Unit4: Ch 46- Sexually Transmitted Infections (Porth's 5th Ed) Flashcards
During unprotected sex, a 17-year-old female high school senior has been exposed to
the human papillomavirus (HPV). The school nurse would recognize that the student is
at a considerable risk of developing which of the following diagnoses?
A) Genital herpes
B) Gonorrhea
C) Condylomata acuminata
D) Candidiasis
Ans: C
Feedback:
HPV is an identified precursor to condylomata acuminata, or genital warts. Herpes,
gonorrhea, and candidiasis are not likely to result directly from HPV.
A campus-based peer counseling group is conducting an information blitz on sexually
transmitted diseases. Which of the following statements about genital warts requires
correction?
A) “Genital warts can take up to a month after exposure to first become visible.”
B) “There is no existing treatment that can eradicate the virus once it’s contracted.”
C) “Condoms do not necessarily prevent the transmission of the virus that causes
genital warts.”
D) “There are a number of subtypes of the virus that cause genital warts, but current
vaccines protect against most common causes of them.”
Ans: A
Feedback:
Genital warts can take between 6 weeks to 8 months to incubate after exposure. The
virus cannot be eliminated, and condoms do not provide proven protection. Vaccine
protects against 4 HPV types.
A 31-year-old male was diagnosed with genital herpes of the HSV-2 type 5 years ago.
He is now broaching the subject with a woman he has recently formed a relationship
with. Which of his statements is most accurate?
A) “If you’ve been exposed to the herpes virus in the past, then there’s no significant
risk of reinfection.”
B) “The worst case scenario is that you’ll develop cold sores, since this is the type of
herpes virus that I’ve got.”
C) “If you’ve had cold sores when you were younger, it means that you’ve got
antibodies against this type of herpes virus.”
D) “Even when I’m not having a recurrence, I could still pass the virus on to you.”
Ans: D
Feedback:
HSV transmission can occur both during and between recurrences. HSV-2 is associated
more with genital herpes than cold sores, and cold sores do not provide antibody
protection. Prior contact with the virus does not confer immunity.
A male college student has arrived at the student clinic complaining of tingling, itching,
and pains in his groin. Upon inspection, the nurse notices some pustules and vesicles.
While taking a detailed sexual history, the nurse should ask which of the following
questions to rule out further complications?
A) “Do you get cold sores very often?”
B) “Do you have pain when you urinate or have difficulty starting the stream?”
C) “Have you noticed excessive swelling in your scrotum the last few days?”
D) “Have you been experiencing flank pain and bloody urine?”
Ans: B
Feedback:
The initial symptoms of primary genital herpes infections include tingling, itching, and
pain in the genital area, followed by eruption of small pustules and vesicles. In men, the
infection can cause urethritis and lesions of the penis and scrotum. Urethritis is
characterized by pain with urination and difficulty starting the stream. Cold sores are not
related to genital herpes. Swelling of the scrotum is common in epididymitis, while
flank pain and bloody urine are associated primarily with kidney stone formation.
pregnant 23-year-old diagnosed with herpes simplex virus (HSV) is receiving
prenatal care from her family physician. To prevent transmission of the virus to her
baby, the physician will educate to include which of the following accurate statements?
A) “After your caesarean section, it will be safest if you don’t breast-feed your child.”
B) “If there aren’t any visible lesions when you enter labor, a vaginal delivery will be
safe to go ahead with.”
C) “A vaginal delivery will be safe as long as you are consistent with taking your
valacyclovir.”
D) “We’ll have to book you a caesarian delivery in order to ensure your baby isn’t
exposed to the virus.”
Ans: B
Feedback:
Vaginal delivery is safe in the absence of lesions at the onset of labor. HSV does not
preclude breast-feeding, and antivirals would not be commonly used in pregnancy, nor
would they guarantee a risk-free vaginal delivery.
