Sexually Transmitted Di⅘?.; 0pseases and Infections

A comprehensive set of practice Q&A flashcards covering AIDS and HIV biology, acute infection, opportunistic infections, STI screening and management, diagnostic testing, vaccinations, and prevention strategies.

What CD4 count defines Acquired Immunodeficiency Syndrome (AIDS) in HIV infection, and what additional criteria accompany this threshold?

AIDS is defined by an absolute CD4 count fewer than 200 cells/mm3 along with certain opportunistic infections and malignancies.

What is the typical survival time for people with AIDS without treatment and with highly active antiretroviral therapy (HAART)?

Without treatment, about 2 years; with HAART, most patients survive >10 years.

Which opportunistic infection is a leading cause of disease in patients with HIV and is specifically mentioned as a major concern?

Pneumocystis jirovecii pneumonia (PCP) is a leading opportunistic infection in HIV patients.

What is Acute HIV Infection (Acute Retroviral Syndrome) and when do symptoms typically develop after exposure?

An estimated 2 to 4 weeks after exposure, often with mono-like symptoms; very infectious with high viral load.

If acute HIV infection is strongly suspected, which test can detect infection earliest after exposure and within what window?

HIV RNA PCR can detect infection about 7 to 28 days after exposure.

At what CD4 count is Pneumocystis pneumonia (PCP) prophylaxis advised?

CD4 count ≤200 cells/mm3.

Describe the classic disseminated gonococcal infection (DGI) presentation and its two classic forms.

DGI occurs in a small percentage of gonococcal infections. Classic forms: (1) triad of tenosynovitis, dermatitis, and polyarthralgia with fever/chills/malaise; (2) purulent arthritis. Skin lesions are typically painless pustules; may have cervicitis, urethritis; perihepatitis (Fitz-Hugh–Curtis) can occur; endocarditis or meningitis are rare.

What does the CDC screening guideline recommend for Chlamydia and gonorrhea in sexually active females aged 25 and younger?

Annual screening for Chlamydia trachomatis and gonorrhea; retest for reinfection 3 months after treatment if positive.

What are the five Ps used in STD history-taking?

Partners, Practices, Protection, Past history of STDs, and Prevention of pregnancy.

What is the recommended STD screening for men who have sex with men (MSM) regarding sites of exposure?

Annual screening for chlamydia and gonorrhea at sites of contact (urethra, rectum); HIV and syphilis testing annually; hepatitis B screening; consider hepatitis C screening in adults.

During pregnancy, which infections should all pregnant patients be screened for at the first prenatal visit?

HIV, syphilis, and HBsAg; chlamydia/gonorrhea screening is also recommended for younger or at-risk patients with follow-up in the third trimester.

What is the recommended screening approach for Chlamydia trachomatis in pregnant women and in nonpregnant young women?

Screen all pregnant women <25 years and at increased risk adults; annual screening for sexually active women <25; retest in the third trimester for those at risk.

What are the primary diagnostic tests for Chlamydia and Gonorrhea and what specimens are used for women and men?

NAATs are the preferred tests. Women: vaginal or cervical swabs; men: first-catch urine. Self-collected vaginal swabs are as sensitive as clinician-collected samples.

What is the first-line treatment for Chlamydia in nonpregnant individuals?

Doxycycline 100 mg orally twice daily for 7 days.

What is the preferred treatment for Chlamydia in pregnancy?

Azithromycin 1 g PO in a single dose (doxycycline avoided in pregnancy); retesting at 3 months for reinfection.

What is the first-line treatment for uncomplicated gonorrhea, and when should doxycycline be added?

Ceftriaxone 500 mg IM as a single dose (1 g if ≥150 kg). Cotreat with doxycycline 100 mg PO BID for 7 days if chlamydial infection has not been excluded.

What follow-up is recommended for gonorrhea treatment in terms of test-of-cure for various infection sites?

No test-of-cure is needed for uncomplicated urogenital/rectal/pharyngeal gonorrhea treated per guidelines, except pharyngeal gonorrhea where testing 7 days after therapy (culture) or NAAT at 14 days may be indicated.

What is the management approach for disseminated gonococcal infection (DGI)?

Ceftriaxone 1 g IV every 24 hours (adjust for weight) for 7–14 days; hospitalize if needed; treat sexual partners; add doxycycline if chlamydia not excluded.

What are the common sites and transmission patterns for HSV-1 and HSV-2, and which type is most commonly genital?

HSV-1 is usually oral; HSV-2 is most commonly genital. HSV can be transmitted via oral–oral, oral–genital, and genital–genital contact; asymptomatic shedding occurs.

What is the general treatment approach for a first episode of genital herpes?

Acyclovir 400 mg TID × 7–10 days; Valacyclovir 1,000 mg PO BID × 7–10 days; Famciclovir 250 mg PO TID × 7–10 days.

How is episodic (flare-up) treatment for genital herpes typically prescribed?

