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CCFP > STI > Flashcards

STI Flashcards

1
Q

Culture-testing results of a urine sample are positive for gonorrhea.

Assuming this patient has no allergies, what are TWO possible preferred oral treatments for gonorrhea that may be considered? Specify drug names, dosage, and duration of treatment.

A

Cefixime 800mg po x 1
Ceftriaxone 250mg IM x 1

Cephalopsorin allergy:
Azithromycin 2g po x 1
Spectinomycyin 2g IM x 1

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2
Q

Treatment of another STI should be given at the same time as gonorrhea. Name this STI

A

Chlamydia trachomatis infection

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3
Q

In Canada, gonorrhea is a reportable disease. What further issues (both personal and related to public health) are appropriate to address with the patient? List THREE

A

Any other sexual contacts the patient has had (contact tracing)
Education on risk of contracting other STIs (HIV, Hepatitis, syphilis)
Marriage Counselling

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4
Q

In testing of urine samples for STIs, a positive result is very dependent on specimen collection. What collection techniques improve the yield from specimen testing? List TWO

A

1st urine catch of urine

Collect urine sample at least 2hrs after the patient has voided

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5
Q

Name the most common sexually transmitted infection in Canada

A

Chlamydia trachomatis

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6
Q

What are the general symptoms of Chlamydia trachomatis and Neisseria gonorrhea?

A

Urinary symptoms - frequency, urgency, dysuria and pelvic pain
In some cases chlamydia may have conjunctivitis

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7
Q

A male presents with with symptoms suggestive of chlamydia trachomatis infection. List FOUR

A

Urethral itch
Urethritis
Urethral discharge
Testicular pain

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8
Q

List FIVE symptoms of chlamydial infection in females

A 
80% asymptomatic
Cervicitis
Dyspareunia
Post-coital bleeding
Vaginal discharge
Vaginal bleeding
Urethral dischage
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9
Q

You suspect a patient may have a Chlamydial trachomatis infection. How would you confirm this diagnosis?

A

Nucleic acid amplification test (NAAT) of cervical, urethral, urine sample

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10
Q

If your patient was male, what are some potential complications of Chlamydial or Gonorrhea infection?

A

Epididymitis/orchiditis
Urethritis
Conjunctivitis
Reactive arthritis (inflammation of large joint due to infection)

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11
Q

What are some potential complications of chlamydial or gonorrheic infection in a female?

A

Pelvic inflammatory disease
Infertility
Chronic pelvic pain
Increased rate of ectopic pregnancy

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12
Q

What are the criteria for Reiters syndrome?

A

Reactive arthritis
Conjunctivitis
Cervicitis (females)
Urethritis (males)

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13
Q

How would you manage this patient from a public health perspective?

A

Partner tracing to report to pubic health (60d)
Advise condom use to prevent transmission
No sex for at least 7d post treatment

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14
Q

Your patient is confirmed to have a Chlamydia trachomatis infection, how would you treat this patient?

A
  • Azithromycin 1g po x 1 (use in preggers/breastfeeding and retest 3-4wks to ensure cure)
  • Doxycycline 100mg po bid x 7d
  • Always treat for gonorrhea as often coinfected (see gonorrhea Tx)
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15
Q

What is the second most common STI in Canada?

A

Neisseria gonorrhea infection

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16
Q

List FOUR symptoms of gonorrhea in men

A 
Epididymitis
Urethral discharge/itch
Testicular pain
Testicular swelling
Rectal pain/discharge
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17
Q

Gonorrhea and chlamydia have some similar symptoms, list THREE different symptoms

A
  • Pelvic pain, urethritis, cervicitis, vaginal discharge, vaginal bleeding, post-coital bleeding, pelvic inflammatory disease
  • Deep dyspareunia
  • Bartholinitis
  • Perihepatitis
  • Rectal pain/discharge
  • Asymptomatic in 80%
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18
Q

What are some general symptoms of gonorrhea?

A
  • Pharyngeal infection
  • Conjunctivitis
  • UTI Sx
  • Proctitis
  • Arthritis
  • Dermatitis
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19
Q

What are some disseminated complications of gonorrhea?

A

Disseminated arthritis, dermatitis, endocarditis, meningitis (ADEM)

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20
Q

In what groups of patients with gonorrhea would you swab and culture?

A

Men who have sex with men (MSM)
Non-genital infections (pharyngeal, cervical)
Resistant/refractory to treatment

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21
Q

What investigations would you order to confirm your diagnosis of gonorrhea?

