Sexually transmitted diseases Flashcards
(109 cards)
1
Q
AIDS is defined by an absolute CD4 count of less than how many cells
A
200 or the presence of an opportunistic infection
2
Q
Signs and symptoms that suggest AIDS are
A
Oral candidiasis/thrush, fever, weight loss, diarrhea, cough, night sweats, purple to bluish-red bumps on the skin, and opportunistic infection
3
Q
What infection causes the most deaths in HIV
A
Pneumocystis jirovecii
4
Q
An acute and brief illness that occurs in 50-80% of persons within a few weeks of exposure to the HIV virus
A
Acute retro viral syndrome, flu-like symptoms, fever, night sweats, and weight loss
5
Q
Is universal screening for HIV recommended
A
Yes
6
Q
ELISA is an initial screening for what?
A
HIV
Sensitivity is >99%
7
Q
Produces a malodorous vaginal discharge
A
BV
8
Q
DNA probe is used for screening
A
Gonorrhea and chlamydia
9
Q
RPR is used for screening
A
Syphilis
10
Q
FTA-ABS, MHA-TP Are diagnostic test for this STI (treponema pallidum)
A
Syphilis
11
Q
Western blot is confirmatory test for what?
A
HIV
12
Q
Etiologic agent is a virus
A
HIV, herpes and HPV
13
Q
This STD produces a discharge
A
HPV, gonorrhea, chlamydia, BV, herpes, trichomonas
14
Q
Treated with acyclovir, valacyclovir, and famciclovir with equal efficacy
A
Herpes
15
Q
May be associated with involuntary weight loss
A
HIV
16
Q
Can produce rash on palms of the hands soles of feet
A
Syphilis
17
Q
What STI is associated with a positive chandelier test
A
PID
18
Q
What is a positive chandelier test
A
Tender cervical area
19
Q
What STD produces a chanere
A
Syphilis
20
Q
What STD produces vesicles on mucous membranes
A
Herpes type one
21
Q
What is the initial screening test for HIV?
A
ELISA
22
Q
What is the confirmatory test for HIV?
A
Western blot - confirmatory
23
Q
In HIV infected patients what disease progresses faster
A
Liver disease and it affects the choice of anti-retroviral therapy
24
Q
What is a significant risk factor for reactivation of latent TB
A
HIV
25
What vaccines do HIV infected patients need annually
Pneumococcal, tetanus, hepatitis A and B, and flu shot
26
Do you administer alive or attenuated vaccine’s to HIV infected patients
No
27
How often do you obtain a CD4 count in an HIV infected patient
First CD4 count baseline then repeat once and usually every 3 to 4 months.
28
How often to check viral load and HIV infected patient
Need baseline and then every 3 to 4 months
29
If on ART, How long does it take for the viral load to be undetectable
Within 16 to 24 weeks of therapy
30
What other screening tests do HIV infected patients need
Hepatitis A, B and C, glucose and lipid panel, and STD assessment
31
If an HIV infected patient has a CD4 count of less than 200 what are they at risk for
Pneumocystis jiroveci, still called PCP
32
What is the prophylactic treatment for pneumocystis jiroveci with a CD4 count less than 200
TMP-SMX (Bactrim)
33
A patient with new onset HIV would present with what symptoms
Fever, night sweats, pharyngitis, nonpruritic macular skin rash, malaise, headache, lymphadenopathy, abrupt eruption of skin disorder such as hives, psoriasis at a later age
34
A 20-year-old male has suspected acute infection of HIV. How should he be screened?
ELISA
35
When taking metronidazole or tinidazole what precautions need to be taken
No alcohol until 24 hours after her last dose
36
With recurrent bacterial vaginosis what must be ruled out
HIV
37
What is the most frequently reported infectious disease in the United States
Chlamydia
38
At what age is chlamydia most common
Less than 25 years old
39
What can cause PID, ectopic pregnancy, infertility, and pelvic pain
Chlamydia
40
What is Chlamydia trachomatis?
| S/S?
