STIs

Question 1

Early symptoms of HIV

Answer 1

fever, night sweats, weight loss

Question 2

3 important monitoring tests for HIV/AIDS

Answer 2

CD4: normal >800, antivirals when ≤350; also Bactrim for prophylactic treatment of Pneumocystis jirovecii
CD4 percentage: risk of progression to AIDS when

Question 3

Diagnosis of HIV

Answer 3

ELISA for screen

Western Blot to confirm

Question 4

Diagnosis of AIDS

Answer 4

CD4 ≤ 200 AND/OR the presence of an opportunistic infection

Question 5

How long does seroconversion from HIV negative to HIV positive take?

Answer 5

3 weeks to 6 months

Question 6

Which two STI’s cause painful lesions?

Answer 6

herpes and chancroid

Question 7

Chancroid: pathology, incidence

Answer 7

• Hemophilus ducreyi
• established as a co-factor for HIV transmission
• women usually asymptomatic, men with single (or multiple) superficial painful ulcer, surrounded by erythematous halo, unilateral swollen inguinal lymph node

Question 8

How do you diagnose chancroid?

Answer 8

Diagnosis of exclusion, mae morphologically.

Painful genital ulcers in absence of Treponema and HSV with co-existing tender inguinal lymphadenopathy.

Question 9

How do you treat chancroid?

Answer 9

Azithromycin 1gm by mouth x1 or
Ceftriaxone 250mg IM x1 or
Cipro 500mg PO BID x3 days

Question 10

Chlamydia: pathology and incidence

Answer 10

• caused by Chlamydia trachomatis

- most common STI in the United States

Question 11

What are the signs and symptoms of chlamydia?

Answer 11

• often asymptomatic
• dysuria
• dyspareunia and postcoital bleeding in women
• spotting in women
• vaginal or penile discharge
• testicular pain

Question 12

What is the differential diagnosis for dyspareunia?

Answer 12

• chlamydia
• pelvic inflammatory disease
• menopause (dry)
• trichomonas

Question 13

Diagnosis and treatment of chlamydia

Answer 13

• culture is most definitive, but enzyme immunoassay (EIA) is quicker so it is the preferred method
• azithromycin 1gm PO x1 or
• doxycycline 100mg PO BID x7 days
• report to the health department

Question 14

Genital warts: cause and incidence

Answer 14

• caused by HPV

- most common VIRAL sexually transmitted disease in the US

Question 15

Genital warts: sx, dx, tx

Answer 15

Sx: painless keratinized cauliflower growth
Dx: colposcopy for flat lesions; may need to biopsy if at risk
Tx: Keratolytic agents (Podophyllin, TCA, BCA), or refer for cryotherapy

Question 16

Gonorrhea: pathology, incidence

Answer 16

• caused by Neisseria gonorrhea
• causes urethritis in men and cervicitis in women
• leading cause of infertility in women in United States

Question 17

Signs and symptoms of gonorrhea

Answer 17

• Often asymptomatic
• Dysuria and urinary frequency
• Vaginal or penile discharge (green)
• Labial pain/swelling, pelvic pain in women
• testicular pain
• dysmenorrhea, abnormal periods
• nausea/vomiting in men

Question 18

How do you diagnose and treat gonorrhea?

Answer 18

• Dx: gram stain of discharge, or cervical culture in Thayer-Martin
• Ceftriaxone 250mg IM x1, PLUS…
• Azithromycin or doxycycline to cover chlamydia (always co-treat)
• report to health department

Question 19

What to do in case of hepatitis B exposure?

Answer 19

• HBIG within 14 days of exposure (the earlier the better)

Question 20

What are the signs and symptoms of herpes?

Answer 20

Initial: Fever, malaise, dysuria, painful/pruritic ulcers for about 12 days
Recurrent: Less painful/pruritic ulcers for about 5 days

Question 21

Diagnosis and treatment of herpes

Answer 21

Dx: viral culture
Tx: no cure; Valacyclovir is the standard for decreasing asymptomatic viral shedding of HSV2; Acyclovir also can be used for acute outbreak

Question 22

Lymphogranuloma Vereneum (LGV): cause, symptoms

Answer 22

• caused by immunotypes L1, L2, or L3 of chlamydia trachomatis
• 2-3mm painless vesicle, bubo, or non-indurated ulcer
• stiffness and aching in groin f/b unilateral swelling of inguinal region

Question 23

Diagnosis and treatment of lymphogranuloma vereneum (LGV)

Answer 23

Dx: may be confused with chancroid, requires isolating Chlamydia trachomatis from appropriate specimen
Tx: doxycycline 100mg PO BID x21 days, aspirate bubos to prevent ulcerations

Question 24

Molloscum contagiosum: sx, dx, tx

Answer 24

Sx: 1-5mm smooth, rounded, firm, shiny flesh-colored to pearly white papules commonly seen on trunk and anogenital region
Dx: inspection and microscopic exam
Tx: cryoanesthesia with liquid nitrogen, but may scar (can also leave alone and they will go away)

Question 25

Syphilis: cause and incidence

Answer 25

• caused by Treponema pallidum, a spirochete

- third most commonly reported infectious disease in the US

Question 26

Clinical stages of syphilis

Answer 26

Primary- PAINLESS chancre, indurated ulcer
Secondary- flu-like symptoms, skin rash on palms/soles/mouth, lymphadenopathy, alopecia, arthralgias
Latent- seropositive but asymptomatic
Tertiary- leukoplakia, cardiac insufficiency, aortic aneurysm, meningitis, hemiparesis/hemiplegia

Question 27

Diagnosis and treatment of syphilis

Answer 27

Dx: screen with VDRL/RPR, confirm with fluorescent treponemal antibody absorption (FTA-ABS)
Tx: Primary/secondary- Pen G 2.4m units IM x1
Tx: Latent/tertiary- Pen G 2.4m units IM weekly x3 weeks
Tx: For penicillin allergy: Doxy or EEC
- report to health department