A

Nucleic acid amplification test (NAAT) of urethral or urine sample

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22
Q

You have a homo patient with gonorrhea, what is the first line treatment?

A

Ceftriaxone 250mg IM x 1

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23
Q

You have a female patient with a pharyngeal confirmed infection of gonorrhea, what is your first line treatment?

A

Ceftriaxone 250mg IM x 1

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24
Q

You have a patient refractory to your first line treatments of gonorrhea, what else can you prescribe?

A

Azithromycin 2g po x 1 + Ceftriaxone 1g IM x 1

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25
Q

What medication do you use if your patient has gonorrhea and is allergic to cephalosporins?

A

Azithromycin 2g po x 1

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26
Q

How would you manage a patient with gonorrhea?

A

Sexual contact tracing and report to public health
Treat with appropriate antibiotics
Could culture infection 3-7d post treatment to assess success
NAAT 2-3wk post Tx
Repeat screen 6 months post Tx

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27
Q

What are the Human Papilloma Virus subtypes responsible for causing cancer?

A

HPV 16 & 18

28
Q

What are the Human Papilloma Virus subtypes responsible for causing warts?

A

HPV 6 +11

29
Q

List FIVE types of cancer that may be caused by HPV

A 
Pharyngeal
Genital
Cervical
Vaginal
Vulvar
Rectal
30
Q

You see cauliflower like warts on the genitalia, what is the dermatological diagnosis?

A

Condyloma acuminate

Females (cervix, vagina, anus)
Male (penis, anus)

31
Q

How would you diagnose an HPV infection?

A 
PAP smear
Colposcopy
Visible inspection
HPV testing
Anoscopy
32
Q

List TWO options for primary prevention

A

Gardisil (HPV 6, 11, 16, 18) immunization in 9-26yo

Cervarix (HPV 16, 18) immunization in 9-26yo

33
Q

True or False: Condom use had not been shown to limit transmission of HPV

A

True

34
Q

How would you treat HPV infection in non-pregnant women?

A

Observe (90% clear in 2yrs)
Symptomatic (vaginal, urethral, anal infection):
*Physician applied: Cryotherapy/Trichloracetic acid 80-90% -> Surgical excision/cautery/laser -> Interferon/Podophillin resin

External skin: *Pt applied imiquimod 5%/podofilox 0.5%

35
Q

How would you treat a pregnant patient with HPV infection?

A

1st line: Cryotherapy, Trichloracetic acid

2nd line: surgical excision, cautery, laser

36
Q

Describe the classic dermatological sign of a herpes simplex virus infection

A

Vessicles on an erythematous base leading to ulcerations

37
Q

What are the common prodromal symptoms of HSV infection?

A 
Pruritus
Tingling
Burning
Pain
Associated with fevers and myalgias
38
Q

Herpes simplex virus infections are typically a clinical diagnosis, what other investigations could you order to confirm the diagnosis?

A 
Serum herpes simplex virus antibody testing
Viral swabs for:
-culture
-antigen testing
-PCR
39
Q

This is your patient’s first episode of an HSV infection, how would you treat this patient?

A

Acyclovir 400mg po tid x 5-7d

Valacyclovir 1000mg po bid x 5-7d

40
Q

This is your patient’s 4th oral herpes outbreak this year, how would you treat this patient?

A

Dx: Acute recurrent herpes simplex virus infection (

41
Q

Your patient had 7 episodes of herpes this year, how would you treat this patient?

A

Dx: Chronic suppressive (>6 eps/yr)
Tx: Acyclovir 400mg po bid x 3-6 months
Valcyclovir 500mg po daily x 3-6months

42
Q

How would you treat a pregnant woman with vaginal herpes?

A

1st episode: acyclovir 200mg po FIVE times per day x 5-10d

Prior infection within previous year: Prophylaxis at 36wks with acyclovir 200mg po qid OR valacyclovir 500mg po bid

43
Q

List the symptoms of primary syphilis

A

Painless papule/ulcer (chancre)

Lymphadenopathy

44
Q

List the symptoms of secondary syphilis.

A 
Rash
Fever
Malaise
Lymphadenopathy
Headache
Mucous lesions
Uveitis
Retinitis
45
Q

Your patient has primary syphilis, how would you treat? What if they now had secondary syphilis?

A

Non-preggers: Benzathine Penicillin G 2.4M units IM x 1 OR Doxycycline 100mg po bid x 14d

Preggers: Benzathine Penicillin G 2.4M units IM weekly x 1-2 weeks

Same treatment in SECONDARY syphilis

46
Q

What are the expected symptoms in a patient with tertiary syphilis?