-Parasitic STD caused by Chlamydia trachomatis that
produces serious reproductive tract complications in
either sex
-Often asymptomatic
Women Men
-Dysuria -Dysuria
-Intramenstrual spotting -Thick, cloudy penile discharge
-Postcoital bleeding -Testicular pain
-Dyspareunia
-Vaginal discharge
41
How do you diagnose Chlamydia/Labs?
```
Enzyme immunoassay (EIA), 30-120 min for results
Chlamydia culture most definitive, results takes 3-9 days
```
42
Who should be screened for Chlamydia and how often
Screen all sexually active females less than 25 years of age and all pregnant women. Re-screen in three months after treatment due to higher rates of reinfection. Follow up in one month if pregnant and symptoms persist they can cause reinfection
43
How do you treat Chlamydia?
Azithromycin 1 gram PO x1
Doxycycline 100 mg PO BID x7 days
Alternatives: Erythromycin, Ofloxacin, Levofloxacin
**Report to the health department**
44
What is gonorrhea?
-Bacterial STI caused by Neisseria gonorrhoeae (gram - diplococci),
-Cultured from genitourinary tract, oropharynx, and/or
anorectum
-Produces urethritis in men and cervicitis in women
-Leading cause of infertility among females in US
-Male to female transmission is 80-90% after exposure
45
S/S of gonorrhea include?
Females Males
- Often asymptomatic -Often asymptomatic
- Dysuria -Dysuria
- Urinary frequency -Urinary frequency
- Green mucopurulent DC -White/yellow/green DC
- Labial pain/swelling -Testicular pain
- Lower abdominal pain
- Fever
- Abnormal menstrual periods
- Dysmenorrhea
46
Gonorrhea Labs/Diagnostics
Treatment
-Gram stain of discharge smear shows gram- diplococci
and WBC
-Cervical culture using modified Thayer-Martin Media
-Ceftriaxone (Rocephin) 250 mg IM x1 dose
-Azithromycin (Zithromax) 1 gram po x1 dose to cover
chlamydia
**Report to health department**
47
Does a minor require parental consent for STD care
No
48
Epididymitis and prostatitis are possible side effects of which type of infection?
Chlamydia
49
What STD causes Reiters syndrome in males?
Chlamydia
50
If a patient is positive for gonorrhea what must they be co-treated for?
Chlamydia
51
What may reduce the risk of PID
Oral contraceptives
52
Chlamydia and/or gonococcal and infection of the liver capsule resulting in expensive scarring between the liver capsule and abdominal contents. Scars look like a violin strings. A complication of disseminated gonorrhea or PID
Fitz-Hugh-Curtis Syndrome (perihepatitis)
53
Sexually active female with symptoms of PID complains of right upper quadrant abdominal pain and tenderness on palpation. The liver function test is normal.
Fitz-Hugh-Curtis Syndrone
54
How do you treat Fitz-Hugh-Curtis syndrome
Treated as a complicated got a real/chlamydial infection for 14 days
55
More common in males. And immune mediated reaction secondary to infection with certain bacteria i.e. chlamydia that spontaneously resolved. Treatment is supportive i.e. NSAIDs
Reiters syndrome
56
A male with current history of chlamydia genital infection i.e. urethritis complains of red and swollen joints that come and go and ulcers on the skin of the glans penis
Reiters syndrome
57
Mneumonic. I can’t to see, Pee, or climb up a tree
Reiters syndrome
58
Is PID a clinical diagnosis
Yes i.e. cervical motion tenderness. Even if gonorrhea and chlamydia test are negative treat a sexually active patient who has signs and symptoms of PID
59
What is syphilis?
Cause?
Diagnostics?
Treatment?
- STI involving multiple organ systems
- Caused by Treponema pallidum, spirochete
- 3rd most common reported infectious disease in US
- 4 stages: primary, secondary, latent, and tertiary
- VDRL/RPR
- Pen G, if allergic, doxycycline or erythromycin
**Report to health department**
60
Primary syphilis
| Treatment if <1 yr duration?
- Chancre is painless
- Indurated ulcer
- Located at the site of exposure
-benzathine penicillin G, 2.4 million units IM
**Report to health department**
61
Secondary syphilis
| Treatment if <1 yr duration?
