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AANP Study Cards > STIs > Flashcards

STIs Flashcards

1
Q

What conditions screening test is ELISA

A

HIV

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2
Q

What STI produces a malordorous vaginal discharge

A

BV

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3
Q

DNA probe is used for screening (2 STI)

A

Chlamydia and Gonorrhea

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4
Q

FTA-ABS, MHA-TP are diagnostic tests for this STI

A

Syphillis or Trepideum pallidum

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5
Q

What is treatment for syphillis (early disease)

A

2.4million units of penicillin IM

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6
Q

What is the treatment for late disease syphillis

A

Treated with 3 doses of benzathine penicillin spaced at weekly intervals

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7
Q

Associated with a positive whiff test

A

BV

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8
Q

Confirmatory test is the western blot

A

HIV

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9
Q

Treated with Flagyl 500mg BID x 7 days

A

BV

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10
Q

The etiologic agent is a virus (3 STIs)

A
  • HPV
  • HIV
  • Herpes
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11
Q

Clue cells are present on the saline wet mount

A

BV

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12
Q

Absent or decreased lactobacilli

A

BV

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13
Q

Wet prep is used for diagnosis of:

A

BV and trich

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14
Q

Treatment is acyclovir, valacyclovir and famciclovir

A

herpes

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15
Q

What STI can produce a rash on hands and feet

A

Syphillis

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16
Q

What STI produces a painless chancre

A

Syphillis

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17
Q

What STI is associated with a positive chandelier test

A

Pelvic inflammatory disease

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18
Q

What are the screening tests for HIV

A

EIA or ELISA

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19
Q

What are considerations when caring for a patient with HIV and Immunizations

A
  • Need pneumococcoal
  • tetanus
  • Hep A/B and influenza
  • Never administer a live vaccine
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20
Q

Lab testing for HIV

A
  • CD4 count- baseline and repeat at 3-4 months
  • Viral load: Baseline and q3-4 months
  • Screen hepatitis
  • STI screening
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21
Q

What is the goal of ART

A

Undetectable load within 16-24 weeks

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22
Q

What is the CD4 count when you consider prophylaxis for pneumocystis carinii

A

CD4 <200

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23
Q

What is the prophylactic treatment for pneumocystis carinii

A

TMP-SMX daily

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24
Q

What is the presentation of initial HIV infection?

A
  • fever
  • pharyngitis
  • non-pruritic macular skin rash
  • malaise
  • headache
  • lymphadenopathy
  • diarrhea
  • weight loss
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25
Q

How long does it take to develop symptoms after HIV infection?

A

2-4 weeks

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26
Q

AIDS is defined as

A

an absolute CD4 cell count <200 cells/mm along with certain opportunistic infections and malignancies

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27
Q

What are some signs and symptoms suggestive of AIDS

A

Opportunistic infections such as: Oral candidiasis, TB, Pneumocystis jirovecii pneumonia (most lethal), CNS toxoplasmosis, histoplasmosis, cryptosporidiosis, Kaposi’s sarcoma

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28
Q

What are complications of untreated STIs?

A
  • infertility
  • ectopic pregnancy
  • congenital infections
  • cervical cancer
  • chronic pelvic pain
  • chronic hepatitis
  • chronic syphillis
  • HIV/AIDS
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29
Q

Routine annual screening for chlamydia and gonorrhea includes:

A
  • females 25 years and younger who are sexually active annually
  • older females at increased risk for infection (new partner, multiple partners, sexual partner with an STI)
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30
Q

What is included in the physical exam for STIs

A

Inspection of the:

  • skin
  • pharynx
  • lymph nodes
  • anus
  • pelvic/genital region
  • neuro
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31
Q

STI screening includes

A

Obtaining the sexual history and assessment of risk factors for STIs. Think 5 P’s

  • Partners
  • Practices
  • Protection
  • Past history of STI
  • Prevention of Pregnancy
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32
Q

Men who have sex with men should be screened annually for

A

chlamydia, gonorrhea, pharyngeal gonorrhea, HIV, syphilis and HBsAg

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33
Q

Pregnant women should be screened for

A

HIV, chlamydia, gonorrhea, syphilis and HBsAg at their first prenatal visit

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34
Q

Pregnant women treated for chlamydia/gonorrhea should have a test of cure

A

within 3-4 weeks of treatment

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35
Q

What are risk factors for STIs

A
  • Young age (15-24)
  • Young age of first intercourse
  • Multiple sexual partners
  • History of previous STI
  • Use of ETOH or drugs
  • Inconsistent condom use
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36
Q

What is the most common bacterial STI in the US

A

Chlamydia

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37
Q

What lab tests are recommended for chlamydia and gonorrhea

A

NAATs

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38
Q

What is the treatment of chlamydia?

