STIs Flashcards
1
Q
Potentially cause chronic pelvic pain and infertility
A
chlamydia
2
Q
ELISA is used as a screening test
A
HIV
3
Q
Screening test may be negative during initial acute flu-like illness
A
HIV
4
Q
If HIV is suspected during acute flu-like illness, what test should be ordered?
A
NAAT: RNA qualitative assay
5
Q
(2) produces malodorous vaginal discharge
A
- trichimoniasis
- BV
6
Q
Frothy yellow discharge
may be asymptomatic especially in >40yo
A
Trichomoniasis
7
Q
NAAT used for screening
A
GC/CG
8
Q
Who should be screened yearly for STIs
A
<25 year olds
9
Q
Term for initial painless lesion associated with syphilis
A
Chancre
10
Q
organism associated with syphillis
A
Treponema pallidum
11
Q
Positive whiff-amine test
A
BV
12
Q
Birth control to increase BV cure rates
A
condoms
13
Q
HIV confirmatory test
A
Western blot
14
Q
Treated with metronidazole 500 mg BID for 7 days
A
- BV
- trich
15
Q
Are metronidazole and clindamycin safe in pregnancy
A
yes, but avoid in 1st trimester
16
Q
STI that causes cervical cancer
A
HPV
17
Q
white, adherent, malodorous discharge
A
BV
18
Q
Serology test to differentiate HSV1 and 2
A
IgG
19
Q
positive “chandelier test” indicates
A
PID
20
Q
Patient group at highest risk for HIV
A
Hispanic MSM
21
Q
__% with HIV report no high-risk behaviors
A
25%
screen everyone
22
Q
If HIV 1/2 antigen/antibody assay is positive (ELISA) what do you order
A
HIV 1/2 antibody differentiation immunoassay (replaces western blot)
- (+) refer
- (-) order NAT (HIV1 RNA qualitative assay)
23
Q
Initial HIV infection duration
A
<14 days
24
Q
Initial HIV infection presentation
A
- fever
- pharyngitis
- nonpruritic macular skin rash
- malaise
- headache
- lymphadenopathy
25
When is HIV most infectious
acute retroviral stage
| 2-4 weeks postinfection
26
What is a significant risk factor for reactivation of latent TB
HIV
27
What should never be given to HIV infected patients
live attenuated vaccines
28
When are HIV antibodies typically developed
within 3 months of exposure
29
AIDs definition
CD4 cell count <200
| infection with opportunistic infections and malignancies
30
s/sx of AIDs
- oral thrush
- fever
- weight loss
- diarrhea
- cough
- SOB
- purple to bluish red bumps on skin
31
What causes the most deaths in patients with HIV
-infection with Pneumocystis jirovecii
32
Which HIV strain is most common in US
HIV 1
33
Step 1 with suspected HIV
- HIV-1/HIV-2 antibodies and P24 antigen with reflex
| - detects if strain 1 or 2
34
Step 2 if HIV1/2 antibodies are positive
- lab performs HIV1/2 antibody differentiation immunoassay
| - if results indeterminate, order HIV RNA test
35
HIV RNA PCR can detect HIV infection as early as
7-28 days
36
Pneumocystis carinii prophylaxis
Bactrim DS one tab daily
37
MOnitoring viral load on ART frequency
every 1-2 months until viral load is undetectable
| then q 3-4 months
38
Tenofovir lab monitoring
-UA every 6 months
| nephrotoxic
39
Zodovudine lab monitoring
-CBC with diff
| BM suppression
40
HIV education what to avoid
- cat litter
- undercooked meat
- turtles, snakes, other amphibians
- bird stool
41
Preventing HIV transmission
- condom every sexual encounter
- do not share needles
- do not share toothbrush, razer, or any blood item
42
HIV infected mothers and breastfeeding
do NOT breastfeed
43
Who should take PrEP
- ongoing sexual relationship with HIV (+) partner
| - LGBT who do not use condoms/high risk sexual behaviors
44
PrEP HIV checks
check for HIV before starting
| -then every 3 months
45
PEP
postexposure prophylaxis
46
Outer limit of PEP
72 hours postexposure
47
When to start prophylaxis for Pneumocystis carinii
when CD4 is <200
48
When to start antiretroviral therapy in HIV infected pregnant women
ASAP
49
Which HIV drug is safest for HIV infected pregnant women
-Zodivudine
50
What to do if HIV+ patient is unwilling to notify partners
-health department will try to locate them
51
Why does BV occur
-replacement of normal vaginal flora with high concentrations of anaerobic bacteria
52
Risks of BV
- multiple sex partners
- new partners
- douching
- IUCs
53
BV increases risk for
STI
UTI
post-gynecologic surgery infections
