STIs

Question 1

Thick white cottage cheese-like discharge + itching or excoriations

Answer 1

Candida
May also have erythematous vulvar findings with satellite lesions

Question 2

Inflamed itchy vaginal mucosa + yellow/green discharge

Answer 2

Desquamative vaginitis

Question 3

Gray/opaque foul-smelling discharge

Answer 3

Bacterial vaginosis

Question 4

Non-specific yellow/green vaginal discharge without systemic manifestation

Answer 4

Trichomonas

Question 5

Which has inflammation - bacterial vaginosis vs Trichomoniasis?

Answer 5

Trichomoniasis - yellow-green, malodorous, frothy discharge

As opposed to off-white, fish odor discharge

Use metronidazole and treat partner

Question 6

Viral-like symptoms followed by burning/irritation prodrome before lesions appear

Answer 6

HSV

Question 7

What should you do for someone with suspected Hep B from partner?

Answer 7

Unvaccinated: Partner is HBsAG+: One dose HBIG and HBV series; otherwise only HBV series
Vaccinated: Responder: No further treatment; otherwise HBIG + HBV series or HBIGx2

Question 8

Symptoms: Lower abdominal tenderness; uterine/adnexal tenderness; mucopurulent cervicitis

Answer 8

Acute salpingitis

DDx: Endometriosis (which does not have fever)

Question 9

Complications of salpingitis

Answer 9

Chronic pelvic pain; hydrosalpinx; tubal scarring; ectopic pregnancy; infertility

Question 10

Genital itching with small black powder like substance on pubic hair

Answer 10

Lice (Phthiraptera)

Question 11

Clue cells on wet prep

Answer 11

Bacterial vaginosis - fuzzyness around cells is due to bacteria coating
Treatment: Metronidazole

Question 12

Treatment for bacterial yeast infection

Answer 12

Clotrimazole

Question 13

CDC recommends what course of action after Chlamydia treatment?

Answer 13

Test for reinfection at 3 months; TOC no longer recommended

Question 14

What areas of skin does secondary syphilis encompass?

Answer 14

Trunk, palms, soles

Question 15

What is Fitz-Hugh-Curtis syndrome?

Answer 15

Perihepatitis - due to ascending upper genital tract infection involving the hepatic capsule

Question 16

What is the HIV intrapartum treatment plan for pregnant patients?

Answer 16

Viral load <=50: ART + vaginal
Viral load >50 <1000: ART + zidovudine + vaginal
Viral load >1000: ART + zidovudine + cesarean

Question 17

What should be avoided in prenatal care in HIV+ pregnant patients if viral load is detectable?

Answer 17

Amniocentesis

Question 18

What should be avoided during intrapartum delivery in HIV+ patients?

Answer 18

AROM
Fetal scalp electrode
operative vaginal delivery

Question 19

How often should HIV testing be done in pregnant patients?

Answer 19

Viral load monthly until undetectable, then every 3 months
CD4 count every 3 months
Resistance testing if not previously performed

Question 20

What is used for HIV pre-exposure prophylaxis?

Answer 20

Emtricitabine-tenofovir disoproxil fumarate (TruvadaTM)

Question 21

Congenital HSV has what risks? How to prevent?

Answer 21

Seizures, blindness, developmental delay

Prevent via antiviral at 36 wks, cesarean if lesions/prodromal at labor

Question 22

Which infection can cause friable, macular cervical lesions (“strawberry cervix”)?

Answer 22

Trichomonas can cause acute cervicitis and these lesions –> postcoital bleeding, dyspareunia

Chlamydia can also cause cervicitis and friable lesions with postcoital bleeding

Question 23

Most common cause of sterile pyuria in sexually active patients

Answer 23

Chlamydia

Question 24

Deep staining intracytoplasmic cysts

Answer 24

Donovan bodies - Klebsiella - granuloma inguinale

Question 25

Extensive, progressive ulcers without LAD

Answer 25

Granuloma inguinale - Klebsiella

Question 26

Initial painless shallow ulcers followed by confluent painful inguinal LAD (buboes)

Answer 26

Chlamydia - also has intracytoplasmic chlamydial inclusion bodies

Question 27

Multinucleated giant cells and intranuclear inclusions

Answer 27

Cowdry type A - HSV

Question 28

Multiple and deep painful ulcers initially, gray/yellow exudate

Answer 28

Chancroid (H ducreyi) Can also have buboes

Question 29

Organisms clump in long parallel strands

Answer 29

Chancroid - H ducreyi - "school of fish"

Question 30

Vulvovaginal candidiasis - treatment

Answer 30

Topical antifungal + single dose of oral fluconazole

Question 31

How does PID treatment differ from simple cervicitis?

Answer 31

Ceftriaxone IM + Doxycycline PO 14d +/- Metronidazole PO 14d