Sexually Transmitted Diseases

B. Yeast

The visualization of yeast in saliva usually indicates Candida species. Yeast are commonly seen in patients who have thrush, vaginitis secondary to yeast, or intertrigo. While thrush is uncommon in adults, it is not uncommon in patinets who are immunocompromised, such as a patient with HIV

A 35 yo patient is HIV positive. Which finding on an oral swab may be indicative of thrush?

A. Epithelial cells

B. Yeast

C. Spores

D. Red blood cells

D. A serum assessment

Patients can be screened for syphilis in three ways. The nontreponemal tests are VDRL (venereal disease research laboratory), RPR (rapid plasma reagin) or TRUST (toluidine red unheated serum test) tests. The main use of the treponemal tests is to confirm positive nontreponemal tests. These results are reports as reactive or nonreactive and are quantitative in nature, which is why they are used as confirmatory tests.

How should a patient with suspected syphilis be screened?

A. Ask about symptoms in the patient

B. Ask about symptoms of sexual partners

C. A urethral swab for culture

D. A serum assessment

C. high viral load periods

Many times this is before a patient has been diagnosed; thus he is capable of transmitting this disease without knowledge that he is doing so. The highest viral load may occur during the earliest stages of HIV and before there is detectable antibody.

The greatest risk of transmitting HIV is during:

A. the acute phase

B. the time that detectable antibody is present

C. high viral load periods

D. late infection phase

C. podophyllin

HPV is a viral infection that increases a woman's risk of cervical cancer. In males HPV causes an increased risk of cancer of the anus and penis. Th warts that are produced are painless and usually appear within weeks of infection. There are several topical treatments for HPV, imiquimod, podophyllin, and trichloracetic acid (TCA). One of these agents may be applied to the warts. Treatments are generally well tolerated. TCA may cause burning. The warts will slough off after one or more treatments. There are no oral antiviral agents indicated for treatment of HPV

A 21 yo female presents with six 0.5 cm HPV lesions on her vulva. An appropriate treatment option for this patient would be:

A. Acetic acid

B. Colposcopy

C. podophyllin

D. Acyclovir

A. dysuria

In males, gonorrhea can have a varied presentation. Gonorrhea produces a purulent inflammation of the mucous membranes, urethral discharge, and dysuria. It can be diagnosed with a urethral culture, a urine screen, or nucleic acid tests. Urine screens are first choice in males; vaginal swabs are preferred in females. Urine screens are used in adolescents or pediatric patients because of ease of specimen collection

A male with gonorrhea might complain of:

A. dysuria

B. a penile lesion

C. abdominal pain

D. fatigue

A. Using a condom to prevent infection with an STD

Primary prevention refers to preventing an event prior to its occurrence.

An example of primary prevention is:

A. Using a condom to prevent infection with an STD

B. Diagnosis of chlamydia prior to symptom development

C. Treatment of chlamydia concurrently with gonorrhea

D. Early treatment of sexual partners

C. Temperature over 101

Symptoms of PID include fever, abnormal cervical or vaginal mucopurulent discharge, presents of abundant WBCs on microscopy or vaginal secretions, elevated sedimentation rate or C-reactive protein. The CDC recommends empiric treatment for PID if lower abdominal pain or pelvic pain is present concurrently with cervical motion tenderness or uterine/adnexal tenderness

A 25 yo female presents with lower abdominal pain. Which finding would indicate the etiology as pelvic inflammatory disease?

A. Presents of hyphae

B. hematuria

C. Temperature over 101

D. Normal sedimentation rate

d. Cervical motion tenderness.

PID is difficult to diagnose and often goes unrecognized b/c of the varied presenting signs and symptoms in women who have it. Delay in diagnosis contributes to inflammatory sequelae in the upper reproductive tract. Consequently, PID is usually diagnosed on imprecise clinical findings. The CDC recommends that healthcare providers maintain a low threshold for diagnosis of PID. Presumptive treatment should be initiated in sexually active women if they are experiencing pelvic or low abd pain and if one or more of the following criteria pare present on pelvic exam: cervical motion tenderness, uterine tenderness, or adnexal tenderness

A 24 yo female presents with abdominal pain. What additional finding supports a diagnosis of pelvic inflammatory disease?

A. Dysuria

B. Vaginal discharge

C. Positive RPR

d. Cervical motion tenderness

B. Meningitis

A 24 yo HIV positive patient presents with photophobia and temperature of 103.2 . He complains of a headache. On exam, he is unable to demonstrate full extension of the knee when his hip is flexed. Which choice below is the most likely diagnosis?

A. Pneumocystitis infection

B. Meningitis

C. Septic bursitis

D. Septic arthrits

C. Report it to public health as required by law

If state law requires reporting of the STD, it should be reported. Patient names or other identifying data are not part of the reporting process, so the NP's patient should not worry about being identified and associated with this finding.

