STIs

Question 1

What is the number 1 cause of vaginal discharge

Answer 1

Bacterial vaginosis

Question 2

What is the number 1 cause of symptomatic bacterial infection in reproductive age women

Answer 2

bacterial vaginosis

Question 3

What symptoms may someone have with bacterial vaginosis

Answer 3

Discharge will be milky with a fishy odor (after KOH prep)

worse after unprotected intercourse

non-irritating

Question 4

How is a diagnosis of bacterial vaginosis made

Answer 4

Amsels criteria

Question 5

What will be present with amsels criteria with bacterial vaginosis

Answer 5

Clue cells on microscopy
alkalotic pH
+ whiff test

Question 6

What is the first line treatment for bacterial vaginosis

Answer 6

Metronidazole PO for 7 days
or intravaginal metronidazole
or
intravaginal clindamycin gel

Question 7

What do you have to warn a patient when prescribing metronidazole

Answer 7

n/v with ETOH

Question 8

What is the risk if BV goes untreated

Answer 8

Increase risk of STI (including HIV)
increased preterm delivery
risk of candidiasis s/p tx

Question 9

What is the second most common reported STI

Answer 9

Gonorrhea

Question 10

What age group has the highest incidence of gonorrhea

Answer 10

15-24
*higher in black patients

Question 11

If symptoms are present with Gonorrhea, what will they be

Answer 11

White/green/yellow purulent discharge

friable cervix
vaginal bleeding
dysuria

Question 12

What are possible extra genital infections occur with gonorrhea

Answer 12

Conjunctivitis
arthritis
disseminated

Question 13

How do you diagnose gonorrhea

Answer 13

NAAT

Question 14

How do you treat gonorrhea

Answer 14

Ceftriaxone IM single dose
+
azithromycin or doxy
*no intercourse for 7 days

Question 15

What are some complications with Gonorrhea

Answer 15

PID
epididymitis
mom-to-baby transmission

Question 16

What is the most frequent reportable bacterial STI

Answer 16

Chlamydia

Question 17

What symptoms will a patient have with chlamydia

Answer 17

pyuria
increased urinary frequency
purulent discharge
friable cervix

Question 18

How do you treat chlamydia

Answer 18

Doxy 100mg PO BID x 7 days

Question 19

What is the most prevalent non-bacterial STI

Answer 19

Trichomonas vaginitis

Question 20

How is trichomoniasis prevented

Answer 20

condom use

Question 21

What symptoms will females have with trichomoniasis

Answer 21

Profuse, malodorous, frothy vaginal discharge

strawberry cervix

Question 22

How do you diagnose trichomoniasis

Answer 22

wet mount (must do immediately post sampling)

Question 23

What is the treatment for trichomoniasis

Answer 23

metronidazole for 7 days for females

1 day for males

Question 24

What are some associated risks for trichomonas

Answer 24

preterm labor
PROM
small gestational age
increased risk for cervical cancer

Question 25

How is candidiasis diagnosed

Answer 25

presence of budding yeast and hyphae on KOH wet mount *culture is gold standard

Question 26

How do you treat candidiasis

Answer 26

OTC: clotrimazole/miconazole RX: Fluconazole PO

Question 27

What are some complications from syphilis

Answer 27

Neurosyphilis ocular syphilis auditory syphilis

Question 28

How do you diagnose early syphilis

Answer 28

Darkfield microscopy *ID spirochetes

Question 29

What is the lab workup for later stages of syphilis

Answer 29

Non-treponemal test treponema test (confirmatory)

Question 30

When should syphilis screening be preformed

Answer 30

MSM every 6-12 months High risk every 3 months Pregnant at prenatal, 3rd tri, and delivery

Question 31

What is the treatment for syphilis

Answer 31

Parenteral Pen G is first line doxy is second line * no intercourse 7-10 days *ID and treat contacts within last 3 months

Question 32

What is Jarisch-Herxheimer reaction

Answer 32

Fever and worsening clinical ssx Starts within hours of tx lysis of spirochetes *associated with syphilis

Question 33

What is chancroid

Answer 33

rare STI seen in younger men and sex workers cause by Haemophilus ducreyi

Question 34

What is the presentation for chancroid

Answer 34

Papule -> pustule -> ulcerations - painful, soft, irregular borders, friable - necrotic base with yellow/gray exudates -swollen lymph nodes (unilateral) near the lesion

Question 35

How do you diagnose chancroid

Answer 35

lesion culture is gold standard

Question 36

How do you treat chancroid

Answer 36

Azithromycin 1g PO x1 or ceftriaxone 250mg IM x1

Question 37

What is the most common cause of genital ulcers

Answer 37

Herpes simplex

Question 38

How will herpes simplex present

Answer 38

Tingling prodrome macular/papular rash vesicle on erythematous base shallow painful ulcers lesions are self limiting over 3 weeks

Question 39

How do you diagnose herpes simplex

Answer 39

clinical if vesicles are present tzank smear HSV PCR Urine culture

Question 40

What is the first line treatment for herpes simplex

Answer 40

Acyclovir or valcyclovir *lifelong disease

Question 41

What strain of HPV is related to genital warts

Answer 41

6 or 11

Question 42

What is the presentation of genital warts

Answer 42

flat pedunculated lesions near Introitus

Question 43

What is the definitive diagnosis of genital warts

Answer 43

Biopsy of a lesion

Question 44

What are the treatment options for genital warts

Answer 44

Cryotherapy surgical excision caustic agent

Question 45

What are patient applied genital wart treatment

Answer 45

imiquimod cream podofilox gel sinecatechins ointment

Question 46

What is PID

Answer 46

Inflammation of upper genital tract *secondary to an ascending infection from lower genital tract

Question 47

What is the most common cause of PID

Answer 47

chlamydia or gonorrhea

Question 48

Who is at increased risk for PID

Answer 48

Multiple partners age previous PID IUD tubal ligation

Question 49

How will PID present

Answer 49

Abdominal or lower pelvic pain vaginal discharge dyspareunia AUB

Question 50

How would you do an exam for suspected PID

Answer 50

Cervical discharge cervical motion tenderness uterine tenderness adnexal tenderness +/- pelvic mass

Question 51

What clinical criteria needs to be present to have a high suspicion for PID

Answer 51

cervical motion tenderness uterine tenderness adnexal tenderness

Question 52

How do you treat PID

Answer 52

IV or PO antibiotics * should improve within 72 hours

Question 53

What are the indications for admissions with PID

Answer 53

-need to rule out other surgical emergency -presence of tubo-ovarian abscess - severe infection (Temp over 101) -no response to PO tx

Question 54

What is the first line abx regimen for PID

Answer 54

Ceftriaxone 1g IM + Doxy 100mg PO + Metronidazole 500mg PO *treat for 14 days

Question 55

What are complications associated with PID

Answer 55

Tubo-ovarian abscess pelvic abscess ectopic pregnancy infertility chronic pelvic pain