STI Flashcards

Question

an immune-modulator treatment for genital warts, and patient can use at home.

Answer 1

podophyllotoxin and imiquimod

Answer 2

ceftriaxone IM 500 mg × one dose. Cotreat for chlamydia only when chlamydial infection has not been excluded.

Answer 3

for gonorrhea and chlamydial infection: Ceftriaxone 500 mg IM as a single dose (1 g if weight ≥150 kg) plus doxycycline 100 mg BID for 7 days

Answer 4

adnexal tenderness

Answer 5

Antibiotic regimen for outpatients: Ceftriaxone (Rocephin) 500 mg IM (or 1 g for individuals >150 kg) × one dose plus doxycycline 100 mg PO BID for 14 days plus metronidazole 500 mg PO BID for 14 days. Follow-up: Evaluate for clinical improvement within 72 hours.

Answer 6

Fitz-Hugh–Curtis Syndrome (Perihepatitis)

Answer 7

spirochete Treponema pallidum.

Answer 8

RPR and VDRL If positive RPR or VDRL (nontreponemal test), confirm with FTA-ABS (treponemal test). If reactive RPR and reactive FTA-ABS, this is diagnostic for syphilis in patients without a history of prior syphilis.

Answer 9

Benzathine penicillin G 2.4 million units IM once per week × 3 consecutive weeks If penicillin allergy, doxycycline 100 mg PO BID for 28 days or ceftriaxone 2 g IV or IM daily for 10 to 14 days

Answer 10

pharynx and conjunctiva

Answer 11

A. Single dose of penicillin G benzathine 2.4 million units intramuscularly (IM) The patient is presenting with signs and symptoms consistent with secondary syphilis. Weeks to months after infection, untreated individuals will develop secondary syphilis with systemic symptoms including fever, rash, headache, malaise, fatigue, and lymphadenopathy. Treatment for early syphilis (primary, secondary, and early latent syphilis) includes a single dose of penicillin G benzathine 2.4 million units IM. Treatment for late latent syphilis or tertiary syphilis includes penicillin G benzathine 2.4 million units IM once weekly for 3 weeks. For patients with neurosyphilis, treatment includes penicillin G 3 to 4 million units IV every 4 hours for 10 to 14 days. If patients are allergic to penicillin, doxycycline is an appropriate treatment alternative.

Answer 12

Answer: A. p24 The p24 antigen appears early in HIV infection and enables earlier detection. The preferred test for HIV screening is the fourth-generation HIV 1/2 combination antibody with p24 antigen test. If there is a strong suspicion of HIV infection, also order the HIV RNA polymerase chain reaction (PCR) test, which detects the HIV virus directly. p20, p18, and p14 are not components of the HIV 1/2 combination antibody/antigen testing.

Answer 13

Trimethoprim-sulfamethoxazole is indicated to prevent pneumocystis pneumonia. Antimicrobial therapy is indicated in certain patients with HIV to prevent an opportunistic infection. Trimethoprim-sulfamethoxazole is indicated to prevent pneumocystis pneumonia in patients with a CD4 count ≤200 cells/mcL. Alternative agents include dapsone, atovaquone suspension, or aerosolized pentamidine. For patients with a CD4 count ≤150 cells/mcL, antifungal prophylaxis is not indicated to prevent infection with histoplasmosis due to limited evidence. For patients with CD4 counts ≤100 cells/mcL, trimethoprim-sulfamethoxazole is indicated to prevent reactivation of Toxoplasma gondii and a positive T. gondii IgG serology. Preventive therapy for cryptococcal disease is not recommended; however, screening may be useful in certain patients.

Answer 14

First clean catch

Answer 15

Answer: A. Cephalosporin As of December 2020, the Centers for Disease Control and Prevention recommends that patients with gonorrhea-positive testing be treated with a higher dose of cephalosporin than previously recommended. Additionally, the recommendation for cotreatment of chlamydia with positive gonorrhea has been removed, provided chlamydia status is confirmed negative. The first-line treatment for gonorrhea-positive culture is ceftriaxone 500 mg intramuscularly (IM) for patients who weigh ≤150 kg and 1 gram IM for patients who weigh ≥150 kg. If the patient has a cephalosporin allergy, the recommended alternative is 240 mg IM plus azithromycin 2 g orally. Screening for gonorrhea again in 3 months is recommended due to the high rates of reinfection.

Answer 16

Answer: B. HPV 16 and HPV 18 Most cases of cervical cancer are caused by HPV. HPV 16 and HPV 18 cause 70% of cervical cancer cases in the United States. There are more than 150 HPV types. HPV can also cause cancer of the vulva, vagina, penis, and anus, as well as oropharyngeal cancers.