In a private NP clinic, a patient presents with trichomonas. State law requires reporting of STDs to the public health department. The patient asks that NP not to report it because her husband works in the public health department. How should this be managed by the NP?

A. Respect the patient's right to privacy and not report it.

B. Tell the patine that it won't be reported, but report it anyway

C. Report it to public health as required by law

D. Report it to public health but don't divulge all the details

A. There are few conditions that cause depletion of CD4 cells other than HIV.

HIV specifically attacks the number of circulating CD4 cells. There is little variability in CD4 counts in immunocompetent adults. There are a number of factors that will cause minor fluctuation in counts. These include things like seasonal and diurnal variations, infections, and steroid intake. The normal CD4 cell count ranges from 800-1050/mm3. Every year after infection with HIV, the CD4 cell count decreases by about 50/mm3 per year. There is great variation in individual decreases. Some patients experience very little decrease in counts. Other patients experience great decreases in counts. Oral antiretroviral agents slow down teh CD4 decreases.

Which of the following statements regarding HIV is correct?

A. There are few conditions that cause depletion of CD4 cells other than HIV

B. CD4 cell counts vary greatly in immunocompetent individuals

C. A normal CD4 count is less than 22/mm3

D. CD4 counts are the first abnormality seen in patients with HIV

D. 14 days or longer

The prostate gland does not absorb antibiotics very readily. Consequently, antibiotics must be given for 2-6 weeks to enable the gland to achieve high enough concentrations to treat and effectively eradicate the organism causing prostatitis. Treatment can be expensive depending on the antibiotic used.

How long should a patient be treated with antibiotics if he has prostatitis secondary to an STD?

A. 3 days

B. About 5 days

C. 7-10 days

D. 14 days or longer

A. 4-6 weeks

The CDC states that for nonoccupational HIV exposure, a screening interval of 4-6 weeks is recommended following initial negative testing. Repeat testing at 3 months after exposure should take place to determine if HIV seroconversion has occurred. Seroconversion within 3 months is likely to occur in patients who are immunocompetent. Seroconversion may be delayed up to 6 months in patients who concurrently acquired hepatitis C at the time of HIV exposure.

A patient was exposed to HIV through sexual intercourse last night. He was screened and found to be negative for HIV. When should he be screened again?

A. 4-6 weeks

B. 8 weeks

C. 3 months

D. 6 months

B. They both should receive metronidazole

Metronidazole is considered the drug of choice to treat males and females. Even though he is asymptomatic, he needs treatment too. Neither partner should resume sexual intercourse until both have been treated. Tinidazole can also be used for treatment. 2 gms of either agent may be given as a single-dose treatment. Alcohol should be avoided for 24 hours if metronidazole is taken; 72 hours if tinidazole is taken.

A female patient and her male partner are diagnosed with trichomonas. She has complaints of vulval itching and discharge. He is asymptomatic. How should they be treated?

A. She should receive metronidazole; he does not need treatment.

B. They both should receive metronidazole

C. She should be treated with ceftriaxone; he should receive ciprofloxacin

D. They both should be treated with azithromycin and doxycycline

B. She should be screened today, with repeat screening at 4-6 weeks, and 3 months.

The period within 3 months after exposure is termed the "window period" and a negative screen must be confirmed. If a 4th generation assay ins use and the screen is negative 3 months after the last exposure, and there is no concern for coinfection with hepatitis C at the time of HIV exposure, she is considered to be negative.

A patient requests screening for HI/v after a sexual exposure. What are CDC's recommendations for screening for this patient?

A. There are no recommendations for screening.

B. She should be screened today, with repeat screening at 4-6 weeks, and 3 months

C. She should be rescreened in 6-12 months

D. She only requires screening if she develops symptoms of HIV

D. Within 3 months

Seroconversion within 3 months is likely to occur in patients who are immunocompetent. Seroconversion may be delayed up to 6 months in patients who concurrently acquired hepatitis C at the time of HIV exposure.

A 32 yo female was exposed to HIV after sexual intercourse. When do the majority of patients seroconvert if they are going to do so?

A. 1 week

B. Within 4 weeks

C. Within 4-6 weeks

D. Within 3 months

A. No clinical symptoms

Trichomonas produces classic symptoms in females of itching and discharge. In males, there are usually no symptoms. Less than 10% of the time, men present with symptoms. However, when symptoms occur in males, they include urethritis with clear or mucopurulent urethral discharge and dysuria.

Which of the following describes the most common clinical presentation of trichomonas in a male?

A. No clinical symptoms

B. Urethritis

C. Burning with urination

D. Testicular pain

B. Ceftriaxone and azithromycin

250 mg ceftriaxone should be given IM in conjunction with 1 gram azithromycin by mouth when gonorrhea is diagnosed. Treatment failure should be reported to CDC.

A 26 yo female patient has been diagnosed with gonorrhea. How should she be managed?

