Term
Chlamydia:
What is the treatment? |
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Definition
Uncomplicated:
Azithromycin 1 gram orally x 1 dose or doxycycline 100 mg orally twice daily X 7 days.
In pregnancy:
Erythromycin base 500 mg orally 4 times daily X 7 days or amoxicillin mg 3 times daily X 7 days. |
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Term
Chlamydia:
What are the urethral symptoms in men? |
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Definition
| Men: the majority are asymptomatic! If signs/symptoms are present they include mucopurulent or purulent discharge, dysuria |
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Term
| Chlamydia: How long before resuming intercourse? |
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Definition
| 7 days following one-dose treatment or after the 7 day course of treatment is completed. |
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Term
| Who should be screened for Chlamydia? |
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Definition
| Screening includes annual screening of sexually active women under the age of 25, screening for sexually active women over the age of 25 with increased risk, follow-up screening for confirmed and treated cases in 3-4 months, all pregnant women in first trimester, pregnant women under the age of 25 or at increased risk in the first and third trimesters. |
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Term
| What is the diagnostic test for Chlamydia? |
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Definition
| Diagnosis can be done by culture (swabbing the endocervix and/or vagina of women, swabbing the utethra of men), nucleic acid amplification tests, and non-nucleic acid amplification tests. Non-NAAT's include direct fluorescent antibody, enzyme immunoassay, nucleic acid hybridization. (Centers for Disease Control, p. 38) |
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Term
| What is Reiter's syndrome and what STI is it associated with? |
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Definition
| Reiter's syndrome is a reactive arthritis that has been known to follow infectious processes such as chlamydia. S&S include low grade fever, urinary distrubances, conjunctivitis, and muscle and joint pain. The muscle and joint pain commonly occurs in the heels, large joints (knee, hip), ankle, and lower back. Urinary symptoms can include dyuria, frequency, hesitancy, discharge, or genital lesions. Symptoms associated with the conjuntivitis include burning, discharge, and redness. Painless ulcerative areas in the mouth, tongue, or glans penis can also occur. (medscape) |
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Term
| What are some common complications of untreated Chlamydia infection in women? |
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Definition
| salpingitis, perihepatitis, endometritis, infertility, ectopic pregnancy, PID, chronic pelvic pain |
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Term
Treating the partner: Chlamydia
Who should be treated? |
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Definition
| Regardless of time elapsed, the last sexual partner should be treated. In addition, any sexual partner within 60 days prior to the onset of symptoms or diagnosis. |
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Term
| According to the CDC, who should be screened for Chlamydia? |
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Definition
1.Sexually active women under the age of 25,
2.Sexually active women over the age of 25 with increased risk,
3.Follow-up screening for confirmed and treated cases in 3-4 months,
4.All pregnant women in first trimester,
5.Pregnant women under the age of 25 or at increased risk in the first and third trimesters. |
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Term
Chlamydia:
What are the urethral symptoms in women? |
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Definition
| Women are also commonly asymptomatic (70%-80% of the time)! If present, they can include mucopurulent discharge, dyuria, pyuria, and frequency. |
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Term
| Which STI is the most common reported NOTIFIABLE STI in the United States? |
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Definition
|
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Term
| Which test for Chlamydia has the highest sensitivity? |
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Definition
| NAAT (nucleic acid amplification test) |
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Term
| Peak incidence of Gonorrhea in women occurs in what age group? |
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Definition
| The peak incidence of infection of women occurs during adolescence at ages 15-19 (Schwartz, 2010). |
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Term
| How is Gonorrhea transmitted? |
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Definition
| Gonorrhea is transmitted by male to female via semen, female to male via urethra, rectal intercourse, fellatio, or maternal to child during vaginal childbirth. |
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Term
| Describe the organism responsible for N. gonorrhoeae. |
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Definition
| The culprit is a bacterium known as Neisseria gonorrhoeae that attaches to the mucosal cell surface and invades causing an inflammatory response (Leone, 2006). This bacterium is a gram negative bacterium. |
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Term
| The clinical signs and symptoms of gonorrhea in women. |
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Definition
Early: Dysuria, dyspareunia, leukorrhea, change in vaginal discharge, unilateral labial pain and swelling, lower abdominal discomfort, pharyngitis
Late symptoms: purulent, irritating vaginal discharge, fever, rectal pain and discharge, abnormal menstrual bleeding, dysmenorrhea, nausea, vomiting, lesions in genital area, labial pain, Joint pain and swelling, upper abdominal pain, pelvic pain. |
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Term
| The clinical signs and symptoms of gonorrhea in men. |
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Definition
Early: Dysuria with frequency, whitish discharge from penis, and Pharyngitis
Late:
Yellow or greenish discharge from penis, epididymitis, proctitis |