Answer 17

Answer: C. Treponema pallidum The Jarisch-Herxheimer reaction is an immune reaction caused by treatment of the spirochete T. pallidum (syphilis) with benzathine penicillin G, given by intramuscular injection. When large amounts of treponema are killed, it releases foreign antigens that the body responds to with symptoms such as fever, chills, headache, myalgia, tachycardia, and increased respiratory rate, all of which occur in the first few hours after treatment and peak in 6 to 8 hours. It is a self-limited reaction. Treatment is corticosteroids, antipyretics, and general supportive measures. Other spirochete bacteria that may elicit this reaction are Borrelia burgdorferi (Lyme disease) and Leptospira leptospirosis, also known as Weil’s disease or swamp fever.

Answer 18

Answer: B. CD4 count is higher compared with the previous test. One of the best indicators that the patient is responding to the ART regimen is an increase in the CD4 count. Another indicator is a decrease in the viral load. An increased leukocyte count seen on the CBC may indicate worsening infection, inflammation, or injury. Genetic testing is not used to assess treatment response.

Answer 19

Answer: D. Trichloroacetic acid The patient is presenting with clinical manifestations suggestive of condylomata acuminata (anogenital warts). The preferred medical treatment for pregnant patients is trichloroacetic acid because it has no systemic absorption or known fetal effects. Cryoablation is also considered safe and effective for pregnant patients. Podophyllin, podophyllotoxin, and interferons are contraindicated due to the potential for fetal harm. Imiquimod and sinecatechins are not recommended due to limited evidence and potential for fetal harm.

Answer 20

Solution: C “Abstain from sexual contact for 7 days after you finish the treatment and your symptoms resolve.” To prevent reinfection the nurse practitioner will inform the patient to abstain from sexual contact for 7 days after the resolution of symptoms and treatment. It is recommended that all patients diagnosed with gonorrhea be tested for other sexually transmitted infections, including HIV; however, HIV testing would be repeated only if there were unrelated concerns. Any of the patient’s sexual partners, within 60 days of the patient’s symptoms or diagnosed infection, will require evaluation for treatment. Only patients with pharyngeal gonorrhea who are treated with an alternative regimen will be instructed to return for a test of cure 14 days after treatment. The Centers for Disease Control and Prevention (CDC) recommends that all patients treated for gonorrhea be retested 3 months after treatment.

Answer 21

Answer: B. Chlamydia trachomatis Reactive arthritis is a rare disease that can occur following a sexually transmitted infection; C. trachomatis appears to be the most common pathogen associated with sexually acquired reactive arthritis. Other inciting pathogens include Campylobacter, Salmonella, and Shigella.

Answer 22

Answer: C. Multiple sexual partners Risk factors for PID include sex (primary risk factor); multiple sexual partners; sexually transmitted infection in the sexual partner; age (highest frequency among those age 15 to 25 years; incidence in female patients older than 35 years is only one seventh that in younger female patients); a personal previous episode of PID; and other conditions (e.g., complete disruption of the vaginal ecosystem). The choice of contraceptive method does not clearly affect the risk of PID; however, consistent and correct condom use has been found to reduce the risk significantly.

Answer 23

Answer: D. Trimethoprim-sulfamethoxazole is indicated to prevent pneumocystis pneumonia. Antimicrobial therapy is indicated in certain patients with HIV to prevent an opportunistic infection. Trimethoprim-sulfamethoxazole is indicated to prevent pneumocystis pneumonia in patients with a CD4 count ≤200 cells/mcL. Alternative agents include dapsone, atovaquone suspension, or aerosolized pentamidine. For patients with a CD4 count ≤150 cells/mcL, antifungal prophylaxis is not indicated to prevent infection with histoplasmosis due to limited evidence. For patients with CD4 counts ≤100 cells/mcL, trimethoprim-sulfamethoxazole is indicated to prevent reactivation of Toxoplasma gondii and a positive T. gondii IgG serology. Preventive therapy for cryptococcal disease is not recommended; however, screening may be useful in certain patients.

Answer 24

Answer: B. First-catch urine Although NAAT can be performed on urethral, meatal, and rectal swabs, first-catch urine is the specimen of choice when screening male patients for Chlamydia trachomatis and Neisseria gonorrhoeae infections. The vaginal swab is the specimen of choice for female patients.

