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STIs Flashcards

1
Q

Potentially cause chronic pelvic pain and infertility

A

chlamydia

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2
Q

ELISA is used as a screening test

A

HIV

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3
Q

Screening test may be negative during initial acute flu-like illness

A

HIV

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4
Q

If HIV is suspected during acute flu-like illness, what test should be ordered?

A

NAAT: RNA qualitative assay

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5
Q

(2) produces malodorous vaginal discharge

A
  • trichimoniasis

- BV

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6
Q

Frothy yellow discharge

may be asymptomatic especially in >40yo

A

Trichomoniasis

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7
Q

NAAT used for screening

A

GC/CG

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8
Q

Who should be screened yearly for STIs

A

<25 year olds

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9
Q

Term for initial painless lesion associated with syphilis

A

Chancre

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10
Q

organism associated with syphillis

A

Treponema pallidum

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11
Q

Positive whiff-amine test

A

BV

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12
Q

Birth control to increase BV cure rates

A

condoms

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13
Q

HIV confirmatory test

A

Western blot

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14
Q

Treated with metronidazole 500 mg BID for 7 days

A
  • BV

- trich

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15
Q

Are metronidazole and clindamycin safe in pregnancy

A

yes, but avoid in 1st trimester

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16
Q

STI that causes cervical cancer

A

HPV

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17
Q

white, adherent, malodorous discharge

A

BV

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18
Q

Serology test to differentiate HSV1 and 2

A

IgG

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19
Q

positive “chandelier test” indicates

A

PID

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20
Q

Patient group at highest risk for HIV

A

Hispanic MSM

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21
Q

__% with HIV report no high-risk behaviors

A

25%

screen everyone

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22
Q

If HIV 1/2 antigen/antibody assay is positive (ELISA) what do you order

A

HIV 1/2 antibody differentiation immunoassay (replaces western blot)

  • (+) refer
  • (-) order NAT (HIV1 RNA qualitative assay)
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23
Q

Initial HIV infection duration

A

<14 days

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24
Q

Initial HIV infection presentation

A
  • fever
  • pharyngitis
  • nonpruritic macular skin rash
  • malaise
  • headache
  • lymphadenopathy
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25
Q

When is HIV most infectious

A

acute retroviral stage

2-4 weeks postinfection

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26
Q

What is a significant risk factor for reactivation of latent TB

A

HIV

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27
Q

What should never be given to HIV infected patients

A

live attenuated vaccines

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28
Q

When are HIV antibodies typically developed

A

within 3 months of exposure

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29
Q

AIDs definition

A

CD4 cell count <200

infection with opportunistic infections and malignancies

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30
Q

s/sx of AIDs

A
  • oral thrush
  • fever
  • weight loss
  • diarrhea
  • cough
  • SOB
  • purple to bluish red bumps on skin
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31
Q

What causes the most deaths in patients with HIV

A

-infection with Pneumocystis jirovecii

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32
Q

Which HIV strain is most common in US

A

HIV 1

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33
Q

Step 1 with suspected HIV

A
  • HIV-1/HIV-2 antibodies and P24 antigen with reflex

- detects if strain 1 or 2

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34
Q

Step 2 if HIV1/2 antibodies are positive

A
  • lab performs HIV1/2 antibody differentiation immunoassay

- if results indeterminate, order HIV RNA test

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35
Q

HIV RNA PCR can detect HIV infection as early as

A

7-28 days

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36
Q

Pneumocystis carinii prophylaxis

A

Bactrim DS one tab daily

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37
Q

MOnitoring viral load on ART frequency

A

every 1-2 months until viral load is undetectable

then q 3-4 months

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38
Q

Tenofovir lab monitoring

A

-UA every 6 months

nephrotoxic

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39
Q

Zodovudine lab monitoring

A

-CBC with diff

BM suppression

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40
Q

HIV education what to avoid

A
  • cat litter
  • undercooked meat
  • turtles, snakes, other amphibians
  • bird stool
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41
Q

Preventing HIV transmission

A
  • condom every sexual encounter
  • do not share needles
  • do not share toothbrush, razer, or any blood item
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42
Q