A

Azithromycin 1g PO single dose or doxycycline 100mg BID x 7 days

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39
Q

What should you educate a patient taking doxycycline

A
  • swallow with large glass of water because of risk for esophagitis
  • Avoid sun or use sunscreen (photosensitivity)
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40
Q

What should you educate a patient taking azithromycin single dose for chlamydia?

A

takes 7 days for tx to become effective

41
Q

How should sexual partners of a patient with chlamydia be treated?

A

Azithromycin 1g PO x 1 dose

42
Q

How is chlamydia tx’d in pregnancy?

A

Azithromycin 1g PO x 1 dose or amoxicillin 500mg PO TID x 7days

43
Q

Unlike chlamydia, gonorrhea can become _____ or ______ if left untreated

A

systematic or disseminated

44
Q

If you have gonorrhea you must always co treat for

A

Chlamydia even if negative test

45
Q

What are symptoms of gonorrhea?

A
  • cervicitis (mucopurulent discharge, pain, bleeding post coital)
  • Urethritis
  • Proctitis in men
  • Pharyngitis
  • Endometritis
  • Signs of disseminated gonococcal infections
46
Q

What are signs of disseminated gonococcal infection

A
  • Petechial or pustular skin lesions of the hands/fingers
  • asymmetric polyarthralgia
  • tenosynovitis
  • oligoarticular septic arthritis
  • meningitis
  • endocarditis
47
Q

What is an alternative to the NAAT test for gonorrhea

A

Thayer-Martin

48
Q

Who should you screen for syphilis

A
  • Individuals with HIV
  • Men who have sex with men
  • presence of any genital ulcers *esp if painless chancre
  • previous STD
  • Pregnancy
  • IV drug use
  • High risk
49
Q

What is the name of the organism that causes syphilis

A

Treponema pallidum

50
Q

What are the sx of the primary syphilis

A
  • painless chancre (heals in 6-9 weeks if not treated)

- Chancre has clean base with well demarcated indurated margins

51
Q

What are the sx of secondary syphilis

A
  • Condyloma lata

- Maculopapular rash on palms and soles that is not pruritic

52
Q

What are the sx of tertiary syphillis

A
  • neurosyphilis
  • gumma (soft tissue tumors)
  • aneurysms
  • valvular damage
53
Q

How do you test for syphilis

A

Step 1: Order screening test
-RPR or VDRL

Step 2: Order confirmatory test
-FTA-ABS or MHA-TP

If both positive then diagnostic for syphilis

54
Q

Treat primary, secondary syphilis

A

-Benzathine penicillin G 2.4 million units IM x 1 dose

55
Q

What is the tx of latent syphilis (>1 year), unknown duration, tertiary without evidence of neurosyphilis?

A

-Benzathine penicillin G 2.4 million units IM 1x/week x 3 weeks

56
Q

When treating a patient for syphilis you should recheck RDR or VDRL at

A

6 and 12 months (want at least 4 fold decrease pre and post treatment)

57
Q

What is the first line treatment of uncomplicated gonorrheal infection

A

Ceftriazone 250mg IM x 1 dose plug cotreat for chlamydia with azithromycin 1g PO x 1 dose

58
Q

Treatment for complicated gonorrheal infections (PID, Acute epididymitis, acute prostatitis, Proctitis)

A

Ceftriaxone 250mg IM x 1 dose + Co treat for chalmydia

-Doxycycline 100mg BID x 14 days +/- flagyl 500mg BID x 14 days

59
Q

Risk factors for PID

A
  • History of PID
  • Multiple partners
  • Age <25
60
Q

What are sx of PID

A
  • acute onset of lower abdomen or pelvic pain
  • Painful intercourse (dyspareunia)
  • Cervical motion tenderness and adnexal pain on bimanual exam
  • Jumping/running aggravates pelvic pain
61
Q

What labs should be considered in suspected PID

A

-NAAT test

62
Q

What is fitz-hugh-curtis syndrome

A

A complication of PID where chlamydia +/- gonorrheal infection ascends to the liver capsule which causes extensive scarring

63
Q

What are sx of fitz-hugh-curtis

A
  • sx of PID

- RUQ abdominal pain and tenderness on palpation1

64
Q

What is Jarisch-Herxheimer Reaction

A
  • A reaction patient’s may experience within a few hours of treatment for syphilis r/t the destruction of T. pallidum
  • can also occur with lyme disease
65
Q

What is the sx of Jarisch-Herxheimer

A
  • fever
  • chills
  • headache
  • myalgia
  • tachycardia
  • increased respiratory rate
66
Q

What is Reiter’s Syndrome

A

A rare disease caused by an immune-mediated reaction secondary to infection with certain bacteria:

  • chlamydia
  • salmonella
  • shigella
  • campylobacter
67
Q

What are the sx of Reiter’s syndrome?