A 
Neurologic abnormalities
Vertigo
Dementia
Ataxia
Aortic aneurysm
Aortic root dilatation
47
Q

List the symptoms of latent syphilis

A

Patients are ASYMPTOMATIC silly!

48
Q

How would you treat a patent with tertiary syphilis?

A
  • No signs of neurosyphilis - Benzathine Penicillin G 2.4M units IM weekly x 3 weeks
  • neurosyphilis = Benzathine Penicillin G 3-4M units IV q4h x 10-14d
49
Q

How would you treat a patient with syphilis but has no symptoms?

A

Dx: latent syphilis
Preggers: Benzathine Penicillin G 2.4M units IM weekly x 3 weeks
øPreggers: Early latent (1yr from infection) = same Tx as Preggers

50
Q

Describe the classic dermatological sign of a herpes simplex virus infection

A

Vessicles on an erythematous base leading to ulcerations

51
Q

What are the common prodromal symptoms of HSV infection?

A 
Pruritus
Tingling
Burning
Pain
Associated with fevers and myalgias
52
Q

Herpes simplex virus infections are typically a clinical diagnosis, what other investigations could you order to confirm the diagnosis?

A 
Serum herpes simplex virus antibody testing
Viral swabs for:
-culture
-antigen testing
-PCR
53
Q

This is your patient’s first episode of an HSV infection, how would you treat this patient?

A

Acyclovir 400mg po tid x 5-7d

Valacyclovir 1000mg po bid x 5-7d

54
Q

This is your patient’s 4th oral herpes outbreak this year, how would you treat this patient?

A

Dx: Acute recurrent herpes simplex virus infection (

55
Q

Your patient had 7 episodes of herpes this year, how would you treat this patient?

A

Dx: Chronic suppressive (>6 eps/yr)
Tx: Acyclovir 400mg po bid x 3-6 months
Valcyclovir 500mg po daily x 3-6months

56
Q

How would you treat a pregnant woman with vaginal herpes?

A

1st episode: acyclovir 200mg po FIVE times per day x 5-10d

Prior infection within previous year: Prophylaxis at 36wks with acyclovir 200mg po qid OR valacyclovir 500mg po bid

57
Q

List the symptoms of primary syphilis

A

Painless papule/ulcer (chancre)

Lymphadenopathy

58
Q

List the symptoms of secondary syphilis.

A 
Rash
Fever
Malaise
Lymphadenopathy
Headache
Mucous lesions
Uveitis
Retinitis
59
Q

Your patient has primary syphilis, how would you treat? What if they now had secondary syphilis?

A

Non-preggers: Benzathine Penicillin G 2.4M units IM x 1 OR Doxycycline 100mg po bid x 14d

Preggers: Benzathine Penicillin G 2.4M units IM weekly x 1-2 weeks

Same treatment in SECONDARY syphilis

60
Q

What are the expected symptoms in a patient with tertiary syphilis?

A 
Neurologic abnormalities
Vertigo
Dementia
Ataxia
Aortic aneurysm
Aortic root dilatation
61
Q

List the symptoms of latent syphilis

A

Patients are ASYMPTOMATIC silly!

62
Q

How would you treat a patent with tertiary syphilis?

A
  • No signs of neurosyphilis - Benzathine Penicillin G 2.4M units IM weekly x 3 weeks
  • neurosyphilis = Benzathine Penicillin G 3-4M units IV q4h x 10-14d
63
Q

How would you treat a patient with syphilis but has no symptoms?

A

Dx: latent syphilis
Preggers: Benzathine Penicillin G 2.4M units IM weekly x 3 weeks
øPreggers: Early latent (1yr from infection) = same Tx as Preggers

64
Q

Name the organism that causes syphilis

A

Treponema pallidum

65
Q

List TWO risk factors for syphilis

A

Men who have sex with men
Sex workers
Clients of sex workers

66
Q

How is syphilis transmitted?

A

Oral sex
Vaginal sex
Anal sex

67
Q

List THREE diagnostic tests for syphilis

A

Veneral Disease Research Lab Reactive (VDRL reactive)
Rapid Plasma Reagin (RPR)
T. pallidum Enzyme Immunoassay (TP-EIA)
Dark field microscopy of mucosal lesions
Direct fluorescent antibody testing of lesions
Serum Polymerase Chain Reaction (Serum PCR)

CCFP (11 decks)

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