STIs

Question 1

most common STI causing vaginitis

Answer 1

T. vaginalis

Question 2

leading age groups for c. trachomatis infection

Answer 2

women age 15-24 and men age 20-29

Question 3

syphilis most commonly affects which groups?

Answer 3

MSM, sex workers and their clients, immigrants from endemic regions

Question 4

types of HPV that cause cancer?

Answer 4

16 and 18

Question 5

types of HPV that cause warts

Answer 5

6 and 11

Question 6

list risk factors for STIs less than 25 years

Answer 6

inconsistent condom use
contact with someone know to have an STI
new partner
>2 partners in last year
serial monogamy
no contraception
IV drug use
any drug use

Question 7

how to screen for chlamydia

Answer 7

NAAT first catch urine or urethra,vaginal or cervical swab.

culture needed for sexual assault cases

Question 8

when to obtain test of cure for chlamydia

Answer 8

3-4 weeks post treatment NAAT

if compliance uncertain, second line treatment used, re-exposure risk high, adolescent is pregnant

Question 9

how to test for gonorrhea

Answer 9

NAAT first catch urine, vagina, cervical swabs.
culture needed for sensitivities if does not respond to treatment promptly
consider culture in MSM as they have higher abx resistance
culture preferred for pharyngeal or rectal infections

Question 10

when to test of cure for gonorrhea

Answer 10

3-7 days post treatment culture OR
NAAT 2-3 weeks post treatment if
second line or alternative tx used
antimicrobial resistance
compliance uncertain
high risk re-exposure
adolescent is pregnant
previous treatment failure
pharyngeal or rectal infection
disseminated infection
does not respond to treatment symptomatically

Question 11

when to re-screen/re-test for chlamydia and gonorrhea (not TOC)

Answer 11

in 6 months because re-infection risk is very high in adolescents

Question 12

how to screen for syphilis

Answer 12

serology
treponema test more sensitive
if non treponemal test used a second treponemal should be used to confirm.

Question 13

how to treat and TOC for syphilis

Answer 13

Refer to ID!!
primary, secondary, early latent
serology at 1,3,6, 12 months
late latent
12 and 24 months
neurosyphilis 
6,12,24 months

Question 14

HIV screening

Answer 14

serology with confirmatory western blot if positive

with 4th generation teswts can be positive by 3 weeks post exposure, but older tests have longer window period

Question 15

men asymptomatic STI screening

Answer 15

first catch G&C urine
pharyngeal or rectal swab if history of exposure
Syphilis and HIV serology
consider Hep A and B and C (only if IV drug use)

Question 16

screening STI for asymptomatic females with risk factors

Answer 16

urine G& C NAAT
pharyngeal and or rectal swab if history of exposure
Serology for syphilis and HIV
consider Hepatitis screening if risk factors

Question 17

male with urethritis

Answer 17

culture urethra for gonorrhea

first catch urine for G and C

Question 18

women with cervicitis

Answer 18

vag or cervical swab for gonorrhea and chlamydia

vaginal swab wet mount

Question 19

genital ulcers

Answer 19

swab for HSV culture or PCR
AND
serology for syphilis
if ulcer painless can consider swab for darkfield microscopy

Question 20

vaginitis

Answer 20

collect pooled vaginal secretions if available

if not get swab for G and C and for wet mount/vaginal culture

Question 21

treatment for gonorrhea/chlamydia

Answer 21

should always co treat
preferred is ceftriaxone 250 mg IM x 1 and azithromycin 1 g po
OR cefizime 800 mg po x 1 dose and azithromycin 1 g po

if pharyngeal infection IM preferred but could consider cefixime as alternative

Question 22

HSV infection treatment

Answer 22

first episode Valtrex 1000 mg po BIDx q0 days or famciclovir 250 mg TID or acyclovir 200 mg five x per day 5-10 days

if secondary infection can give lower doses

Question 23

treatment for trichomonas vaginalis

Answer 23

Flagyl 2 g x 1 dose po or 500 mg BID x 7 days