Sexually Transmitted Infections

Question 1

what are the 3 modes of transmission of HIV?

Answer 1

sexual
parenteral
vertical

Question 2

what gene is used in serological tests for HIV?

Answer 2

p24

Question 3

which HIV type has a lower transmissibility/lower progression to AIDS?

Answer 3

HIV-2

Question 4

what is the pathophys of HIV?

Answer 4

infects CD4 + cells and kills them = suppresses cell-mediated immunity

Question 5

a patient presents with a frequent sore throat, painful ulcers, lymphadenopathy, fever, headache, N/V/D, weight loss, and arthralgias. Dx?

Answer 5

acute HIV

Question 6

what can acute HIV be confused with?

Answer 6

mononucleosis

Question 7

what 3 serologies can be used to diagnose HIV?

Answer 7

IgM
IgG
p24 antigen

Question 8

what treatment in all patients with HIV?

Answer 8

antiretroviral therapy (ART)

Question 9

AIDS is primarily a consequence of continuous, high-level replication of _____, leading to virus and immune-mediated killing of CD4 lymphocytes.

Answer 9

HIV-1

Question 10

stage 1 with CD4 over 1500 with flu-like symptoms: fever, rash, lymphadenopathy, and myalgias. Dx?

Answer 10

acute HIV

Question 11

stage 2 of HIV characterized by CD4 of 200-1500, the patient becomes sicker with thrush, cervical dysplasia, herpes zoster, and peripheral neuropathy.

Answer 11

clinical latency

Question 12

stage 3 with CD4 less than 200, the most severe phase of HIV

Answer 12

AIDS

Question 13

which stage of HIV requires prophylaxis to be started for opportunistic infections?

Answer 13

stage 3 (AIDS)

Question 14

what physical exam finding can be expected in the latent period of HIV or during chronic HIV without AIDS?

Answer 14

lymphadenopathy

Question 15

what are the 3 criteria that can indicate AIDS?

Answer 15

CD4 cell count < 200
CD4 % < 14.5
AIDS-defining condition

Question 16

what will be seen in chest radiograph to indicate pneumocystis jiroveci pneumonia?

Answer 16

diffuse or perihilar infiltrates

Question 17

what are 3 sputum labs to diagnose pneumocystis jiroveci pneumonia?

Answer 17

wright-giemsa stain
direct fluorescence antibody test (DFA)
bronchoalveolar lavage

Question 18

what is the treatment for pneumocystis jiroveci pneumonia?

Answer 18

trime-sulfa

Question 19

caused by intense replication of Epstein-Barr virus that presents with a white lesion on the lateral aspect of the tongue

Answer 19

oral hairy leukoplakia

Question 20

what are 2 treatment options for oral hairy leukoplakia?

Answer 20

zidovudine
acyclovir

Question 21

a patient presents with odynophagia or pain on swallowing. Endoscopy shows mucosal plaque-like lesions and biopsy shows yeast and pseudohyphae. Dx? Treatment?

Answer 21

candidal esophagitis
fluconazole

Question 22

low-grade vascular tumor associated with infection with human herpesvirus 8. presents as purple/brown papular lesions

Answer 22

kaposi sarcoma

Question 23

what is the treatment for kaposi sarcoma?

Answer 23

anti-retroviral therapy

Question 24

what is the rule of thumb for HIV treatment?

Answer 24

once treatment is started, patient should never come off it

Question 25

what must we do before treating patient for HIV?

Answer 25

test for hypersensitivity to drugs (abacavir)

Question 26

what should be monitored after starting HIV treatment?

Answer 26

viral load

Question 27

what is the goal for monitoring HIV treatment?

Answer 27

suppress below the limits of assay detection

Question 28

who should be screened for HIV?

Answer 28

patients 15-65 years at least once

Question 29

used for HIV-uninfected patients at high risk for acquiring HIV

Answer 29

tenofovir disoproxil fumarate-emtricitabine (PrEP)

Question 30

what can be used for post-exposure prophylaxis (PEP)?

Answer 30

bictegravir-emtricitabine-tenofovir alafenamide

Question 31

how is syphilis contracted? (2)

Answer 31

sexual vertical transmission

Question 32

a patient presents with a painless papule at site of inoculation with regional lymphadenopathy. Dx?

Answer 32

primary syphilis

Question 33

a patient presents with a rash, fever, headache, malaise, anorexia, sore throat, weight loss, condyloma (weeping papules) in moist skin areas, moth-eaten alopecia, and lymphadenopathy. Dx?

Answer 33

secondary syphilis

Question 34

what form of syphilis is noninfectious to sex partners but can be transmitted to the fetus?

Answer 34

late latent syphilis

Question 35

a patient presents with gummas (heaped up granulomatous lesions), dilated aorta, and aortic valve regurgitation. Dx?

Answer 35

late syphilis

Question 36

a patient presents with unequal reflexes, irregular pupils with poor light and accommodation reflexes (argyll robertson pupils), and local motor taxia (tabes dorsalis). Dx?

Answer 36

neurosyphilis (tertiary syphilis)

Question 37

what serological diagnostics can be used for syphilis? (3)

Answer 37

VDRL or Rapid Plasms Reagin (RPR) + FTA-ABS or MHA-TP

Question 38

what diagnostic can show us a spirochete to diagnose syphilis?

