STI's

Question 1

Pt presents w/ CC of dyspareunia, pruritus, and burning. On physical exam you see kerratotic papular masses on external genitalia. DX? Tx?

Answer 1

DX: HPV
TX: Podofilox, cryotherapy, surgical excision

Question 2

Rare expression of HPV (6 +11) in children

Answer 2

Recurrent respiratory papillomatosis

Question 3

When to BX genital warts

Answer 3

• Generally Colcoscopy b4 Bx*
  1) visible protruding lesions on cervix
  2) pap w/ HSIL
  3) Pap + ASC-H or LSIL + colposcopy abnormality

Question 4

When to refer for colposcopy

Answer 4

Abnormal PE (lesions) +/- HPV DNA testing

Question 5

Pt presents w/ Pain, itching, dysuria, HA + Malaise. On PE you find inguinal adenopathy TTP, Fever of 38C, and vesicolour lesions on erathematous base. Diagnostic study? Tx?

Answer 5

Dx: Viral Culture of mucotaneous lesions = HSV

TX Acyclovir, Valcyclovir, Famcyclovir -> Primary, episodic, CST

Question 6

When is CST indicated for HSV?

Answer 6

when pt is having outbreaks > 1 x /month. Safe for 1-5 years depending on Tx

Question 7

Pt is 25 yo pregnant female, presents w/ watery mucopurulent discharge w/ cervical bleeding. On PE you see friable cervix + discharge. Dx? Tx 1st + 2nd?

Answer 7

Dx: Chlamydia
Tx: 1) Azythromycin 1g x1
2) Amoxicillin 500 mg TID x 7 day
NAAT repeat testing 3 weeks post tx

Question 8

Why do younger pts tend to get Chlamydia

Answer 8

BC there ectropion (center of cervix) is more external. It tends to move more internally as women age

Question 9

how long do you (Public Health board etc) have to notify partners of Pt’s w/ confirmed GC?

Answer 9

60 days

Question 10

Pt presents w/ bacteremia w/ skin lesions arthralgia, tenosynovitis, myocarditis. W/o any urogenital sx/ Dx? TX?

Answer 10

Disseminated GCI: bx any infected area of the pt and culture for GC
Tx: Ceftriaxone 250 mg IM ( + Azythromycin for chlamydia)

Question 11

Textbook answer to difference in discharge between Gonorrhea and Chlamydia

Answer 11

Gonorrhea should be more “Gray”

Question 12

Adcending infection: cervicitis - endometritis - salpingitis oophoritis/ tubo ovarian abscess - peritonitis. DX? Bug? Tx?

Answer 12

DX: PID
Bug: 25-75% GC
Tx: Mild-Mod: Ceftriaxone 250 mg IM + Doxy 100mg BID x 14d, +/- metro for suspected anaerobes or BV+
Severe TX: Cefotetan 2g IV q 12hr or Cefoxitin 2 g IV q 6 hr +Doxy 100 mg q 12hr IV or PO. Continue 24 hr past substantial clinical improvement. Complete 14 day Doxy 100mg PO BID

Question 13

What is a diagnostic finding for PID?

Answer 13

Cervical Motion Tenderness or adnexal Pain on palpation is diagnostic

Question 14

Fever chills N/V, purulent vaginal dc, high white count. PE: +CMT on exam, and pain w/ palpation, guarding/ rebound tenderness, uterine or adnexal tenderness on bimanual exam. Dx? Tx?

Answer 14

Severe PID
Admit! Cefotetan 2g IV q 12hr or Cefoxitin 2 g IV q 6 hr +Doxy 100 mg q 12hr IV or PO. Continue 24 hr past substantial clinical improvement. Complete 14 day Doxy 100mg PO BID

Question 15

Follow up for HIV+ pt w/ syphalis

Answer 15

primary/secondary: 3,6,9,12 month titers

Latent/tertiary: 6,12,18, 24 month titers

Question 16

How to dx primary syphalis

Answer 16

Dark field = diagnostic, + RPR/VDRL for titer.

FTA - ABS if no dark field available

Question 17

Tx for late latent + tertiary syphalis

Answer 17

Pen G 2.4 mill U IM 1x/week x 3 weeks

Question 18

Tx for Pregnant pt w/ syhalis + penicillin Allergy

Answer 18

Admit! desensitize to to Penicillin and tx.

Question 19

Frothy grayish green foul smelling vaginal dc. What do you expect to see on pelvic exam? What do you expect pH to be? how do you dx?

Answer 19

Trichomoniasis:
Pelvic exam: “strawberry cervix”
pH > 4.5
wet mount

Question 20

Several drops of a potassium hydroxide (KOH) solution are added to a sample of the vaginal discharge. A strong fishy odor from the mix means bacterial vaginosis is present. what is this exam?

Answer 20

whiff test

Question 21

A previously healthy 21-year-old woman presents to your office with a complaint of lower abdominal discomfort and vaginal discharge for the past 2 weeks. She is currently single, but admits to occasionally “fooling around” with men she meets at parties. She expresses concern that she might be pregnant because of increasing tenderness in her lower abdomen for the past 3 days. Which of the following is the most likely diagnosis?

Appendicitis
Ectopic pregnancy
Pelvic inflammatory disease
Pregnancy

Answer 21

Pelvic inflammatory disease

Question 22

A 26-year-old sexually active woman presents to the clinic with several days of vulvovaginal discomfort and pruritus. A pelvic exam shows copious frothy green vaginal discharge, inflamed vaginal walls, and a cervix with punctate hemorrhages. This physical exam is most consistent with what cause of vaginitis?

Answer 22

Trichomonas vaginalis

Question 23

A 22-year-old woman presents with lower abdominal pain and vaginal discharge. She is sexually active with men with inconsistent barrier protection. Her vitals are normal other than temperature of 101°F. On examination, there is yellow cervical discharge, no cervical motion tenderness, but uterine and left adnexal tenderness. An ultrasound does not show any evidence of tubo-ovarian abscess. What is the most appropriate treatment?

Answer 23

Ceftriaxone 250 mg IM and doxycycline 100 mg BID for 14 days (+/- metronidazole if bv is suspected) for tax of PID