

Answer 4

cervical cancer

Question 5

When is HPV DNA testing NAAT done?

Answer 5

Triage ASC-US

Adjunct to pap screen for cervical cancer in women > 30

Question 6

Treatment of HPV on genitals

Answer 6

Podofilox 0.5% solution or gel (Condylox)

Imiquimod 5% cream (Aldara)

Question 7

What should be done next if HPV signs on cervical?

Answer 7

colposcopy, then possibly a biopsy

Question 8

Gold standard of HSV diagnosis?

Answer 8

viral culture of lesions

Question 9

Treatment of HSV

Answer 9

self-limiting, 10-12 days

Episodic:
Acyclovir 800 mg PO TID x 7-10 d OR
Valacyclovir 1000 mg PO BID x 7-10 d OR

Suppressive (+1 episode per month):
Acyclovir 400 mg BID for up to 5 years

Question 10

Painful clustered vesicular lesions on genitals that are cause itching, dysuria, and vaginal discharge.

Answer 10

HSV - genital or cervical herpes

Question 11

Who has annual screening for chlamydia and gonorrhea?

Answer 11

sexually active patients 25 and under

> 25 with risk factors

pregnant women in 1st trimester

Question 12

Chlamydia sx’s based on location

Answer 12

cervicitis: mucopurulent opaque dc, cervical bleeding, friability
urethritis: dysuria, pyuria, freq

Bartholinitis: swelling of gland

Question 13

Dx of chlamydia and gonorrhea

Answer 13

NAAT by swab or dirty urine

culture

Question 14

Treatment of Chlamydia

Answer 14

Azithromycin 1 g orally in a single dose (or doxy if allergic, unless pregnant use amoxicillin)

Add ceftriaxone for gonorrhea

Question 15

Partner management for patient’s with dx’d STI

Answer 15

eval and treat all partners within 60 days or last partner if > 60 days

Question 16

Sequelae of GC, Chlamydia, PID in women

Answer 16

infertility, ectopic pregnancy, chronic pelvic pain

Question 17

Disseminated gonorrhea

Answer 17

rare! Systemic, women>men, bacteremia without urogenital sx

skin lesions, arthralgia, tenosynovitis, arthritis, hepatitis, myocarditis, endocarditis, meningitis

Question 18

Gonorrhea treatment

Answer 18

Ceftriaxone 250 mg IM

Add Azithromycin 1 gram po x 1 to treat Chlamydia

Question 19

Etiologies of Pelvic Inflammatory Disease

Answer 19

Chlamydia and Gonorrhea (25-75% co-infected)

Other bacteria (E. coli, Bacteroides, streptococcus, etc.), endometritis, salpingitis, tubo ovarian abscess

Question 20

What can pap smear thin prep test for?

Answer 20

HPV, GC, Chlamydia

Question 21

mucopurulent vaginal dc, pelvic pain, dyspareunia. DDX?

Answer 21

Chlamydia, Gonorrhea, PID (+/-)

Question 22

Risk factors for PID

Answer 22

Risky sexual behavior
cervical ectopy (adolescence, OCP)
h/o STI
Douching
IUD
Bacterial vaginosis

Question 23

Hallmark findings of PID

Answer 23

Positive cervical motion tenderness

Uterine or adnexal pain

Question 24

gray vaginal discharge =

Answer 24

Gonorrhea

Question 25

Treatment of pelvic inflammatory disease

Answer 25

Treat with broad spectrum coverage to capture GC/CHL plus other vaginal organisms

Subclinical/Mild to mod: Ceftriaxone 250 mg IM in single dose + Doxycycline for 14 days
*Must follow up in 2 days; if worse admit for IV tx

Severe: admit; Cefotetan 2g IV q 12 hrs

Question 26

The risk of ________ is increased 6 to 8 fold after PID.

Answer 26

ectopic pregnancy

Question 27

Signs of severe PID that needs admission?

Answer 27

systemic finding: F/C, N/V, high WBC count

purulent vaginal discharge, severe pelvic pain

Question 28

Etiology of Syphilis

Answer 28

Treponema Pallidum

Question 29

What next if RPR/VDRL positive?

Answer 29

FTA-ABS

Question 30

Signs of secondary syphilis

Answer 30

mucocutaneous rashes on palms and soles

Titers highest in this stage

Question 31

Signs of primary syphilis

Answer 31

Chancre = painless indurated ulcer

Question 32

Signs of tertiary syphilis

Answer 32

gummatous lesions, aneurysms, aortic regurg, iritis. aortitis

Question 33

Signs of latent syphilis

Answer 33

No symptoms

+ serologic tests

Question 34

Syphilis labs if Chancre seen?

Answer 34

Darkfield microscopy and RPR/VDRL

Question 35

Syphilis labs if no chancre or lesion to test?

Answer 35

RPR/VDRL and FTA-ABS

Question 36

Lab results of neuro syphilis

Answer 36

+ serology
+ VDRL of CSF
elevated proteins in CSF

Question 37

Primary, secondary, and early latent syphilis treatment

Answer 37

penicillin G 2.4 million units IM in a single dose

Question 38

Late latent and tertiary syphilis treatment

Answer 38

penicillin G 7.2 million units total

3 doses of 2.4 million units IM each at 1-week intervals

Question 39

early vs late latent syphilis

Answer 39

early < 1 year

late > 1 year or unknown

Question 40

If HIV+ with syphilis, then how is treatment adjusted?

Answer 40

more freq and longer course of follow up due to increased likelihood of treatment failure

Question 41

Treatment of neurosyphilis

Answer 41

Aqueous crystalline penicillin G

Question 42

Reaction to anti-traponemal therapy with fever, malaise, N/V

Answer 42

Jarisch-Henheimer Reaction

Question 43

Syphilis follow up management

Answer 43

f/u at 6 and 12 months

extend f/u to 18 and 24 months for latent or tertiary

Question 44

Test for ____ infection to prevent syphilis.

Answer 44

HIV

Question 45

How is syphilis partner management different than other STI’s?

Answer 45

all partners exposed within 90 days instead of usual 60 are treated

Question 46

Symptoms of Trichomoniasis

Answer 46

foul smelling, grayish green vaginal discharge, strawberry cervix

Question 47

How is Trich dx’d?

Answer 47

wet mount for motile protoza
culture
NAAT
high vaginal pH

Question 48

Trichomonas treatment

Answer 48

Metronidazole 2g in single dose

• No alcohol for 24 hrs