Answer 38

darkfield microscopy

Question 39

what is the treatment for syphilis?

Answer 39

penicillin

Question 40

what is a common complication in early syphilis that occurs due to massive destruction of spirochetes during the treatment of syphilis?

Answer 40

jarisch herxheimer reaction

Question 41

which HSV causes symptomatic infections in the genital tract?

Answer 41

HSV 2

Question 42

what is a common occurrence in HSV contraction?

Answer 42

viral shedding without lesion

Question 43

where are lesions most commonly present in HSV?

Answer 43

oral

Question 44

a patient presents with a cold sore that occurred with prodromal pain. on physical exam, they have vesicular, ulcerative lesions with severe mouth pain, fever, itching and cervical lymphadenopathy. Dx?

Answer 44

HSV

Question 45

what are 6 manifestations of HSV?

Answer 45

herpetic whitlow herpes gladiatorum erythema multiforme eczema herpeticum ocular infections (keratitis, chorioretinitis) encephalitis

Question 46

what is the gold standard to confirm a HSV diagnosis?

Answer 46

viral culture (HSV cell culture) of the lesion

Question 47

what is the treatment for HSV?

Answer 47

acyclovir

Question 48

what are 2 topical treatment options for HSV?

Answer 48

penciclovir docosanol

Question 49

what is the treatment for HSV that has involvement of the eye or disseminated infection due to immunosuppression? (2)

Answer 49

urgent referral IV antiviral therapy

Question 50

predominantly a disease of lymphatic tissue that is reported among men-sex-with-men

Answer 50

chlamydia lymphogranuloma venereum

Question 51

a patient presents with genital ulcers/mucosal inflammatory reaction, painful inguinal buboes, fever, malaise, anal pruritis, and rectal discharge. Dx?

Answer 51

chlamydia lymphogranuloma venereum

Question 52

how to diagnose chlamydia?

Answer 52

NAAT

Question 53

what is the treatment for chlamydia lymphogranuloma venereum? alternative? for allergies/pregnancy?

Answer 53

doxycycline alt: tetracycline erythromycin for allergies/pregnant

Question 54

what is the most common site of chlamydia in women?

Answer 54

cervix

Question 55

what is the most common site of chlamydia in men?

Answer 55

urethra

Question 56

chlamydia is a major cause of nongonoccal _____ and _____

Answer 56

cervicitis urethritis

Question 57

a female patient presents with cervicitis, PID, proctitis, conjunctivitis, and pharyngitis. Dx?

Answer 57

chlamydia

Question 58

a male presents with urethritis, epididymitis, prostatitis, proctitis, conjunctivitis, pharyngitis, Reiter syndrome (reactive arthritis). Dx?

Answer 58

chlamydia

Question 59

what is the treatment for chlamydia in a confirmed diagnosis or a pregnant patient?

Answer 59

azithromycin

Question 60

what is the treatment for chlamydia in a suspected case?

Answer 60

doxycycline

Question 61

gonococcal infections (gonorrhea) commonly causes what in men and women?

Answer 61

urethritis cervicitis

Question 62

a patient presents with mucopurulent/copious discharge, pruritis, urethritis, cervicitis, epididymitis, prostatitis, Reiter syndrome, conjunctivitis, and pharyngitis. Dx?

Answer 62

gonorrhea

Question 63

how to diagnose gonorrhea?

Answer 63

NAAT

Question 64

what should all patients diagnosed with gonorrhea be offered?

Answer 64

HIV testing

Question 65

what is the treatment for gonorrhea? (2)

Answer 65

ceftriaxone + doxycycline

Question 66

caused by HPV infection and is the most common viral sexually transmitted disease in the US; causes cervical cancer

Answer 66

condylomata acuminata

Question 67

how is condylomata acuminata acquired?

Answer 67

sexual activity

Question 68

a patient presents with a skin-colored/pink wart that has smooth flattened papules, and has a verrucous papilliform appearance. Dx?

Answer 68

condylomata acuminata

Question 69

what are 4 patient applied treatments for condylomata acuminata?

Answer 69

podophyllin/popfilox imiquimod sinecatechins

Question 70

what are 4 provider administered treatments for condylomata acuminata?

Answer 70

cryotherapy trichloroacetic/bichloroacetic acid surgical removal laser therapy

Question 71

what is the vaccination for condylomata acuminata used for?

Answer 71

prevent cancer

Question 72

a flagellated, sexually transmitted protozoan that causes infection of the vagina or male genital that can be asymptomatic, or cause urethritis, vaginitis, cystitis, epididymitis, or prostatitis

Answer 72

trichomoniasis

Question 73

a female patient presents with copious yellow-green, frothy discharge with a fishy odor, vulva and perineum soreness, with punctate/red strawberry spots on the cervix. Dx?

Answer 73

trichomoniasis

Question 74

a male patient presents with urethritis, transient/frothy/purulent discharge, dysuria and frequency. Dx?

Answer 74

trichomoniasis

Question 75

how to diagnose trichomoniasis?

Answer 75

NAAT

Question 76

what is the treatment for trichomoniasis?

Answer 76

metronidazole