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Term
| Complications of untreated gonorrhea in women and in men |
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Definition
| Untreated gonorrhea can lead to serious problems such as sepsis, PID, ectopic pregnancy, and/or infertility in women and epididymitis. Women infected with gonorrhea infection have the risk of developing pelvic inflammatory disease (PID). PID occurs in 10 to 40 percent of infected women due to the absence of symptoms |
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Term
| Common sites of perinatal infant gonorrheal infection |
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Definition
| Gonorrhea can be passed from mother to child which may result in blindness, joint infection, or life threatening blood infection of the child. |
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Term
| How is gonorrhea diagnosed? |
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Definition
| The gold standard in both women and men for diagnosing Gonorrhea is the culture on Thayer-Martin agar. In men the culture can be obtained using a cotton swab on a plastic shaft inserting the swab 2 to 3 centimeters into the urethral meatus. The most sensitive and specific test for gonorrhea infection in women is nucleic acid amplification (DNA amplification). |
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Term
| Best treatment regimen the case of a patient with an uncomplicated gonococcal infection, and who has not been tested for chlamydia? |
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Definition
| The treatment recommended by the CDC for uncomplicated urogenital and anorectal infection in males and cervical, urethral, and anorectal infection in females is Ceftriaxone 125 mg intramuscularly (IM) once or Cefixime 400 mg orally once |
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Term
| Best way to handle a gonorrhea culture? |
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Definition
| The specimen must be inoculated immediately and transported rapidly to the laboratory for processing due to the difficult nature of the organism. |
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Term
| Gonorrhea treatment in pregnancy |
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Definition
| Pregnant women should not be treated with a tetracycline or quinolone. They should be treated with a recommended cephalosporin such as Rocephin. |
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Term
| At which stage of syphilis neurosyphilis can occur? |
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Definition
| At any stage of the disease. |
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Term
| What are the symptoms of primary syphilis? |
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Definition
| Primary syphilis is a chancre that is generally painless and resolves without treatment. |
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Term
| Signs of secondary syphilis include: |
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Definition
* Alopecia
* Condylomata lata
* Palmar/plantar rash
* Papulosquamous rash
* Mucocutaneous lesions |
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Term
| Treatment of syphilis in pregnancy. |
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Definition
| A woman diagnosed with secondary syphilis in her third trimester of pregnancy needs immediate treatment with penicillin and the baby will need treatment after birth. In pregnancy, the risk of transmission to the fetus is highest during primary and secondary which stages of syphilis. |
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Term
| Which of the following is true regarding the diagnosis of syphilis? |
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Definition
| A reactive RPR or VDRL is not sufficient for diagnosis of syphilis. A reactive nontreponemal test should be confirmed by a treponemal test. |
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Term
| The following may cause a false-positive serologic test for syphilis: |
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Definition
* Autoimmune disease
* Febrile illness
* Drug abuse |
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Term
| What is the treatment of choice for syphilis? |
|
Definition
Benzathine penicillin G
(Doses vary with primary (2.4 million units), tertiary (7.2 million units) and pregnancy (2.4 million units) |
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Term
| Syphilis: How does one know if the treatment is successful after the 6 month repeat RPR? |
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Definition
| The ratio should decrease by at least one fourth if treatment is working. |
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Term
| Which partners of a patient of syphilis should be treated and why? |
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Definition
| All partners at risk should be treated due to severe neurologic and cardiovascular disorders (Even if the partner has no symptoms). |
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Term
| Why is the number of hospitalized PID decreasing? |
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Definition
| Increase in outpatient treatment of PID and use of screening tools |
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Term
| PID is associated with ascending spread of microorganisms to the upper genital tract. The fate of these organisms depends on: |
|
Definition
| pathogenicity of organisms, host defense mechanisms, and viability of organisms |
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Term
| Risk factors associated with PID |
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Definition
| Adolescence, Douching, History of having an STD. Increased risk of PID related to douching because douching causes vaginal flora changes, epithelial damage and disruption of cervical mucous barrier |
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Term
TRUE OR FALSE:
PID is usually polymicrobial |
|
Definition
|
|
Term
| How does PID usually present? |
|
Definition
The most common clinical presentation of PID is no pain, and it is subclinical (although less frequently woman may be in severe pain and have a fever)
The most sensitive sign of upper genital tract infection is adnexal tenderness. |