Answer 25

Answer: D. Trichloroacetic acid The patient is presenting with clinical manifestations suggestive of condylomata acuminata (anogenital warts). The preferred medical treatment for pregnant patients is trichloroacetic acid because it has no systemic absorption or known fetal effects. Cryoablation is also considered safe and effective for pregnant patients. Podophyllin, podophyllotoxin, and interferons are contraindicated due to the potential for fetal harm. Imiquimod and sinecatechins are not recommended due to limited evidence and potential for fetal harm.

Answer 26

Answer: A. Pregnancy test The findings are presumptive of a clinical diagnosis of pelvic inflammatory disease (PID). For all female patients suspected of having PID, the following tests should be obtained: pregnancy test (to rule out ectopic pregnancy and complications of intrauterine pregnancy); microscopy of vaginal discharge (to assess for increased white blood cells); nucleic acid amplification tests (NAATs) for Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium; HIV screening; and serologic testing for syphilis (to rule out sexually transmitted infections that share similar risk factors with PID). While an erythrocyte sedimentation rate and C-reactive protein can often be obtained to assess severity, these tests have poor sensitivity and specificity for the diagnosis of PID. A urinalysis should be checked in female patients with urinary symptoms. Hepatitis virus testing may be indicated depending on the patient’s risk history, but it is not a priority at this time.

Answer 27

Answer: B. Chlamydia trachomatis Reactive arthritis is a rare disease that can occur following a sexually transmitted infection; C. trachomatis appears to be the most common pathogen associated with sexually acquired reactive arthritis. Other inciting pathogens include Campylobacter, Salmonella, and Shigella.

Answer 28

Answer: C. Multiple sexual partners Risk factors for PID include sex (primary risk factor); multiple sexual partners; sexually transmitted infection in the sexual partner; age (highest frequency among those age 15 to 25 years; incidence in female patients older than 35 years is only one seventh that in younger female patients); a personal previous episode of PID; and other conditions (e.g., complete disruption of the vaginal ecosystem). The choice of contraceptive method does not clearly affect the risk of PID; however, consistent and correct condom use has been found to reduce the risk significantly.

Answer 29

Answer: A. Single dose of penicillin G benzathine 2.4 million units intramuscularly (IM) The patient is presenting with signs and symptoms consistent with secondary syphilis. Weeks to months after infection, untreated individuals will develop secondary syphilis with systemic symptoms including fever, rash, headache, malaise, fatigue, and lymphadenopathy. Treatment for early syphilis (primary, secondary, and early latent syphilis) includes a single dose of penicillin G benzathine 2.4 million units IM. Treatment for late latent syphilis or tertiary syphilis includes penicillin G benzathine 2.4 million units IM once weekly for 3 weeks. For patients with neurosyphilis, treatment includes penicillin G 3 to 4 million units IV every 4 hours for 10 to 14 days. If patients are allergic to penicillin, doxycycline is an appropriate treatment alternative

Answer 30

Answer: C. Treponema pallidum The Jarisch-Herxheimer reaction is an immune reaction caused by treatment of the spirochete T. pallidum (syphilis) with benzathine penicillin G, given by intramuscular injection. When large amounts of treponema are killed, it releases foreign antigens that the body responds to with symptoms such as fever, chills, headache, myalgia, tachycardia, and increased respiratory rate, all of which occur in the first few hours after treatment and peak in 6 to 8 hours. It is a self-limited reaction. Treatment is corticosteroids, antipyretics, and general supportive measures. Other spirochete bacteria that may elicit this reaction are Borrelia burgdorferi (Lyme disease) and Leptospira leptospirosis, also known as Weil’s disease or swamp fever.

Answer 31

Answer: A. Valacyclovir 1,000 mg orally twice a day for 7 to 10 days This patient is presenting with clinical manifestations consistent with genital herpes simplex virus (HSV) infection; the characteristic lesions of HSV begin as grouped 2- to 4-mm vesicles with underlying erythema that progress to vesicles, pustules, erosions, and ulcerations. Vesicles and pustules may have an umbilicated appearance due to central depression. Systemic symptoms may occur during the first episode, such as fever, headache, malaise, and myalgias. Antiviral therapy is indicated for most patients experiencing a first episode of genital HSV; treatment should be started within 72 hours of lesion appearance. For a first episode, valacyclovir 1,000 mg orally twice daily for 7 to 10 days is recommended along with acyclovir 400 mg three times daily and famciclovir 250 mg three times daily. Parenteral therapy is indicated in patients with a complicated infection (e.g., central nervous system involvement, end-organ disease, disseminated HSV). Chronic suppressive therapy may be indicated for patients with severe or frequent recurrence or for immunocompetent patients. Topical antiviral therapy is not recommended in the treatment of genital herpes.