-Flu-like symptoms
-Highly variable skin rash on palmar and plantar surfaces,
mucous patches
-Lymphadenopathy
-Malaise
-Anorexia
-Alopecia
-Arthralgias
-benzathine penicillin G, 2.4million units IM
**Report to health department**
62
Latent syphilis
| Treatment?
-Seropositive, but asymptomatic
--benzathine penicillin G, 1.4 million units IM 1/week x3
weeks
**Report to health department**
63
Tertiary syphilis
| Treatment?
- Leukoplakia
- Cardiac insufficiency
- Aortic aneurysm
- Meningitis
- Hemiparesis
- Hemiplegia
--benzathine penicillin G, 1.4 million units IM 1/week x3
weeks
**Report to health department**
64
What is the screening test for syphilis
RPR or VDRL - Nontreponemal
**Report to health department**
65
For patients with syphilis prophylaxis for all sexual contacts should be given in the last how many days
90
66
What is the treatment for syphilis
Benzathine penicillin G 2.4 million units IM in adults
If PCN allergic...
DOxycycline 100 mg BID
Erythromycin 500 mg QID
**Report to health department**
67
Treponema infection is associated with
Syphilis
**Report to health department**
68
What is the order of screening test for syphilis?
First order screening test is RPR or VDRL.
If reactive, next step is to confirm with FTA – ABS.
Confirms 85-90% of primary cases and 100% of
secondary cases
Microhemagglutination assay for antibody to T. palladium
(MHA-TP)
**Report to health department**
69
If both the RPR and FTA-ABS or positive
This is diagnostic for syphilis
70
When do you recheck the RPR or VDRL after treatment
At six and 12 months
71
RPR and VDRL are screening tests for
Syphilis
**Report to health department**
72
If RPR or VDRL a positive how do you confirm?
FTA – ABS (treponemal test)
73
Maculopapular rash on the palms and soles are signs and symptoms of?
Secondary syphilis
74
The most common criterion collection is used to diagnose PID is
Cervical motion tenderness
75
Used to stage HIV infection and to determine when to start prophylaxis. Check at the same time of the day using the same laboratory each time
CD4 T cells counts
76
What is the screening test for HIV
ELISA Enzyme Linked Immunosorbent Assay
77
What is the confirmatory test for HIV
Western blot
78
Went a CD4 count is less than 100 Cells what kind of cause
Toxoplasma Gondii infections (Protozoa)
| Causes brain abscesses. Avoid cleaning cat litter boxes and eating undercooked meats
79
When a patient is on HAART and ART how should their viral load be monitored
Check every 1 to 2 months until viral load is undetectable then every 3 to 4 months
80
What are the recommended vaccines for HIV and AIDS patients
HIV and AIDS patients can receive inactivated vaccines such as hepatitis A, hepatitis B, annual flu vaccine, pneumococcal vaccine, TD/TDAp
81
What is some HIV education teaching points
Do not handle cat litter or eat uncooked lamb, beef, or pork as this is a risk for toxoplasmosis. Avoid Bird stool, turtles and other amphibians, and use gloves or avoid gardening.
82
When is PCP prophylaxis initiated in HIV patients
CD4 less than 200
83
If a patient with HIV is allergic to sulfa what drug should be used for PCP prophylaxis
Dapsone 100 mg PO daily
84
What is used for both prophylaxis and treatment of PCP
Bactrim DS
85
If a patient presents with hairy leukoplakia on the tongue, recurrent candidiasis thrush what must be ruled out
HIV
86
Can patients with HIV breast-feed
No
87
What is another name for genital warts?
| Treatment?
-Condyloma acuminata
-Most common viral STD in the US
-Keratolytic agents - podophyllin (Pododerm),
trichloroacetic acid (TCA) or bichloracetic acid (BCA)
-Referral fo cryotherapy, laser therapy, electrocautery, or
excision
88
Specialize microscope for evaluating and treating cervix
Colposcopy
89
What is the gold standard in diagnosing cervical cancer
Biopsy of cervical tissue
90
The majority of general HPV external warts are caused by which HPV strain
HPV 6 or 11
91
What is herpes?
