Term
| What are some early signs of HIV infection? |
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Definition
| Hairy leukoplakia of the tongue, shingles in a healthy adult, lymphadenopathy |
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Term
| Sexually active adult from high-risk population, complains of petechial skin rashes of hands/soles, swollen, red, and tender joints in one large joint (migratory asymmetrical arthritis) such as the knee. Accompanied by signs of STD (cervicitis, urethritis, etc). Dx? |
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Definition
| Disseminated gonococcal dz (disseminated gonorrhea). |
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Term
| Pharyngitis present, severe sore throat w/ green purulent throat exudate that does not respond to usual antibiotics used for strep throat. What potential STD? |
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Definition
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Term
| Describe disseminated gonococcal dz (gonorrhea). |
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Definition
| Sexually active adult from high-risk population, complains of petechial skin rashes of hands/soles, swollen, red, and tender joints in one large joint (migratory asymmetrical arthritis) such as the knee. Accompanied by signs of STD (cervicitis, urethritis, etc). |
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Term
| Painless chancres in teh gnitals or mouth that resolve in 2 weeks. Dx? |
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Definition
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Term
| What organism causes syphilis? |
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Definition
| Treponema pallidum (spirochete). |
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Term
| STD screening recommendations as peer the CDC (age/gender)? |
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Definition
| All sexually active adolescents and females ages 20 to 24 years. |
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Term
| Obligate intracellular bacteria that infects squamous epithelial cells of the urinary/genital tracts. - does not infect pharynx and rectum. Dx? |
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Definition
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Term
| Most common bacterial STD in US? |
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Definition
|
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Term
| Majority of chlamydia trachomatis patients are obviously infected or asymptomatic? |
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Definition
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Term
| Possible chlamydia trachomatis infection sites manifest as what in women? |
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Definition
| urethritis, cervicitis, endometritis, salpingitis (falloopian tubes), PID |
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Term
| Possible chlamydia trachomatis infection sites manifest as what in men? |
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Definition
| Urethritis, epididymitis, prostatitis. |
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Term
| Describe chlamydia trachomatis infection. |
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Definition
| Obligate intracellular bacteria that infects squamous epithelial cells of the urinary/genital tracts. - does not infect pharynx and rectum. |
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Term
| What are 4 possible treatments for chlamydia trachomatis infection? |
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Definition
| 1) Azithromycin 1 g PO single dose, 2) doxycycline 100mg BID x 7 days, 3) cefixime (Suprax) 400mg x 1 dose, or 4) Cipro 500 mg or Floxin 400 mg x 1 dose. |
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Term
| When should a test for cure be done after tx for chlamydia trachomatis infections in nonpregnant patients? |
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Definition
| No test of cure is necessary for azithromycin or doxycycline. |
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Term
| How should chlamydia trachomatis be treated in pregnant women? |
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Definition
| Erythromycin base QID x 7 days. |
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Term
| When should pregnant patients being treated for chlamydia trachomatis be tested for cure? |
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Definition
| 3 weeks after completion of tx b/c tx is not as effective as azithromycin or doxycycline. |
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Term
| Describe neisseria gonorrhea (GC). |
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Definition
| A gram-negative bacterium that infects the urinary and genital tracts, rectum, and pharynx. Unlike chlamydia, GC can become systemic or disseminated if left untreated. |
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Term
| What dz has a high rate of coinfection for neisseria gonorrhea (GC)? |
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Definition
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Term
| If a patient is positive for neisseria gonorrhea (GC), how should their antibiotic therapy be focused? |
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Definition
| It should be focused on both gonorrhea and chlamydia. |
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Term
| What are some possible sites of infection of neisseria gonorrhea? |
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Definition
| Urethritis (dysuria, frequency), proctitis (rectal pain, tenesmus, purulent rectal discharge/stool), pharyngitis (severe sore throat unresponsive to typical antibiotics, purulent discharge on the posterior pharynx), cervicitis (mucopurulent cervical discharge, mild bleeding after intercourse), endometritis (heavy menstrual bleeding), salpingitis (fallopian tubes) and PID (pelvic or lower abdominal pain, adnexal pain, dyspareunia or painful intercourse), epididymitis and prostatitis. |
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Term
| Describe a classic case of neisseria gonorrhea (GC). |
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Definition
| Sexually active teen to young adult female c/o purulent vaginal discharge, pelvic pain, dyspareunia, and pain on jarring pelvis (i.e, heel drop test). Hx of new male partner (< 3 months) or multiple sex partners. Inconsistent condom use. |
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Term
| What are the bimanual exam findings in neisseria gonorrhea? |
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Definition
| Cervical motion tenderness (CMT), lower abdominal tenderness/one-sided adnexal pain. Mucopurulent cervical discharge (may pool in the posterior fornix of vagina. |
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Term
| What's the tx plan for uncomplicated neisseria gonorrhea (GC) (cervicitis, urethritis, pharyngitis)? |
