STDs

Question 1

In men, what is the best initial test for dx of urethritis?

Answer 1

Urethral swab for gram stain and WBC, look for intracellular gram negative diplococci for N.gonorrhea

Question 2

What is the most accurate test for urethritis

Answer 2

Urine for nucleic acid (NAAT) detects gonorrhea and chlamydia

Question 3

Organisms causing urethritis?

Answer 3

N.gonorrhea
Chlamydia
Mycoplasma genitalium
Ureaplasma

Question 4

Best initial test for dx of urethritis in women?

Answer 4

Self administered vaginal swab

Question 5

What is tx for urethritis?

Answer 5

One drug for gonorrhea and one for chlamydia
Gonorrhea: cefixime (resistant to quinolones) or ceftriaxone
Chlamydia: azithromycin or doxy

Question 6

Cervicitis px

Answer 6

Cervical discharge, strawberry cervix

Question 7

Cervicitis tx

Answer 7

Ceftriaxone or cefixime and azithromycin or doxy

Question 8

Cervicitis dx

Answer 8

Self administered cervical swab for NAAT

Question 9

PID is caused by which bugs?

Answer 9

Gonorrhea, chlamydia

Question 10

PID presentation

Answer 10

Lower abdominal tenderness, fever, cervical motion tenderness (found on bimanual exam), leukocytosis

Question 11

Most specific tests for PID

Answer 11

Culture, DNA probe or nucleic acid amplification (NAAT)

Clarify need for treating the partner

Question 12

How to determine resistance of organisms causing PID?

Answer 12

Culture

Question 13

When to use laparoscopy in PID and why?

Answer 13

It is the most accurate test, use only if the dx is unclear, sx persist despite tx or there is recurring episodes for unclear reasons
It is very rarely done

Question 14

PID tx?

Answer 14

Inpatient: cefoxitin or cefotetan combined with doxy
Outpatient: ceftriaxone and doxy (possibly with metronidazole)

Question 15

Patient has PID but anaphylaxis to penicillin, what is the tx?

Answer 15

Levofloxacin and metronidazole in outpatient

Clindamycin and gentamycin in inpatient

Question 16

In ulcerative genital disease, how to make a ddx with px and hx?

Answer 16

Painless ulcer : syphillis
Painful ulcer : chancroid (hemophilus ducreyi)
Tender and supurrating lymph nodes : lymphogranuloma venereum
Painful ulcer with prior vesicules : herpes simplex

Question 17

Best initial test for syphillis?

Answer 17

Dark field microscopy (best in primary) if positive, no further testing is necessary!, VDRL or PCR (75% sensitive only), FTA or MHA-TP (for confirmation only)

Question 18

Dx test for chancroid?

Answer 18

Stain and culture (special media): pleomorphic gram neg coccobacillus

Question 19

Dx test for lyphogranuloma venerum?

Answer 19

Complement fixation titers serology, nucleic amplification testing on swab

Question 20

Dx for herpes simplex?

Answer 20

Tzank prep (best initial test): multinucleated giant cells
Viral culture : most accurate test

Question 21

Tx for syphillis?

Answer 21

One dose IM benzathine penicillin

Question 22

Tx for syphillis if the patient is allergic to penicillin?

Answer 22

Doxy

Question 23

Tx for chancroid?

Answer 23

Single dose of azithromycin

Question 24

Tx for lymphogranuloma venerium

Answer 24

Doxy

Question 25

Tx for herpes simplex

Answer 25

Acyclovir, valacyclovir, famciclovir

Question 26

How to detect aciclovir resistant herpes?

Answer 26

Viral sensitivity testing

Question 27

What is the tx for aciclovir resistant herpes?

Answer 27

Foscarnet

Question 28

Woman comes to the clinic with multiple painful genital vesicles, what is the next best step?

Answer 28

Go straight to tx (not tzank prep), gove acyclovir orally

Question 29

Primary syphillis sx

Answer 29

Painless genital ulcer, can become painful is secondarily infected, painless adenopathy, chancres will heal spontaneously but use penicillin to prevent secondary/tertiary

Question 30

Secondary syphillis sx and presentation

Answer 30

Rash on palms and soles Alopecia areata Mucous patches Condylomata lata

Question 31

Tertiary syphilis presentation

Answer 31

Neurosyphilis: meningovascular (stroke at a young age); tabes dorsalis (loss of position and vibratory sense, incontinence, cranial nerve), general paresis (memory and personality changes), argyll robertson pupil, Gummas (skin and bone lesions) Aortitis (aortic regurgitation, aortic aneurysm)

Question 32

What could cause a false positive VDRL/RPR?

Answer 32

Infection, older age, injection drug use, AIDS, malaria, antiphospholipid syndrome and endocarditis

Question 33

Titers for VDRL or RPR are reliable at? | Rarely false positive at?

Answer 33

Reliable at >1:8 (lower is often false positive) | Rarely false positive at >1:32

Question 34

Treatment of primary and secondary syphilis

Answer 34

Single dose IM injection of penicillin, oral doxy if allergic

Question 35

Tx of tertiary syphilis?

Answer 35

IV penicillin, desensitization if allergic

Question 36

What is the Jarish-herxheimer reaction?

Answer 36

Fever, headache, myalgiad after treatment | Give aspirin and antipyretics, it is benign and will pass

Question 37

When to desensitize patients that have syphilis?

Answer 37

In neurosyph if penicillin allergic or pregnancy only

Question 38

How to diagnose genital warts (condylomata acuminata)

Answer 38

Visual appearance (no biopsy, serology or stains)

Question 39

How to treat genital warts?

Answer 39

Remove it by cryotherapy, surgery if large, laser, podophyllin or trichloroacetic acid imiquimod (apply locally): immunostimulant

Question 40

How does pediculosis presents

Answer 40

Itchy little "black dots" , visible on hair baring areas (axilla, pubis)

Question 41

How to treat crabs?

Answer 41

Permethrin

Question 42

How do scabies present?

Answer 42

Visible burrows in web spaces (between fingers and toes), around nipples, near genitals

Question 43

How to dx scabies?

Answer 43

Scrape and magnify

Question 44

Tx for scabies?

Answer 44

Permethrin If widespread scabies: oral ivermectin Severe disease needs repeat dosing

Question 45

What are the common sx between cystitis and urethritis and how to differentiate them based on symptomatology?

Answer 45

Dysuria, frequency and burning are common sx | Cystitis does NOT have discharge