A 20-year-old male has presented to a health clinic with multiple genital lesions that are
filled with a viscous, creamy exudate and has subsequently been diagnosed with
molluscum contagiosum. What is his care provider most likely to tell him about the plan
for treating the diagnosis?
A) “This kind of infection often subsides on its own and doesn’t grow more serious
over time.”
B) “These lesions usually respond well to oral antiviral medications.”
C) “Treatment of this problem is usually successful, but if untreated, it can lead to
sterility.”
D) “The bacteria that cause this disease are often latent for several years at a time,
and you would be contagious for the entire period.”
Ans: A
Feedback:
Molluscum contagiosum is considered a benign and self-limiting viral illness. Oral
antivirals are not a common treatment, and it is not noted to lead to sterility.
After hearing horror stories about the signs, symptoms, and course of lymphogranuloma
venereum (LGV), a high school student has asked a visiting sexual health educator
about the odds of acquiring the disease among sexually active Americans. Which of the
following facts will most accurately underlie the educator’s response?
A) LGV has been eradicated in the United States but still has significant prevalence
and incidence in Southeast Asia and Central America.
B) This disease is not common in the United States, but existing cases
disproportionately affect women.
C) Men who have sex with men are at particular risk of LGV.
D) The virus that causes LGV is rare outside the tropics.
Ans: C
Feedback:
In the United States, men who have sex with men are the population with the highest
prevalence and incidence of LGV. It is bacterial in etiology and affects more men than
women.
Which of the following factors are known to contribute to vaginal yeast infections? Select all that apply. A) Inflammation of the Skene and Bartholin glands. B) Poorly controlled diabetes C) Recent antibiotic therapy D) Excessive physical exercise E) Use of oral contraceptives F) High hormone levels during pregnancy
Ans: B, C, E, F
Feedback:
Reported risk factors for the overgrowth of C. albicans include recent antibiotic therapy,
which suppresses the normal protective bacterial flora; high hormone levels owing to
pregnancy or the use of oral contraceptives, which cause an increase in vaginal glycogen
stores; and uncontrolled diabetes mellitus or HIV infection, because they compromise
the immune system. Exercise and glandular inflammation are not noted risk factors for
yeast infections.
A patient with a yeast infection asks the nurse how they diagnose this infection. The
nurse will base her response knowing this is primarily diagnosed by
A) the look and smell of the secretions.
B) looking at the spores on a wet-mount slide using 20% potassium hydroxide.
C) looking for Lactobacillus species under the microscope.
D) sending a blood test to lab for DNA testing on the specimen.
Ans: B
Feedback:
Accurate diagnosis is made by identification of budding yeast filaments or spores on a
wet-mount slide using 20% potassium hydroxide. When the wet-mount technique is
negative but the clinical manifestations are suggestive of candidiasis, a culture may be
necessary. Definite diagnosis consists of more than a visual look at the secretions.
Diagnosis of bacterial vaginosis is made by looking at the number of Lactobacillus
species under the microscope. DNA testing may be required when dealing with HSV
infection.
A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on
urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual
activity during the last 6 months. Her records show that she has diabetes mellitus and
uses oral contraceptives. Which category of antimicrobial medication is most likely to
clear her symptoms?
A) Clotrimazole, an antifungal agent
B) Penicillin V potassium, a broad-spectrum antibiotic
C) Ciprofloxacin, a fluoroquinolone antibiotic
D) Tenofovir, an antiviral agent
Ans: A
Feedback:
The character of the discharge and the lack of recent sexual activity suggest infection
with Candida, which can exist asymptomatically and flare up only if conditions such as
an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or
oral contraceptive use enable the fungus to proliferate. Candidiasis responds well to
treatment with azole antifungal agents.
A young woman presents with vaginal itching and irritation of recent onset. Her labia
are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH
of 6.8. She has been celibate during the last 6 months and has been taking antibiotics for
a throat infection. Which medication is most likely to clear her symptoms?