A
  • red and swollen joints that come and go
  • ulcers on the skin of the glans penis
  • “I can’t see (conjunctivitis), pee (urethritis) or climb up a tree (migratory arthritis in large joints)
68
Q

What are risk factors for HIV

A
  • Sex with HIV-infected person or with gay or bisexual men
  • Receipt of blood products between 1975-185
  • Hx of injection drug use/partner who drugs
  • Hx of other STIs
  • Multiple partners
  • homelessness
  • inmates
69
Q

Annual routine HIV screening is recommended in

A
  • injection drug uses and their partners
  • sex workers
  • sex partners with HIV
  • Heterosexuals with multiple partners
  • Ppl being treated for hepatitis, TB or another STI
  • MSM and bisexual
70
Q

HIV RNA can detect HIV infection as early as

A

7-28 days after exposure

71
Q

What other labs need to be ordered in HIV

A
  • Hep A/B/C
  • Syphilis
  • Other STIs
  • Cervical cytology
  • TB testing
72
Q

What is the HIV-1/HIV-2 antibiody with p24 with reflexes

A
  • screening test to diagnose HIV infection

- if + lab will perform HIV-1/HIV-2 antibody differentiation immunoassay to confirm initial test

73
Q

ELISA

A

-Older screening test if positive next step is western blot

74
Q

Western blot

A
  • Older confirmatory test

- If positive next step is HIV RNA PCR

75
Q

Rapid HIV test

A

Screening test; results in <30 minutes if positive follow with blood test

76
Q

HIV RNA PCR

A

Test for HIV virus directly
-1st test for infants of HIB + moms

*Use if indeterminate results on antibody-antigen testing

77
Q

CD4 T-cell count

A

-Check before starting ART, staging HIV infection, disease progression and treatment response to ART

78
Q

Viral load HIV

A
  • Monitor treatment response

- If on ART monitor q1-2 mths until non-detectable, then q3-4 months

79
Q

What is the treatment for prophylaxis for opportunistic infections

A

Bactrim one tablet daily

80
Q

Monitoring viral load

A
  • Check HIV RNA (viral load) 2-8 weeks after starting therapy, then 1-2 months until viral load undetectable
  • monitor viral load, CD4 and CBC q3-4 months for the first 2 years of ART
81
Q

What are recommended vaccines for HIV and AIDS

A
  • Hep A
  • Hep B
  • Inactivated influenza
  • pneumococcal
  • Td/Tdap q 10 years
  • HPV (until 26 years)
82
Q

Education for HIV patients

A
  • Do not handle cat litter, uncooked or undercooked meat
  • avoid bird stool (histoplasmosis spores)
  • Use gloves when cleaning animal cages
  • Healthy lifestyle
83
Q

Prevention of HIV

A
  • Condom use with sex
  • Don’t share needles or syringes
  • Don’t share toothbrushes, razors
  • HIV moms should not breastfeed
  • Limit sexual partners
84
Q

If pt is allergic to sulfa what med should they use for opportunistic infections

A

Dapasone 100mg PO daily

85
Q

In HIV infected pregnant women when should you start AZT

A

Start AZT ASAP

86
Q

Hairy leukoplakia, recurrent yeast and thrush create high suspicion for

A

HIB

87
Q

What is Acute retroviral syndrome or primary HIV infection

A

-Influenza-like similar to mononucleosis infection, vry infectious

88
Q

What are condyloma acuminata

A

Genital warts that appear as soft flesh-colored pedunculated, flat or papular growths

89
Q

HPV vaccine is recommended for

A

Both girls and boys as early as age 9.

  • if 1st dose <15 only need 2 doses 6-12 months apart
  • if 1st dose >15, need 3 doses 0, 1-2 and 6)
90
Q

Treatment for genital warts

A
  • Podofilox 0.5% gel or cream

- Imiquimod 5%

91
Q

Sx of HSV

A

-acute onset of small veicles on a reddened base that rupture easily and become small shallow painful ulcers

92
Q

First episode treatment for HSV

A

Zovirax 5x/day or Valtrex TID or Favier BID x 7-10 days

93
Q

Most cases of cervical cancer are caused by

A

HPV 16 and 18

94
Q

Flare up tx for HSV

A

Zovirax or Valtrex or Favier BID x 5 days

95
Q

Treatments for genital warts that are contraindicated in pregnancy are

A

Podofilox, podophylla and imiquimod

96
Q

Treatment of genital wars in pregnancy includes

A

Cyro, laser, excision

97
Q

Tzanck smear shows multinucleated giant cells with herpes virus infection

A

-varicella, herpes simplex

98
Q

HSV for primary treatment duration is

A

7-10 days

99
Q

HSV for breakout duration of treatment is

A

5 days

AANP Study Cards (20 decks)

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