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Term
| Potential sequelae of untreated PID includes |
|
Definition
| ectopic pregnancy, tubal infertility, chronic pelvic pain. PID is a preventable cause of infertility |
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Term
| The CDC recommends which women with PID to be admitted to the hospital? |
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Definition
| non-response to oral antimicrobial therapy within 48-72 hours, have a likely tubo-ovarian abscess, severe illness, current immunodeficiency, and any pregnant woman. |
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Term
| CDC recommends empiric treatment for PID if the patient has: |
|
Definition
| Uterine or adnexal tenderness or cervical motion tenderness |
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Term
| What are the parenteral and PO treatments recommended for PID? |
|
Definition
1)parenteral treatment of PID includes a cephalosporin plus Doxyclycine
2)oral treatment regimen for PID is Doxycycline 100 mg 2 times a day for 14 days |
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|
Term
| PID: Treatment of the partner |
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Definition
| Partners of women with PID should be examined and treated if they had sexual contact with the patient during the 60 days preceding onset of her symptoms. |
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|
Term
|
Definition
Chlamydia screening of all sexually active women ages 25 and under on an annual basis, screening and treating women with bacterial vaginosis prior to surgical abortion or hysterectomy, encouraging abstinence, monogamy with an uninfected partner, condom use, and limiting number of sex partners
Latex condoms can reduce the risk of transmission of gonorrhea and chlamydia. All sexually active patients should be instructed in proper condom use. |
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Term
|
Definition
| sexual activity with asymptomatic and subclinical person, contact with viable HPV or skin/mucous membranes that have endured microtrauma |
|
|
Term
| -HPV types that account for more than half of HPV types found in genital cancers |
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Definition
|
|
Term
| Do most women infected with high-risk HPV types develop cervical cancer? |
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Definition
| No, these women usually have normal Pap test results. |
|
|
Term
| Is high-risk HPV associated with genital warts? |
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Definition
|
|
Term
| Risk factor associated with development of cervical cancer precursors (high-grade cervical cell changes) and cervical cancer |
|
Definition
Age
High-risk HPV types
Persistence of HPV infection
Immunodeficiency |
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Term
| What happens if visible warts are left untreated- |
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Definition
| Untreated warts may remain unchanged, resolve on thier own, or increase in size and number. |
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Term
| Factor that should guide genital wart treatment? |
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Definition
| Treatment should be decided on three factors: 1) Available resources 2) The experience of the provider and 3) the patient's preference (CDC, 2004). |
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Term
| Describe physical presentations of genital warts |
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Definition
| Condylomata acuminata, smooth papules, flat papules, keratotic warts |
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|
Term
| Physical anatomical site manifestations of genital HPV infection (can include what sites?) |
|
Definition
| External genitalia such as the penis, vulva, scrotum, perineum, and perianal skin, uterine cervix, vagina, urethra, anus, and mouth. Other sites include conjuncival, nasal, oral, and larngeal. |
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Term
| Sensitivity and specificity, and cost effectiveness of Acetic acid evaluation of external genital warts, and therefore, is it of value or is it of limited value? |
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Definition
| This test is of limited value due to its low specificity (many false positives) (CDC, 2004). |
|
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Term
| Which HPV types usually cause cervical cancer? |
|
Definition
|
|
Term
| -Explain how the diagnosis of external genital warts is usually made |
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Definition
|
|
Term
| -The FDA has approved the HPV DNA test for use in what group of women, and for what purpose? |
|
Definition
| Triage of women with ASC-US Pap test results |
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|
Term
| Cervical cellular abnormalities are detected by which test? |
|
Definition
|
|
Term
| What is the goal of treatment for genital warts? |
|
Definition
| Removal of symptomatic warts |
|
|
Term
| -Patient-applied treatment(s) for external genital warts |
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Definition
|
|
Term
| Provider-administered treatment(s) for external genital warts: |
|
Definition
1. Cryotherapy with liquid nitrogen or cryoprobe
2. Trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80%-90%
3. Podophyllin resin 10%-25% in compound tincture of benzoin |
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Term
| External genital wart treatments that may be used in pregnancy: |
|
Definition
1. Surgical removal
2. Trichloroacetic acid (TCA) or biochloroacetic acid (BCA) 80%-90%
3. Cryotherapy |
|
|
Term
| -Features of HPV infection in immunodeficient patients- |
|
Definition
| Genital warts appear more frequently, are more resisitant to conventional therapy, and are more likely to have atypical lesions occur (CDC, 2004). |
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|
Term
| Patient counseling and education for HPV |
|
Definition
| Risk reduction, the nature of HPV infection, and transmission issues (CDC, 2004 |
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|
Term
| Partner management in genital warts: |
|
Definition
# Sex partner examination is not necessary for management of genital warts because no data indicate that reinfection plays a role in recurrences.
