STIs, sexual abuse, chronic pelvic pain

Question 1

Amsel’s criteria for diagnosis of BV

Answer 1

1. Homogeneous thin vaginal discharge
2. Clue cells
3. pH > 5.0
4. Amine odor on 10% KOH prep

Question 2

Bacteria associated with BV

Answer 2

Anaerobes: gardnerella (prevatella), mobiluncus (mycoplasma)

Question 3

Most common non-viral STI in US

Answer 3

Trichomonas

Question 4

Contraception associated with higher risk of GC/CT

Answer 4

OCPs because of cervical ectopy

Question 5

Types of anaerobes that GC and CT are

Answer 5

GC facultative

CT obligate

Question 6

Petechial / pustular rash, asymmetric arthritis, septic arthritis

Answer 6

Disseminated gonococcal infection (formerly “acute arthritis-dermatitis syndrome”)
Tx: hospitalization and daily ceftriaxone

Question 7

Alternative to cefoxy/doxy/flagyl for PID

Answer 7

Gent/clinda

Question 8

Test for primary syphilis

Answer 8

Dark field exam

Question 9

Causes of false positive RPR

Answer 9

Auto-immune disease, hx of malaria, hx of smallpox, mycoplasma, elderly / debilitated, IV drug use

Question 10

Goals of syphilis treatment by RPR monitoring

Answer 10

4-fold decline at 3 months
8-fold decline at 6 months
Baseline / non-reactive at 12 months

Question 11

Jarisch-Herxheimer reaction

Answer 11

Fever, headache, arthralgias, lesions at 4-6 hrs post-treatment for secondary syphilis, due to release of endotoxins, lasts 24 hrs

Question 12

Painful genital ulcers, adenopathy -> bubo

Answer 12

Chancroid (hemophilus ducreyi)

Dx based on ruling out syphilis and HSV

Question 13

Small, often silent ulcer heals in 3-10 days; double crease sign with unilateral adenopathy and draining sinuses

Answer 13

Lymphogranuloma venereum (chlamydia)

Question 14

Small painless nodule, progresses to granulomatous mass, no adenopathy

Answer 14

Granuloma inguinale (klebsiella granulomatis), common in India, Papua/New Guinea, South Africa

Question 15

Molluscum contagiosum cause and treatment

Answer 15

MCV poxvirus

Self-limited - no treatment indicated

Question 16

PrEP meds

Answer 16

Emtricitabine / tenofovir

Question 17

Risks of PrEP

Answer 17

1. Risk of resistance if HIV positive during use
2. Hep B pos -> acute flare and hepatic injury
3. Lactic acidosis
4. Severe hepatomegaly / steatosis

Question 18

Treatment for chronic Hep B

Answer 18

Nucleotide analogues (tenofovir, entecavir)
Interferon alpha, pegylated interferon
(Treatments are non-curative.)

Question 19

Treatment for Hep C

Answer 19

Nucleoside analogues*
Protease inhibitors
CYP3A4 inhibitor
Pegylated interferons

Question 20

Most common sexual dysfunction

Answer 20

Female sexual arousal disorder

Question 21

Antifantasies (negative imaginings of sexual encounters)

Answer 21

Sexual aversion disorder

Question 22

Normal sexual desire and orgasm but absent external signs of stimulation

Answer 22

Sexual arousal disorder

Question 23

Commonly associated with “spectatoring” during sexual encounters

Answer 23

Primary anorgasmia

Question 24

Treatment for primary anorgasmia

Answer 24

Directed masturbation

Question 25

Vaginismus treatment

Answer 25

Counseling regarding conditioned responses, vaginal dilator therapy, address underlying medical issues (like endometriosis, PID, imperforate hymen, vaginal stenosis)

Question 26

Differential diagnosis for vulvar vestibulitis syndrome

Answer 26

Infections, contact allergy, vaginal pH alteration, skin damage from HPV treatment etc

Question 27

Pharmacologic treatment for dyspareunia / VVA

Answer 27

1. Vaginal estrogen 2. Ospemifene (SERM) 3. DHEA (precursor to sex steroids) intra-vaginal, Prasterone (Intrarosa)

Question 28

Treatments for female sexual interest / arousal disorder

Answer 28

1. Androgens (post-menopausal only, none FDA approved) 2. Flibanserin (5HT-1A agonist) 3. Bremelanotide (melanocortin stimulator) 4. Bupropion 5. Phosphodiesterase inhibitors (like Sledenafilm equivocal benefit) 6. Gabapentin / amantadine