Answer 32

Answer: C. Pelvic inflammatory disease A clinical diagnosis of pelvic inflammatory disease is highly suggested in sexually active young female patients who are at risk for sexually transmitted infections. Often, patient presentation includes pelvic or lower abdominal pain and evidence of cervical motion, uterine, or adnexal tenderness. Additional supportive findings include fever, mucopurulent discharge or cervical friability, presence of white blood cells on microscopy of vaginal secretions, and detection of genital infection with Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium. While cervical motion tenderness may be found in other conditions, such as appendicitis and ectopic pregnancy, the patient’s pain is not localized to the right iliac fossa, and the patient does not have a positive pregnancy test. Cystitis is also less likely because the patient denies a history of urinary frequency and/or dysuria.

Answer 33

Answer: B. HPV 16 and HPV 18 Most cases of cervical cancer are caused by HPV. HPV 16 and HPV 18 cause 70% of cervical cancer cases in the United States. There are more than 150 HPV types. HPV can also cause cancer of the vulva, vagina, penis, and anus, as well as oropharyngeal cancers.

Answer 34

Answer: B. CD4 count is higher compared with the previous test. One of the best indicators that the patient is responding to the ART regimen is an increase in the CD4 count. Another indicator is a decrease in the viral load. An increased leukocyte count seen on the CBC may indicate worsening infection, inflammation, or injury. Genetic testing is not used to assess treatment response.

Answer 35

Solution: B and C Pharynx and Conjunctiva. Neisseria gonorrhoeae is a gram-negative bacteria that causes a gonorrhea infection. In addition to typical genitourinary sites, gonorrhea infections can also occur in the prostate, pharynx, and anorectum areas. Gonococcal ophthalmia neonatorum is a conjunctival gonorrhea infection that primarily affects newborns. The sinuses, lungs, and small intestines are not potential sites for infection.

Answer 36

Abstain from sexual contact for 7 days after you finish the treatment and your symptoms resolve.” To prevent reinfection the nurse practitioner will inform the patient to abstain from sexual contact for 7 days after the resolution of symptoms and treatment. It is recommended that all patients diagnosed with gonorrhea be tested for other sexually transmitted infections, including HIV; however, HIV testing would be repeated only if there were unrelated concerns. Any of the patient’s sexual partners, within 60 days of the patient’s symptoms or diagnosed infection, will require evaluation for treatment. Only patients with pharyngeal gonorrhea who are treated with an alternative regimen will be instructed to return for a test of cure 14 days after treatment. The Centers for Disease Control and Prevention (CDC) recommends that all patients treated for gonorrhea be retested 3 months after treatment.

Answer 37

Answer: D. A sexually active female patient who is 35 years old and has a history of gonorrhea should be screened for chlamydia. According to the CDC, all sexually active female patients who are 25 years old should be screened for chlamydia and gonorrhea. Screen sexually active women older than 25 years if they are at increased risk (e.g., previous or coexisting STI, history of exchanging money or drugs for sex). Men who have sex with men should be screened at least annually for chlamydia, gonorrhea, and syphilis regardless of condom use. All pregnant patients younger than 25 years should be screened for chlamydia, gonorrhea, and syphilis; those older than 25 years at increased risk should be screened as well. Routine HSV-2 serologic screening among pregnant patients who are asymptomatic is not recommended. There is insufficient evidence for screening heterosexual men at low risk of infection for chlamydia and gonorrhea.

Answer 38

Answer: A. p24 The p24 antigen appears early in HIV infection and enables earlier detection. The preferred test for HIV screening is the fourth-generation HIV 1/2 combination antibody with p24 antigen test. If there is a strong suspicion of HIV infection, also order the HIV RNA polymerase chain reaction (PCR) test, which detects the HIV virus directly. p20, p18, and p14 are not components of the HIV 1/2 combination antibody/antigen testing.

Answer 39

Answer: A. Cephalosporin As of December 2020, the Centers for Disease Control and Prevention recommends that patients with gonorrhea-positive testing be treated with a higher dose of cephalosporin than previously recommended. Additionally, the recommendation for cotreatment of chlamydia with positive gonorrhea has been removed, provided chlamydia status is confirmed negative. The first-line treatment for gonorrhea-positive culture is ceftriaxone 500 mg intramuscularly (IM) for patients who weigh ≤150 kg and 1 gram IM for patients who weigh ≥150 kg. If the patient has a cephalosporin allergy, the recommended alternative is 240 mg IM plus azithromycin 2 g orally. Screening for gonorrhea again in 3 months is recommended due to the high rates of reinfection.

STI Flashcards

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