STI Cards

Question 1

What virses cause genital herpes?

Answer 1

80-90% are HSV-2; 10% are HSV-1 (more often associated with cold sores)

Question 2

What is the most common cause of genital ulcers?

Answer 2

HSV

Question 3

Is HSV infectious in the asymptomatic latent phase?

Answer 3

Yes. There is intermittent shedding of virus at the genital skin

Question 4

What is the clinical presentation of genital herpes?

Answer 4

Often asymptomatic. If symptomatic: Multiple painful vesicular lesions over erythematous base. Self-resolving in 2-4 weeks, worse in primary disease than secondary.

Question 5

What histology test is used to diagnose genital herpes?

Answer 5

Tzanck smear (showing multinucleated giant cells)

Question 6

What is the treatment for genital herpes?

Answer 6

Acyclovir, famciclovir, valacyclovir

Question 7

What causes syphilis?

Answer 7

Spirochete Treponema pallidum

Question 8

In which populations are syphilis infections increasing?

Answer 8

MSM population in the US, Canada, Europe, and Australia

Question 9

How is T. pallidum transmitted?

Answer 9

Sexual contact or maternal-fetal

Question 10

What are the clinical manifestations of syphilis in the early stage?

Answer 10

Primary: single painless indurated chancre, condylomata lata; Secondary: fever, lymphadenopathy, rash on palms and soles

Question 11

What are the clinical manifestations of syphilis in the latent stage?

Answer 11

None. Latent syphilis is asymptomatic.

Question 12

What are the clinical manifestations of syphilis in the late stage?

Answer 12

Tertiary syphilis: CNS involvement, skin involvement, CVD, gumma (granulomatous disease)

Question 13

What are the outcomes of early stage syphilis?

Answer 13

1/3 of patient self-cure; 2/3 progress to latent infection

Question 14

What is a common presentation of neurosyphilis?

Answer 14

Infection of the posterior column of the spinal cord leads to demyelinization resulting in Tabes Dorsalis: ataxia, areflexia, loss of proprioception, and Argyll Robertson pupil

Question 15

What are possible CNS manifestations of syphilis?

Answer 15

Asymptomatic; acute syphilitic meningitis; general paresis; tabes dorsalis

Question 16

What are the outcomes of untreated syphilis infection in pregnancy?

Answer 16

80% of cases are miscarriage, stillbirth, or congenital infeciton

Question 17

What are the early clinical manifestations of congenital syphilis?

Answer 17

Snuffles, pneumonia, hepatitis, bone involvement, meningitis

Question 18

What are the late clinical manifestations of congenital syphilis?

Answer 18

Hutchinson’s incisors, keratitis, deafness, Saber shins, iritis

Question 19

How is an active syphilis infection most specificially diagnosed?

Answer 19

Dark field microscopy

Question 20

What tests are used to screen or monitor syphilis infection?

Answer 20

Non-treponemal rapid plasma reagin antibodies or VDRL

Question 21

When are screening tests for syphilis likely to give a false positive result?

Answer 21

Patients with autoimmune disease, mononucleosis, and elderly

Question 22

What test is used to confirm syphilis infection?

Answer 22

Treponemal antibody test (FTA-ABS), which remains positive for life

Question 23

What causes chancroid?

Answer 23

H. ducreyi, a small GNR

Question 24

What is the clinical presentation of chancroid?

Answer 24

Painful genital ulcers + marked regional lymphadenopathy

Question 25

What is the treatment for chancroid?

Answer 25

Azithromycin

Question 26

How is chancroid diagnosed?

Answer 26

PCR

Question 27

What causes lymphogranuloma venerum?

Answer 27

Chlamydia trachomatis serovars L1-L3

Question 28

What populations does lymphogranuloma venerum usually affect?

Answer 28

Tropics (endemic) or MSM in developed countries

Question 29

What is the clinical presentation of lymphogranuloma venerum?