A. Ceftriaxone only

B. Ceftriaxone and azithromycin

C. Cefixime and azithromycin

D. Penicillin G

B. Chlamydia and gonorrhea

BV and HIV are not associated with dysuria or penile discharge in male patients. Herpes produces lesions that are painful. HIV is not specifically associated with dysuria. Syphilis produces a painless lesion. Chlamydia and gonorrhea are usually associated with dysuria and discharge. Trich is often asymptomatic in males, but can produce dysuria

A male patient presents with dysuria and penile discharge. He states that his female partner has an STD, but he is not sure which one. Which of these should be part of the differential?

A. BC and trich

B. Chlamydia and gonorrhea

C. HIV and herpes

D. Syphilis an dchlamydia

A. When other STDs are present.

tHERE ARE SEVERAL RISK FACTORS FOR hiv TRANSMISSION. vIRAL LOAD IS LIKELY THE GREATEST RISK FACTOR. tHE PRESENCE OF stdS INCREASES THE RISK OF hiv TRANSMISSION. specifically, THE PRESENCE OF CHLAMYDIA INCREASES THE RISK OF ACQUIRING hiv BY 5 TIMES. lack OF CIRCUMCISION INCREASES THE RISK OF TRANSMISSION.

The risk of HIV transmission is increased:

A. When other STDs are present.

B. In females

C. When patients are aware of their hiv STATUS

d. iN PATIENTS WITH DIABETES

B. A rash

Secondary syphilis can present as a rash on the body, but more commonly as a rash on the palms of the hands or soles of the feet. This can persist for up to 6 weeks. It will resolve without treatment, however, the patient will still be infected with syphilis. Primary syphilis is characterized by a chancre. This is a painless lesion that can persist for 1-5 weeks. It will resolve without treatment.

Syphilis may present as:

A discharge

B. A rash

C. a painful lesion

D. Dysuria

A. HIV

Chancroid is an STD caused by Haemophilus ducreyi. It is spread by sexual contact or by contacting pus from an infected lesion. This is common in tropical countries but can occur in the US. The ulcer is usually very painful in men, but not usually painful in women. The ulcer begins as a papule, fills with pus, and becomes and open, eroded area. Chancroid is a cofactor in the transmission of HIV. In patients with HIV, the chancroid heals much more slowly than in patients who are immunocompetent.

Chancroid is considered a cofactor for transmission of:

A. HIV

B. Gonorrhea

C. Chlamydia

D. Trichomoniasis

A. HIV test

During asymptomatic HIV infection, patient often have persistent generalized lymphadenopathy (PGL). PGL is defined as enlarged lymph nodes involving at least two contiguous sites other than inguinal nodes. The lymphatic tissue serves as a primary reservoir for HIV. Studies of lymph nodes in patients at the asymptomatic phase demonstrate high concentrations of HIV.

A 27 yo asymptomatic male presents with generalized lymphadenopathy. He has multiple sexual partners and infrequently uses condoms. Of the following choices, what test should be performed?

A. HIV test

B. RPR

C. Lymph node biopsy

D. Sedimentation rate

A. Treat with azithromycin

Chlamydia is commonly treated with a single dose of azithromycin (1 gram). This patient should be screened for other STDs now, including hepatitis B, C, and HIV. According to the 2015 STD guidelines, this patient should not be treated for gonorrhea unless this is diagnosed too.

A female patient has been diagnosed with chlamydia. How should this be managed?

A. Treat with azithromycin

B. Treat with ceftriaxone by injection

C. Treat withdoxycycline

D. Treat for gonorrhea also

D. Alcohol should be avoided when taking this medication

Metronidazole may be associated with a disulfiram reaction when mixed with alcohol. Advice that should be given to all patients who take metronidazole is to avoid alcohol entirely while this medication is being taken. Additionally, alcohol should be avoided for 24 hours after the last dose of medication. The disulfiram reaction is characterized by fever, abdominal pain, nausea, vomiting, and headache. This reaction is called the "Antabuse" reaction

A patient being treated for trichomoniasis receives a prescription for metronidazole. What instructions should she be given?

A. Take this medication with food

B. Do not take this medication if you are pregnant

C. Take this medication on an empty stomach

D. Alcohol should be avoided when taking this medication

A. Acute bacterial prostatitis

A common presenting symptom is prostate tenderness, especially with bowel movements. A common cause in a 30-yo male who is sexually active is infection with chlamydia or gonorrhea. He should be screened for sexually transmitted diseases. If these are negative, a urinary pathogen is the likely cause.

A 30-year -old male who is sexually active complains of pain during bowel movements. The digital rectal exam is negative for hemorrhoids, but the prostate gland is tender. What should be suspected?

A. Acute bacterial prostatitis

B. Prostate cancer

C. Benign prostatatic hyperplasia

D. Trichomoniasis