Acyclovir 800 mg TID × 2 days or 800 mg BID × 5 days; Famciclovir 1,000 mg BID × 1 day or 125 mg BID × 5 days; Valacyclovir 500 mg BID × 3 days or 1,000 mg once daily × 5 days.

What are the chronic suppressive therapy options for recurrent HSV infections?

Acyclovir 400 mg PO BID; Famciclovir 250 mg PO BID; Valacyclovir 500 mg once daily or 1,000 mg once daily.

What diagnostic tests are used to confirm HSV infection and how reliable is the Tzanck smear?

Herpes viral culture or PCR assay for HSV-1/HSV-2 RNA are preferred; Tzanck smear shows multinucleated giant cells but has poor sensitivity and specificity.

What is the role of HIV screening in routine care and what populations may require more frequent testing?

Routine HIV screening is recommended for many adults; MSM and high-risk groups may benefit from more frequent testing (every 3–6 months).

What constitutes Fourth-Generation HIV testing and its stepwise algorithm?

Step 1: HIV-1/2 antibodies and p24 antigen with reflex testing; Step 2: confirm with HIV-1/2 antibody differentiation immunoassay; if positive or indeterminate, order HIV RNA test.

What are the key HIV monitoring markers after starting ART and the targets for success?

Viral load (undetectable <50 copies/mL) and CD4 count should rise; monitor viral load 2–8 weeks after starting ART, then every 1–2 months until undetectable, then every 3–4 months for the first 2 years.

What vaccines are recommended for people with HIV and what CD4 level affects vaccine efficacy?

Inactivated vaccines (hepatitis A/B, influenza, pneumococcal, Td/Tdap, HPV up to 26) are recommended; vaccines work best if CD4 counts exceed 200 cells/mm3.

Which HPV types are most associated with cancer risk, and what vaccine helps prevent infection?

HPV types 16 and 18 are oncogenic; Gardasil 9 vaccine covers oncogenic HPV types.

What is the recommended HPV vaccine dosing schedule for-dose timing based on age at first vaccination?

If first dose before age 15: two doses (0 and 6–12 months). If first dose at age 15 or older: three doses (0, 1–2, 6 months).

What is condyloma acuminata and which HPV types are most commonly associated with it?

External anogenital warts caused by HPV types 6 and 11.

What are common topical and provider-applied treatments for genital warts and when are they used?

Topical: Podophyllotoxin, Imiquimod, Sinecatechins; provider-applied: cryotherapy, TCA, surgical excision, electrosurgery, CO2 laser; choice depends on wart size and pregnancy status.

How is condyloma lata distinguished from condyloma acuminata?

Condyloma lata are associated with secondary syphilis; condyloma acuminata are HPV-related genital warts.

What is the standard initial evaluation for a patient with suspected gonorrhea or chlamydia in terms of partner management and testing?

Expedited partner therapy (EPT) is permissible in many states; treat partners without clinical evaluation when appropriate; cotest for chlamydia and gonorrhea; screen for HIV and other STDs.

What is Fitz-Hugh-Curtis syndrome and how does it relate to PID?

Perihepatitis with RUQ pain and violin-string adhesions; occurs in about 10% of PID cases.

What is the recommended treatment for early syphilis (primary/secondary/early latent) and for late latent/tertiary without neurosyphilis?

Early: Benzathine penicillin G 2.4 million units IM × 1 dose. Late latent/tertiary without neurosyphilis: Benzathine penicillin G 2.4 million units IM weekly × 3 weeks.

What is the recommended treatment for neurosyphilis and for pregnancy-related syphilis?

Neurosyphilis: IV penicillin G 3–4 million units IV q4h for 10–14 days. Pregnancy: same penicillin regimen as nonpregnant; desensitization if penicillin-allergic.

What is Jarisch-Herxheimer reaction and how is it managed?

Acute febrile reaction within 24 hours after therapy for spirochete infections; managed supportively with antipyretics/NSAIDs.

What is the role of preexposure prophylaxis (PrEP) and its general efficacy?

Daily oral PrEP reduces HIV transmission by more than 90% in at-risk individuals; distinguish from PEP and require baseline HIV testing and ongoing monitoring.

What is postexposure prophylaxis (PEP) and the critical timing for initiation?

PEP should be started as soon as possible after exposure (within 72 hours) and continued for 28 days (4 weeks); baseline labs include HIV rapid test, HCV RNA, HBsAg, and HBV surface antibody.

What samples and tests are used for HIV exposure in newborns and infants?

HIV RNA PCR is used for testing infants of HIV-positive mothers; fourth-generation antibody/antigen tests are used for adults; RNA testing helps detect infection in window period.

What are the common routes of occupational HIV exposure and the fluids involved?

Exposure to blood, semen/preseminal fluid, vaginal fluids, breast milk; contact with mucous membranes or damaged tissue or direct bloodstream injection.