S/S
Diagnostics
Management
-A recurrent viral STD with no cure, associated with
painful genital lesions
-Type 1 - associated with lips, face, and mucosa
-Type 2 - associated with genitalia
-Fever, malaise, dysuria, painful/pruritic ulcers for approx
12 days
-Recurrent episodes are usually less painful/pruritic for
appox 5 days
-Identified with Pap or Tzanck stain
-Most definitive test is a viral culture
-No treatment/cure
-Symptomatic treatment with drying and antipruritics
-Acyclovir recommended for topical, oral, and IV
-Famciclovir
-Valacyclovir
92
What are prodrome herpes simplex symptoms
Itching, burning, and tingling
93
Sudden onset of groups of small vesicles sitting on an erythematous base. Easily ruptures and it’s painful. Primary episode more severe and can last from 2 to 4 weeks. Vesicle fluid and crust are contagious.
Herpes simplex
94
What Risk factor has the highest impact on HIV transmission?
Viral load
95
A 32 year-old female was exposed to HIV after sexual intercourse. When do the majority of patients seroconvert if they are going to do so
3 weeks to 6 months
96
Chancroid is considered a cofactor for transmission of
HIV
97
HPV infection of the larynx has been associated with
Laryngeal Neoplasma
98
Complication of having pelvic inflammatory disease that was caused by vaginal infection such as gonorrhea or chlamydia
Fitz-Hugh-Curtis
99
How do you reveal subclinical lesions on the penile skin of a patient that presents with HPV infection
Apply acetic Acid to the penile shaft and look for Ace to white changes
100
The diagnosis of human papilloma virus infection in males is usually made by
Clinical appearance
101
Absolute CD4 lymphocyte normal count is
>800
102
What is viral load?
-PCR: Based quantitate copies of HIV-branched DNA or
RNA
-Results correlate closely with progression of HIV
-Ideally should be 0 or undetectable
103
Prevention of HPV/Vaccinations
-Gardasil for Types 6, 11, 16, & 18
-Gardasil 9 for prevention of cervical, vulvar, vaginal, and
anal cancer
-Indicated for females and males ages 9-26
-Given in 3 injections
-Cervarix for Types 16 and 18
-Indicated for females ages 10-25
-Given in 3 injections
104
HPV Types known to cause CA
Types 6, 11, 16, and 18
105
What STI's need to be reported to the health department?
Gonorrhea
Chlamydia
Syphilis
106
Hep-B prevention and treatment
-Two vaccines, Recombivax HB and Engerix-B both
administered at 0, 1, and 6 months.
-Supportive and symptomatic care
-Hep B immune globulin (HBIG) IM single dose may be
given within 14 days of exposure, earlier administration
may be more effective
107
What is lymphogranuloma venereum (LGV)
S/S
Dx
Treatment
-Immunotypes L1, L2, and L3 of Chlamydia trachomatis
-2-3 painless vesicles, bubo or nonindurated ulcer
-Regional adenopathy follows in approx 1 month and is
the most common finding
-Stiffness and aching in groin followed by unilateral
swelling of inguinal region
-May be confused with chancroid
-Definitive dx requires isolating C. trachomatis from an
appropriate specimen
-Doxycycline 100 mg po BID x21 days
-Aspirate bubos to prevent ulcerations
108
What is molluscum contagiosum?
S/S
Dx
Treatment
-Virus
-Occurs infrequently, about 1:100 cases
-Lesions are 1-5 mm, smooth, rounded, firm, shiny flesh-
colored to pearly-white papules
-Commonly seen on trunk and anogenital region
-Inspection and microscopic exam
-Cryoanesthesia with liquid nitrogen, may resolve without
scarring
109
What is lymphogranuloma venereum?
S/S?
Diagnosis?
Treatment?
(LGV)
-Caused by immunotypes L1, L2, or L3 of Chlamydia
trachomatis
- 2-3 mm painless vesicle, bubo, or non-indurated ulcer
-Regional adenopathy follows in approximately one
month and is the most common finding
-Stiffness and aching in the groin followed by unilateral
swelling of the inguinal region
-May be confused with chancroid
-Definitive dx requires isolated Chlamaydia trachomatis
from an appropriate specimen
-Doxycycline 100 mg BID x21 days
-Aspirate buboes to prevent ulceration