# Providing treatment solely for the purpose of preventing future transmission cannot be recommended because the value of treatment in reducing infectivity is not known.
# The counseling of sex partners provides an opportunity for these partners to learn about the implications of having a partner who has genital warts and about the potential for future disease transmission and receive STD and Pap screening if necessary. |
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|
Term
| Average incubation period of HSV? |
|
Definition
|
|
Term
| When does most transmission of HSV occur? |
|
Definition
| While the patient is asymptomatic. |
|
|
Term
| Do all people with HSV have symptoms? |
|
Definition
| Up to 90% of persons seropositive for HSV-2 antibody have no clinical history of anogenital herpes outbreaks |
|
|
Term
| Can HSV be transmitted if the patient is not symptomatic? |
|
Definition
| Most persons who are seropositive for HSV-2 but report no symptoms still shed virus from the genital area intermittently. |
|
|
Term
| When is HSV transmission highest? |
|
Definition
| Rates of asymptomatic shedding with HSV-2 are highest in early infection and decrease over time. |
|
|
Term
| How long does primary infection last? |
|
Definition
| Primary infection without treatment lasts 2-4 weeks |
|
|
Term
| Which is longer in duration, recurrent HSV infection or primary? |
|
Definition
| Recurrent infection without treatment has shorter duration than primary infection. |
|
|
Term
|
Definition
| Type-specific serology, Antigen detection, PCR assay |
|
|
Term
| HSV systemic antiviral therapy includes |
|
Definition
| Acyclovir, Valacyclovir, Famciclovir |
|
|
Term
| Episodic treatment of recurrent episodes of HSV |
|
Definition
* It can ameliorate or shorten the duration of lesions
* Patient should self-initiate the medication
* Successful treatment requires initiation of therapy within 1 day of lesion onset |
|
|
Term
| Patients with genital herpes should be informed that: |
|
Definition
* Sexual transmission of HSV can occur during asymptomatic periods.
* Stressful events may trigger recurrences.
* The frequency of outbreaks generally decreases with increasing duration of the infection. |
|
|
Term
| Patient education should include all of the following |
|
Definition
* HSV can be transmitted sexually during asymptomatic periods.
* The frequency of outbreaks generally decreases with increasing duration of infection.
* Sex partners of infected persons are could be infected, even if they do not have symptoms.
* Risks of neonatal infection should be explained to women and men. |
|
|
Term
| Patient education should include all of the following |
|
Definition
* HSV can be transmitted sexually during asymptomatic periods.
* The frequency of outbreaks generally decreases with increasing duration of infection.
* Sex partners of infected persons are could be infected, even if they do not have symptoms.
* Risks of neonatal infection should be explained to women and men. |
|
|
Term
| Patients with genital herpes should be advised to: |
|
Definition
* Abstain from sexual activity with uninfected partners when prodromal symptoms are present.
* Inform their obstetric providers of their HSV status, if they are women who are pregnant or of child-bearing age.
* Inform future sex partners that they have genital herpes before initiating a sexual relationship. |
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