STI's and the Labs assicated

Question 1

What is one thing that you must maintain to ensure adolescents keep coming back to you for help?

Answer 1

Maintain confidentiality!!!

Question 2

In ____ states, what could potentially break the law regarding adolescents?

Answer 2

32; if you disclose the fact that an adolescent came to you for treating/caring for an STI to their parents

Question 3

For someone who presents with dysuria, what are the top three diagnoses to work up?

Answer 3

UTI, genital tract infection (cervicitis, urethritis), skin related abnormalities/mucosal perineal (a painful sore: trauma, herpes)

Question 4

For that person who presents with dysuria, what additional info would you need to know?

Answer 4

1. Onset and duration of symptoms
2. Description of symptoms
3. Associated symptoms: nausea/vomiting, fever and chills, back and abdo pain, sores, lumps, bumps, dyspareunia

Question 5

What would the five P’s be regarding the sexual history you would take once you find out someone has dysuria?

Answer 5

1. Partners (gender, number)
2. Prevention of pregnancy (contraception, EC)
3. Protection from STIs (condom use)
4. Practices (types of sex: anal, vaginal, oral)
5. Past history of STIs

Question 6

Patient reports that symptoms began week ago, yellowish discharge and intermittent burning with urination; no fever, back, abdo pain, no frequent urination, doesn’t know about bumps; episodes of unprotected sex in last two months, not on hormonal contraception but uses condoms typically; engages in oral and vaginal sex, no known history of STIs. What is left in the differential?

Answer 6

GTI, skin related abnormalities/mucosal perineal

Question 7

After you’ve gone through the history with this patient, what do you do NEXT? What would the speculum exam tell you if you see odorous yellow discharge in the vault but not in the os?

Answer 7

Normal external exam (ie pelvic exam); you might suspect vaginitis since the discharge isn’t straight from the os!!

Question 8

List three common causes of vaginitis

Answer 8

Trichomonas, bacterial vaginitis, candida vaginitis

Question 9

List the symptoms of trichomonas infection; how many males and females are found to be asymp?

Answer 9

Women: foul-smelling, frothy discharge, dyspareunia, urge to urinate and dysuria, vag itching or redness, post-coital bleeding, excessive or prolonged menses;
Men: symptoms could present as non-gonococcal urethritis, perhaps if there’s recurrent urethritis;
50% females symp, most males are asymp

Question 10

What are symptoms of bacterial vaginosis? What is the prevalence of it? Potential sequelae?

Answer 10

Odorous discharge, itching; 24-27% of STI clinic patients; pregnancy complications, possible increase in PID

Question 11

What are candidiasis symptoms?

Answer 11

Women: genital itching, “cottage cheese-like” discharge, fire red tissue
Men: itchy penile rash

Question 12

For trichomonas diagnosis, what would be most often used in the clinic for testing?

Answer 12

Affirm test (DNA probe) with 60-70% sens, 100% spec;
culture not usually done anymore, wet mount can be done but is not very efficient (83% sens, 97% spec)

Question 13

How does one often diagnose candida? How else could you diagnose it regarding testing?

Answer 13

Largely a clinical diagnosis; could use DNA probe (80% sens, 98% spec) or wet mount (35-45% sens, 97-99% spec)

Question 14

For bacterial vaginitis, how would you work up that diagnosis?

Answer 14

Whiff test positive for fishy odor or musty odor when KOH added; clue cells; vaginal pH > 4.5; homogenous non-inflammatory discharge; GRAM STAIN is the GOLD STANDARD!!

Question 15

What in the patient’s history would point to trichomonas?

Answer 15

History (odorous yellow discharge and dysuria); strawberry cervix w/ discharge

Question 16

Without a DNA probe to test for these three organisms, what could you do in a clinic?

Answer 16

Candida (no history or PE); trich vs. BV: pH paper would just rule out candida, KOH test might take too long, and microscope might not be efficient; usually clinical diagnosis, but if uncertain, send wet mount to lab

Question 17

What is the treatment for BV and trich?

Answer 17

Metronidazole for both; test partner for trich

Question 18

What are the most common causes of cervicitis?

Answer 18

Chlamydia and gonorrhea

Question 19

Chlamydia symptoms?

Answer 19

Female: heavy or prolonged menses, spotting, dysmenorrhea, dyspareunia, vaginal discharge;
males: itchy penile rash;
up to 75% asymp in females, up to 50% asymp in males

Question 20

Gonorrhea symptoms?

Answer 20

Females: yellow or bloody vaginal discharge, painful urination, dysmenorrhea;
males: discharge from penis with pain, burning during urination, swollen testicles;
both 50% asymp

Question 21

What tests do you order for cervicitis?

Answer 21

Nucleic Acid Amplification Test (GOLD STANDARD); culture ONLY for medical legal purposes

Question 22

What sample would be best for the NAAT?

Answer 22

Self-collected vaginal swabs (could use 10-15 cc of urine from men and women but has to be >2 hours after last void)

Question 23

For this particular patient, knowing what she has, what other testing could you do?

Answer 23

HIV and syphilis testing; hep B and HPV vaccines; counsel/motivational interviewing: protect against STIs, protect against pregnancy, consensual relationship