A) Azithromycin
B) Valacyclovir
C) Penicillin
D) Metronidazole
Ans: D
Feedback:
The character of the discharge, lack of recent sexual activity, and current antibiotic
treatment point to infection with Trichomonas vaginalis, which can exist
asymptomatically and flare up only if conditions such as an imbalance in normal vaginal
flora resulting from antibiotic treatment enable the protozoan to proliferate. Patients
with trichomoniasis respond well to treatment with metronidazole.
A 24-year-old woman has presented to an inner city free clinic because of the copious,
foul vaginal discharge that she has had in recent days. Microscopy has confirmed the
presence of Trichomonas vaginalis. What are the woman’s most likely treatment and
prognosis?
A) Abstinence will be required until the infection resolves, since treatments do not
yet have proven efficacy.
B) Oral antiprotozoals to the patient and sexual partners to help prevent
complications.
C) Antifungal medications are effective against the anovulation and risk of HIV that
accompany the infection.
D) Vaginal suppositories and topical ointments can provide symptom relief but
cannot eradicate the microorganism
Ans: B
Feedback:
The treatment of choice for Trichomonas vaginalis is oral, metronidazole or tinidazole,
medications that are effective against anaerobic protozoans. Antifungals are not a
relevant treatment, and eradication of the infection is possible with treatment.
A 40-year-old woman with gray, runny vaginal discharge that has a foul, fishy odor has
been told that she most likely has vaginosis. Which of the following phenomena most
likely contributed to her present condition?
A) Unprotected sex with a new partner who is a carrier of the relevant bacteria.
B) Autoinoculation from a cold sore, wart or oral fungal infection.
C) A sharp reduction in the number of lactobacilli in the client’s vaginal flora.
D) Proliferation of sexually transmitted protozoa.
Ans: C
Feedback:
Vaginosis is a disorder characterized by a shift in the vaginal flora from one dominated
by hydrogen peroxide–producing Lactobacillus to one with greatly reduced numbers of
Lactobacillus species and an overgrowth of other organisms. Autoinoculation or sexual
transmission of bacteria or protozoa is unlikely to contribute
A 20-year-old male has been diagnosed with a chlamydial infection, and his primary
care provider is performing teaching in an effort to prevent the client from infecting
others in the future. Which of the following statements by the client demonstrates the
best understanding of his health problem?
A) “Either me or a partner could end up with an eye infection from chlamydia that
could make us blind.”
B) “Even though I couldn’t end up sterile, a woman that I give it to certainly could.”
C) “Each of the three stages of the disease seems to be worse than the previous one.”
D) “Even if I spread it to someone else, there’s a good chance she won’t have any
symptoms or know she has it.”
Ans: D
Feedback:
Seventy-five percent of woman with chlamydial infections are asymptomatic. Blindness
is a rare complication in adults who live in industrialized countries, and both men and
women can become sterile from the effects. Syphilis, not chlamydial infections, has a
course of three distinct stages.
The health nurse is dealing with a case of untreated chlamydial infection. The nurse
suspects the patient has developed Reiter syndrome. Which of the following clinical
manifestations would support this diagnosis? Select all that apply.
A) Diffuse pinkness of the conjunctiva along with watery and itchy eyes
B) Asymmetric complaints of stiffness and pain in knees and sacroiliac joints
C) Cervical tissue very friable and bleeds easilly
D) Pain when urinating
E) Fatigue and tiredness from heart valve vegetation
Ans: A, B, D
Feedback:
The most serious complication of untreated chlamydial infection is the development of
Reiter syndrome. This triad of symptoms includes urethritis, conjunctivitis, and arthritis
of weight-bearing joints, such as the knees and sacroiliac and vertebral joints. Pain when
urinating occurs in both men and women and is associated with urethritis. Women can
also develop reactive arthritis, but the male-to-female ratio for this complication is 5:1.
The arthritis begins 1 to 3 weeks after the onset of chlamydial infection. The joint
involvement is asymmetric, with multiple affected joints and a predilection of the lower
extremities. Cervical tissue friability is not part of Reiter syndrome.