Answer 29

Painless papules, lymphadenopathy in groin or axilla (buboes/"groove sign", proctitis, and ulcers

Question 30

What is the treatment for lymphogranuloma venerum?

Answer 30

Doxycycline

Question 31

What are four reportable STIs to the US public health departments?

Answer 31

Chlamydia, gonorrhea, syphilis, and trichomonas

Question 32

What % of the US population has HSV?

Answer 32

25% have serological evidence of HSV

Question 33

What is the predominant normal vaginal flora?

Answer 33

Lactobacillus

Question 34

What are normal variations on vaginal discharge?

Answer 34

Mycoid, especially at midcycle; thicker/whiter during pregnancy

Question 35

How does candida vaginitis present?

Answer 35

"Cottage cheese" white and clumpy discharge

Question 36

How is candida vaginitis diagnosed?

Answer 36

Wet mount KOH stain showing yeast and pseudohyphae

Question 37

What is the treatment for vaginal candidiasis?

Answer 37

Oral fluconazole, micinazole suppository, or butoconazole cream

Question 38

What causes bacterial vaginosis?

Answer 38

Gardnerella vaginalis or other anaerobes

Question 39

How does bacterial vaginosis present?

Answer 39

Malororous, grey, thin discharge

Question 40

How is bacterial vaginosis diagnosed?

Answer 40

"Clue cells" on wet mount, fish odor on KOH stain.

Question 41

What is the treatment for bacterial vaginosis?

Answer 41

Metronidazole (oral or gel) or tinidazole (oral)

Question 42

How does trichomonas vaginalis present?

Answer 42

Foul-smelling, green-yellow vaginal discharge + itching or burning

Question 43

How is trichomonas vaginalis diagnosed?

Answer 43

Wet mount shows motile trophozoites. May see "Strawberry cervix" on physical exam

Question 44

How is trichomonas vaginalis transmitted?

Answer 44

Sexually transmission (so treat partners!)

Question 45

How is trichomonas vaginalis treated?

Answer 45

Metronidazole or tinidazole (oral)

Question 46

What are the two most common causes of urethritis?

Answer 46

N. gonorrhoeae and C. trachomatis

Question 47

What are the 4 clinical presentations of chlamydia?

Answer 47

Genital tract infection, trachoma, atypical pneumonia, and psittacosis

Question 48

What species of chlamydia causes genital tract infection?

Answer 48

C. trachomatis D-K

Question 49

What is the treatment for chlamydia?

Answer 49

Doxycycline or azithromycin

Question 50

How does chlamydia present in neonates?

Answer 50

Conjunctivitis and pneumonitis

Question 51

What is one uncommon but serious sequelae of chlamydia infection?

Answer 51

Reactive arthritis (post-infectious uveitis, urethritis and arthritis)

Question 52

How is reactive arthritis treated?

Answer 52

NSAIDS

Question 53

What is the gram stain and shape of N. gonorroeae?

Answer 53

Gram negative, diplococci

Question 54

What different ways can N. gonorroeae present?

Answer 54

Men: urethritis, epididymitis, prostatitis. Women: cervicitis, PID. Infants: conjunctivitis.

Question 55

How does N. gonorroeae present if infection is disseminated?

Answer 55

Arthritis, rash.

Question 56

How is N. gonorroeae diagnosed?

Answer 56

Postiive graim stain, cultures on Thayer-Martin media, or nucleic acid testing

Question 57

What is the treatment of N. gonorrhoeae?

Answer 57

Ceftriazone IM plus azithromycin oral, one-time

Question 58

What are the minimum clinical criteria for PID?

Answer 58

Uterine tenderness OR adnexal tenderness OR cervical motion tenderness

Question 59

Describe the presentation of N. gonorrhoeae and C. trachomatis in infants

Answer 59

Neonatal conjunctivitis (opthalmia neonatorum)

Question 60

How can opthalmia neonatorum be prevented?

Answer 60

Prophylactic erythromycin ointment at delivery protects againt N. gonorrhoeae, although not C. trichomatas.