preterm labor
54
BV organisms
- Prevotella
- Mobiluncus
- G.vaginalis
55
BV Amsel criteria
- requires 3 for diagnosis
- white discharge coating vulva/vagina
- vaginal pH of >4.7
- fishy odor before or after addition of KOH (whiff test)
- clue cells on microscopy
56
BV management
- screen for other STIs
- Metronidazole 500 mg PO BID x 7 days (cream available)
- Clindamycin 300 mg PO BID x 7 days
57
Patient teaching with metronidazole
-no alcohol until 24 hours after last dose
58
With recurrent BV, what must you rule out
HIV
59
Pregnant women treated with GC/CG should have test-of-cure when
3-4 weeks after treatment
60
Pregnant women who were treated should be tested again for GC/CT when
at 3 months
61
Most chlamydial infections are symptomatic
false
62
Which STD is most common in US
chlamydia
63
Lab testing for GCCT
NAAT
| -swabs or urine sample
64
Treatment for uncomplicated chlamydia
- Azithromycin 1 g PO single dose
| - OR doxycyline 100 mg BID x 7 days
65
Is a test-of-cure necessary for uncomplicated chlamydia
no
66
Chlamydia treatment for sexual partners
- azithromycin 1 g PO
| - abstain from sex for 7 days
67
Expedited Partner Therapy
practice of treating sexual partner of a patient diagnosed with STD without evaluating them
-Allowed in 41 states
68
Treatment for PID
- Ceftriaxone (Rocephin) 250 mg IM x one dose
- PLUS doxycycline PO BID x 14 days
- with or without metronidazole PO BID x 14 days
69
What can happen with gonorrhea infection if not treated
-can become systemic or disseminated
70
Treatment for gonorrhea
-treat for both chlamydia and gonorrhea d/t high rates of coinfection
71
Gonorrhea presentation
- purulent green-colored vaginal discharge
- shuffling gait to avoid abdominal pain
- cervix friable
- males can have penile discharge
- new onset sex partner or multiple sex partners
- inconsistent condom use
72
Proctitis presentation
- pruritus
- rectal pain
- tenesmus (cramping of rectum)
- feeling urge to defecate even if rectum is empty
- avoiding defecation due to pain
73
Gonorrhea presentation in men
- may be asymptomatic
- dysuria
- discharge
- testicular pain
74
Trichomoniasis presentation
- asymptomatic for decades
- frothy yellow green discharge
- vulvar irritation
- dysuria
- cervical petechiae
75
Diagnosis of trichomoniasis
- wet prep --> flagellated motile cells
| - NAAT
76
Trichomoniasis management
- Metronidazole 2 g single dose
- abstinence from sex until treatment completion
- treat sexual partners
- avoid alcohol x 72 hours after dose
77
Trichomoniasis organism
trichomoniasis vaginalis
78
Primary syphilis findings
- chancre
- indurated and painless, well demarcated
- persists for 1-5 weeks and heals spontaneously
- regional lymphadenopathy
79
Secondary syphilis findings
- symmetrical bilateral rash
- frequently on palms and soles
- 2-6 weeks and resolves
- condyloma lata: moist, pink, warty lesions
80
Condyloma lata indicates which stage of syphilis
secondary
81
Latent syphilis findings
asymptomatic
82
Tertiary syphilis findings
- CVD: aortic valve disease, aneurysms
- Neuro: meningitis, encephalitis, tabes dorsalis, dementia
- Skin: gummas
- Ortho: Charcot joints, osteomyelitis
83
Syphilis organism
treponema pallidum
84
Syphilis management
Benzathine PCN G (Bicillin) 2.4 million units IM
85
First labs to order with syphilis
- nontreponemal tests: RPR or VDRL
| - if positive: order confirmatory tests
86
Confirmatory test for syphilis
Treponemal tests
| -FTA-ABS
87
What is diagnostic for syphilis
+RPR and +FTA-ABS
88
What to monitor for treatment response in syphilis
- sequential RPR
| - four fold or higher decrease means responding well to treatment
89
Treatment for primary, secondary, or early latent syphilis (<1 year)
-Benzathine PCN G (Bicillin L-A) 2.4 million units IM x one dose
90
Syphilis follow up
RPR or VDRL at 6 and 12 months of treatment
91
When to refer syphilis to infectious disease specialist
- suspected neurosyphilis
- poor response to treatment
- PCN allergy
- or if not familiar with management
92
Proctitis patho
Lining of inner rectum becomes inflamed
| -can be due to STI's
93
Complicated gonococcal infections include...
