STD's

Question 1

Acquired Immune Deficiency Syndrome

Answer 1

AIDS

Immunodeficiency disorders in which human immunodeficiency virus uses T4 (CD4) cells as a receptor and reservoir for HIV

Question 2

Transmission of HIV/AIDS

Answer 2

Blood, semen, vaginal secretions and breast milk

Question 3

S/S of HIV

Answer 3

Flu-like symptoms
Think SEROCONVERSION (process of converting HIV neg to HIV pos) takes approx. 3 weeks to 6 months
Early s/s: fever, night sweats, and weight loss

Question 4

CD4 count for AIDS

Answer 4

<200 cells and/or the presence of an opportunistic infection

Question 5

Labs/diagnostics of HIV/AIDS

Answer 5

ELISA for initial – 99.9% sensitive
Western blot for confirmatory
Absolute CD4 lymphocyte count (normal >800)
Risk of progression to AIDS is high when <20% CD4 count
Viral Load: PCR (results correlate closely with progression of HIV) Ideally should be zero or undetectable

Question 6

Management of AIDS/HIV

Answer 6

Therapy for opportunistic infections: Bactrim for pneumocystis jirovecii prophy
Antiretroviral tx: combo therapy is standard
(AART)
When to start AART is somewhat controversial–CDC recommends starting meds at time of HIV+ diagnosis

Question 7

Chancriod

Answer 7

Hemophilus ducreyi, a gram - bacillus
Well established as co-factor for HIV transmission
10% of pts are also infected w/ syphilis or HIV

Question 8

S/S of chancroid

Answer 8

Women usually asymptomatic

Men: single or multiple superficial, painful ulcer, surrounded by erythematous HALO

Question 9

Diagnosis of chancroid

Answer 9

Definitive diagnosis of chancroid if made morphologically

Hard to diagnose– probable diagnosis usually made by matter of exclusion

Question 10

Sensitivity

Answer 10

the degree to which those who HAVE the disease test POSITIVE

Question 11

Specificity

Answer 11

the degree to which those who do NOT have the disease test NEGATIVE

Question 12

Tx of chancroid

Answer 12

Azithromycin 1gm PO x1
Ceftriaxone 250mg IM x1
Ciprofloxacin 500mg PO 2x daily x3days

Question 13

Chlamydia

Answer 13

A PARASITIC std caused by Chlamydia trachomatis that produces serious reproductive tract complications
Most common STD in the US

Question 14

S/S of chlamydia

Answer 14

Often asymptomatic
Females: dysuria, intramenstrual spotting, postcoital bleeding, dysparenuria, vaginal d/c
Males: dysura, thick cloudy penile d/c, testicular pain

Question 15

Diagnostics of chlamydia

Answer 15

Chlamydia culture

EIA methods preferred

Question 16

Treatment of chlamydia

Answer 16

Azithromycin 1gm PO x1

Doxycyline 100mg PO BID x7 days

Question 17

Genital Warts

Answer 17

Condyloma acuminate
caused by HPV
most common VIRAL STD in the US

Question 18

S/S genital warts

Answer 18

Single or multiple soft, fleshy, papillary, or sessile, painless keratinized growth around anus, vulvovaginal area, penis, urethra or perineum

Question 19

Diagnosis of genital warts

Answer 19

Clinical presentation
ASCUS or squamous intraepithelial lesion on PAP
Colposcopy useful in diagnosing flat lesions

Question 20

Tx of genital warts

Answer 20

Keratolytic agents: Podophyllin, trichloracetic acid (TCA), or bichloracetic acid

Question 21

Prevention of HPV

Answer 21

Gardasil–indicated for ages 9-26

Cervarix– indicated for females ages 10-25 years

Question 22

Gonorrhea

Answer 22

A bacterial STD caused by Neisseria Gonorrhoeae, causative organism may be cultured from the GU tract, oropharynx and/or anorectum
Leading cause of infertility in women
Male to female transmission 80-90% after exposure

Question 23

S/S of gonorrhea

Answer 23

Often asymptomatic 
Dysuria
frequency
mucopurulent vaginal d/c
labial pain/swelling
lower abd pain
fever
abnormal menstrual cycle
testicular pain

Question 24

Diagnostics of gonorrhea

Answer 24

Gram stain of d/c smear shows gm neg diplococci and WBC

Cervical culture

Question 25

Tx of gonorrhea

Answer 25

Ceftriaxone 250 mg IM x1 | + Azithromycin 1gm orally x1 for chlamydia coverage

Question 26

Hepatitis B

Answer 26

Hep B vaccine given at 0, 1 and 6 months Supportive and symptomatic care Hep B immune globulin 0.06 ml/kg IM in single dose within 14 days of exposure

Question 27

Herpes

Answer 27

A recurrent viral STD with no cure, associated w/ painful lesions

Question 28

HSV 1

Answer 28

associated with infection of the lips, face and mucosa

Question 29

HSV 2

Answer 29

Genetalia

Question 30

S/S of HSV

Answer 30

Initial: fever, malaise, dysuria, painful/pruritic ulcers for usually 12 days Recurrent: less painful/pruritic ulcers for usually 5 days

Question 31

Labs for HSV

Answer 31

Papanicolaou or Tzanck stain | Most definitive= viral culture

Question 32

Management of HSV

Answer 32

No treatment for cure Symptomatic treatment Acyclovir recommended Valacyclovir-- asymptomatic viral shedding of HSV 2

Question 33

Lymphogranuloma Verereum (LGV)

Answer 33

Immunotypes L1, L2, L3 of Chlamydia

Question 34

S/S of LGV

Answer 34

2-3mm painless vesicle, bubo or non-indurated ulcer Regional adenopathy follows in approx one month and it the most common finding May be confused with chancroid

Question 35

Tx of LGV

Answer 35

Doxy 100 mg PO BID x21 days

Question 36

Molluscum Contagiosum

Answer 36

Molluscum Contagiosum virus | Occurs infrequently about 1 for every 100 cares of GC

Question 37

S/S of MC

Answer 37

Lesions are 1-5mm, smooth, rounded, firm, shiny, fleshcolored to pearly white papules trunk and anogenital region

Question 38

Syphilis

Answer 38

STD involving multiple organ systems | Treponema Pallidum

Question 39

Primary stage of Syphilis

Answer 39

Chancre is painless Indurated ulcer Located at site of exposure

Question 40

Secondary stage of syphilis

Answer 40

Flu-like symptoms Rash on palmar and plantar surfaces lymphadenopathy malaise, anorexia, alopecia

Question 41

Latent stage of syphilis

Answer 41

Seropositive but asymptomatic

Question 42

Tertiary stage of syphilis

Answer 42

``` Leukoplakia Cardiac issues aortic aneurysm meningitis hemiparesis hemiplegia ```

Question 43

Serologic tests of syphilis

Answer 43

Nontreponemal: VDRL/RPR

Question 44

Tx of syphilis

Answer 44

Primary, secondary or early syphilis of less than 1 year duration= Benzathine penicillin G 2.4 million units IM Late, latent, and indeterminate length, tertiary stage= benzathine penicillin G 2.4 million units IM Penicillin allergic= doxy, erythromycin