HIV infected mothers and breastfeeding

A

do NOT breastfeed

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43
Q

Who should take PrEP

A
  • ongoing sexual relationship with HIV (+) partner

- LGBT who do not use condoms/high risk sexual behaviors

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44
Q

PrEP HIV checks

A

check for HIV before starting

-then every 3 months

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45
Q

PEP

A

postexposure prophylaxis

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46
Q

Outer limit of PEP

A

72 hours postexposure

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47
Q

When to start prophylaxis for Pneumocystis carinii

A

when CD4 is <200

48
Q

When to start antiretroviral therapy in HIV infected pregnant women

A

ASAP

49
Q

Which HIV drug is safest for HIV infected pregnant women

A

-Zodivudine

50
Q

What to do if HIV+ patient is unwilling to notify partners

A

-health department will try to locate them

51
Q

Why does BV occur

A

-replacement of normal vaginal flora with high concentrations of anaerobic bacteria

52
Q

Risks of BV

A
  • multiple sex partners
  • new partners
  • douching
  • IUCs
53
Q

BV increases risk for

A

STI
UTI
post-gynecologic surgery infections
preterm labor

54
Q

BV organisms

A
  • Prevotella
  • Mobiluncus
  • G.vaginalis
55
Q

BV Amsel criteria

A
  • requires 3 for diagnosis
  • white discharge coating vulva/vagina
  • vaginal pH of >4.7
  • fishy odor before or after addition of KOH (whiff test)
  • clue cells on microscopy
56
Q

BV management

A
  • screen for other STIs
  • Metronidazole 500 mg PO BID x 7 days (cream available)
  • Clindamycin 300 mg PO BID x 7 days
57
Q

Patient teaching with metronidazole

A

-no alcohol until 24 hours after last dose

58
Q

With recurrent BV, what must you rule out

A

HIV

59
Q

Pregnant women treated with GC/CG should have test-of-cure when

A

3-4 weeks after treatment

60
Q

Pregnant women who were treated should be tested again for GC/CT when

A

at 3 months

61
Q

Most chlamydial infections are symptomatic

A

false

62
Q

Which STD is most common in US

A

chlamydia

63
Q

Lab testing for GCCT

A

NAAT

-swabs or urine sample

64
Q

Treatment for uncomplicated chlamydia

A
  • Azithromycin 1 g PO single dose

- OR doxycyline 100 mg BID x 7 days

65
Q

Is a test-of-cure necessary for uncomplicated chlamydia

A

no

66
Q

Chlamydia treatment for sexual partners

A
  • azithromycin 1 g PO

- abstain from sex for 7 days

67
Q

Expedited Partner Therapy

A

practice of treating sexual partner of a patient diagnosed with STD without evaluating them
-Allowed in 41 states

68
Q

Treatment for PID

A
  • Ceftriaxone (Rocephin) 250 mg IM x one dose
  • PLUS doxycycline PO BID x 14 days
  • with or without metronidazole PO BID x 14 days
69
Q

What can happen with gonorrhea infection if not treated

A

-can become systemic or disseminated

70
Q

Treatment for gonorrhea

A

-treat for both chlamydia and gonorrhea d/t high rates of coinfection

71
Q

Gonorrhea presentation

A
  • purulent green-colored vaginal discharge
  • shuffling gait to avoid abdominal pain
  • cervix friable
  • males can have penile discharge
  • new onset sex partner or multiple sex partners
  • inconsistent condom use
72
Q

Proctitis presentation

A
  • pruritus
  • rectal pain
  • tenesmus (cramping of rectum)
  • feeling urge to defecate even if rectum is empty
  • avoiding defecation due to pain
73
Q

Gonorrhea presentation in men

A
  • may be asymptomatic
  • dysuria
  • discharge
  • testicular pain
74
Q

Trichomoniasis presentation

A
  • asymptomatic for decades
  • frothy yellow green discharge
  • vulvar irritation
  • dysuria
  • cervical petechiae
75
Q

Diagnosis of trichomoniasis

A
  • wet prep –> flagellated motile cells

- NAAT

76
Q

Trichomoniasis management

A
  • Metronidazole 2 g single dose
  • abstinence from sex until treatment completion
  • treat sexual partners
  • avoid alcohol x 72 hours after dose
77
Q

Trichomoniasis organism

A

trichomoniasis vaginalis

78
Q

Primary syphilis findings

A
  • chancre
  • indurated and painless, well demarcated
  • persists for 1-5 weeks and heals spontaneously
  • regional lymphadenopathy
79
Q

Secondary syphilis findings

A
  • symmetrical bilateral rash
  • frequently on palms and soles
  • 2-6 weeks and resolves
  • condyloma lata: moist, pink, warty lesions
80
Q

Condyloma lata indicates which stage of syphilis

A

secondary

81
Q

Latent syphilis findings

A

asymptomatic

82
Q

Tertiary syphilis findings

A
  • CVD: aortic valve disease, aneurysms
  • Neuro: meningitis, encephalitis, tabes dorsalis, dementia
  • Skin: gummas
  • Ortho: Charcot joints, osteomyelitis
83
Q