- PID
- acute epididymitis
- acute prostatitis
- acute proctitis
94
Risks for PID
- history of PID (25% recurrence)
- Multiple partners
- Age <25
95
Urine specimen is best collected with
first urine of the day
96
STI's requiring serum
- HIV
- Hep B and C
- syphilis
- HSV type 2
97
Sexual assault after care
- Hep B immunization
- HPV vaccination
- GC/CT treatment: Rocephin +Azithromycin
- Trich and BV treatment: Metronidazole 2 g
- consider PEP for HIV with zidovudine
98
Complication of PID due to chlamydia or gonorrhea infection
Fitz-Hugh-Curtis syndrome
99
Jarisch-Herxheimer reaction
- acute febrile reaction during first 24 hours of syphilis treatment and other spirochetes
- resolves spontaneously within 24 hours
100
Reiter's syndrome
- more in males
- joint pain and swelling
- conjunctivitis
- urethritis
- immune-mediated reaction secondary to infection with certain bacteria that resolves spontaneously
- supportive treatment
101
Reiter's syndrome mnemonic
cant see
cant pee
cant climb a tree
102
Follow up for PID treatment
- within 72 hours
| - retest for adnexal tenderness or cervical motion tenderness
103
Condyloma acuminata
genital warts
104
HPV vaccine is given at age
- 9-14: 2 doses 6-12 months apart
| - 15-45, IC: 0, 1-2, 6
105
Genital warts treatment
- Podofilox (Condylox) 0.5% gel or cream x 3 days, hold for 4 days, repeat up to 4 times
- Imiquimod or Zyclara, thin layer three times a week
- Sinecatechins
- electrocautery
106
HSV prodrome
-itching, burning, tingling on site
107
HSV diagnostic test
- herpes viral culture
| - RPR assay for HSV 1/2 DNA --> more sensitive
108
First herpes outbreak treatment
- Acyclovir 400 mg TID 7-10 days or 200 mg five x/day
- Famciclovir 1 g BID 7-10 days
- Valacyclovir TID 7-10 days
109
Episodic HSV treatment
- best if started within 1 day of lesion onset
- Famciclovir 125 mg BID x 5 days
- Acyclovir x 5 days
- Valacyclovir x 5 days
110
HSV suppressive treatment
-Acyclovir 400 BID or famciclovir 250 mg BID
111
Imiquimod
- immune modulator
| - patient can use at home
112
Genital warts treatment C/I in pregnancy
- podofilox
- podophylla
- imiquimod
113
Genital warts treatment for pregnancy
- manual removal by HCP
| - cryo, laser, excision
114
Which strains of HPV are oncogenic
- 16
| - 18
115
Screening test for HIV
-combination HIV-1 and HIV-2 antibody immunoassay with p24 antigen
116
ELISA and Western Blot test for HIV tests what
HIV antibody