Syphilis organism

A

treponema pallidum

84
Q

Syphilis management

A

Benzathine PCN G (Bicillin) 2.4 million units IM

85
Q

First labs to order with syphilis

A
  • nontreponemal tests: RPR or VDRL

- if positive: order confirmatory tests

86
Q

Confirmatory test for syphilis

A

Treponemal tests

-FTA-ABS

87
Q

What is diagnostic for syphilis

A

+RPR and +FTA-ABS

88
Q

What to monitor for treatment response in syphilis

A
  • sequential RPR

- four fold or higher decrease means responding well to treatment

89
Q

Treatment for primary, secondary, or early latent syphilis (<1 year)

A

-Benzathine PCN G (Bicillin L-A) 2.4 million units IM x one dose

90
Q

Syphilis follow up

A

RPR or VDRL at 6 and 12 months of treatment

91
Q

When to refer syphilis to infectious disease specialist

A
  • suspected neurosyphilis
  • poor response to treatment
  • PCN allergy
  • or if not familiar with management
92
Q

Proctitis patho

A

Lining of inner rectum becomes inflamed

-can be due to STI’s

93
Q

Complicated gonococcal infections include…

A
  • PID
  • acute epididymitis
  • acute prostatitis
  • acute proctitis
94
Q

Risks for PID

A
  • history of PID (25% recurrence)
  • Multiple partners
  • Age <25
95
Q

Urine specimen is best collected with

A

first urine of the day

96
Q

STI’s requiring serum

A
  • HIV
  • Hep B and C
  • syphilis
  • HSV type 2
97
Q

Sexual assault after care

A
  • Hep B immunization
  • HPV vaccination
  • GC/CT treatment: Rocephin +Azithromycin
  • Trich and BV treatment: Metronidazole 2 g
  • consider PEP for HIV with zidovudine
98
Q

Complication of PID due to chlamydia or gonorrhea infection

A

Fitz-Hugh-Curtis syndrome

99
Q

Jarisch-Herxheimer reaction

A
  • acute febrile reaction during first 24 hours of syphilis treatment and other spirochetes
  • resolves spontaneously within 24 hours
100
Q

Reiter’s syndrome

A
  • more in males
  • joint pain and swelling
  • conjunctivitis
  • urethritis
  • immune-mediated reaction secondary to infection with certain bacteria that resolves spontaneously
  • supportive treatment
101
Q

Reiter’s syndrome mnemonic

A

cant see
cant pee
cant climb a tree

102
Q

Follow up for PID treatment

A
  • within 72 hours

- retest for adnexal tenderness or cervical motion tenderness

103
Q

Condyloma acuminata

A

genital warts

104
Q

HPV vaccine is given at age

A
  • 9-14: 2 doses 6-12 months apart

- 15-45, IC: 0, 1-2, 6

105
Q

Genital warts treatment

A
  • Podofilox (Condylox) 0.5% gel or cream x 3 days, hold for 4 days, repeat up to 4 times
  • Imiquimod or Zyclara, thin layer three times a week
  • Sinecatechins
  • electrocautery
106
Q

HSV prodrome

A

-itching, burning, tingling on site

107
Q

HSV diagnostic test

A
  • herpes viral culture

- RPR assay for HSV 1/2 DNA –> more sensitive

108
Q

First herpes outbreak treatment

A
  • Acyclovir 400 mg TID 7-10 days or 200 mg five x/day
  • Famciclovir 1 g BID 7-10 days
  • Valacyclovir TID 7-10 days
109
Q

Episodic HSV treatment

A
  • best if started within 1 day of lesion onset
  • Famciclovir 125 mg BID x 5 days
  • Acyclovir x 5 days
  • Valacyclovir x 5 days
110
Q

HSV suppressive treatment

A

-Acyclovir 400 BID or famciclovir 250 mg BID

111
Q

Imiquimod

A
  • immune modulator

- patient can use at home

112
Q

Genital warts treatment C/I in pregnancy

A
  • podofilox
  • podophylla
  • imiquimod
113
Q

Genital warts treatment for pregnancy

A
  • manual removal by HCP

- cryo, laser, excision

114
Q

Which strains of HPV are oncogenic

A
  • 16

- 18

115
Q

Screening test for HIV

A

-combination HIV-1 and HIV-2 antibody immunoassay with p24 antigen

116
Q

ELISA and Western Blot test for HIV tests what

A

HIV antibody

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