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Definition
| 1) ceftriaxone 125 mg IM x 1 dose, plus co-treat for chlamydia. 2) Ciprofloxacin (Cipro) 400 mg po x one dose. 3) must cotreat for chlamydia. |
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Term
| What's the treatment plan for complicated neisseria gonorrhea (GC) (acute epididymitis, acute prostatitis, acute proctitis, PID)? |
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Definition
| 1) ceftriaxone (Rocephin) 250 mg IM x 1 dose, 2) must cotreat for chlamydia. |
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Term
| What complications make a neisseria gonorrhea (GC) infection "complicated"? |
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Definition
| Acute epididymitis, acute prostatitis, acute proctitis, PID. |
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Term
| What are 4 risk factors for PID? |
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Definition
| 1) IUD: the first few months after insertion, 2) hx of PID: 25% reoccurrence, 3) multiple partners, and 4) age 24 or younger). |
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Term
| What drug class reduces the risk fo PID d/t a thickened mucous plug? |
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Definition
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|
Term
| In female pts w/ suspected STIs, what must always be ruled out first? |
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Definition
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Term
| Sexual assault at any age requires mandatory what kind of cultures? |
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Definition
|
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Term
| What is the most common lab for detecting chlamydial infections in the outpatient environment? |
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Definition
|
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Term
| What is a chocolate agar? |
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Definition
| non-selective, enriched growth medium & contains lysed RBCs. |
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Term
| What is the "Thayer-Martin" in the context of STD testing? |
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Definition
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Term
| What is the Thayer-Martin chocolate agar used to detect in the context of STI testing? |
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Definition
|
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Term
| Gram staining is useful in chlamydial or gonorrheal detection? |
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Definition
|
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Term
| What is Fitz-Hugh-Curtis syndrome? |
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Definition
| Chlamydial and/or gonococcal infection of the liver capsule (not the liver itself [perihepatitis]) resulting in extensive scarring between the liver capsule and abdominal contents (i.e., colon). |
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Term
| What syndrome causes "violin strings" scarring seen on laparoscopy? |
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Definition
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|
Term
| Sexually active female with symptoms of PID complains of RUQ abdominal pain and tenderness on palpation. LFTs are normal. Pt also appears to have chlamydia/gonorrhea/PID. Dx? |
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Definition
| Fitz-Hugh-Curtis Syndrome. |
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Term
| Describe Jarisch-Herxheimer reaction. |
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Definition
| The sudden massive destruction of spirochetes after a pcn G injection - causes an immune-mediated reaction that usually resolves spontaneously. |
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Term
| What is the tx for Jarisch-Herxheimer reaction? |
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Definition
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Term
| Adult patient c/o severe chills, fever, myalgia, and tachycardia after being treated for syphilis. BP was high, but then fell. Dx? |
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Definition
| Jarisch-Herxheimer reaction. |
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Term
| Describe Reiter Syndrome. |
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Definition
| An immune-mediated reaction secondary to infection with certain bacteria (i.e., chlamydia) that spontaneously resolves. More common in males. Tx is supportive (i.e., NSAIDs). |
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Term
| A male w/ current hx of chlamydia genital infection (i.e., urethritis) c/o dry red and swollen joints that come and go (migratory arthritis in large joints such as the knee) and ulcers on the skin of the glans penis. Dx? |
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Definition
|
|
Term
| What's the mnemonic for remembering Reiter syndrome? |
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Definition
| Can't see, pee, or climb up a tree. |
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|
Term
| T/F Chlamydia is a hard organism to culture or test for. |
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Definition
|
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Term
|
Definition
| Treponema pallidum (spirochete) infection. Becomes systemic if untreated. |
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|
Term
| Painless chancre (heals in 6 to 9 weeks if not tx'd). Dx? |
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Definition
| Syphilis - primary stage. |
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|
Term
|
Definition
| Infectious white papules in moist areas that look like white warts. |
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|
Term
| Pt presents w/ condyloma lata and maculopapular rash on palms and soles that is not pruritic. Dx? |
|
Definition
| Syphilis - secondary stage (> 2 years) |
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Term
| Describe the s/s of syphilis' latent stage. |
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Definition
|
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Term
| Describe the s/s of syphilis' tertiary stage. |
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Definition
| 3-10 years, Neurosyphilis, gumma (soft tissue tumors), aneurysms, valvular damage, and so forth. |
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Term
| What are the two screening tests for syphilis? |
|
Definition
|
|
Term
| What is the diagnostic test for syphilis? |
|
Definition
| Darkfield exam, FTA-ABS (fluorescent antibody absorption antibody test). |
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|
Term
| What labs are used to monitor tx response in syphilis? |
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Definition
|
|
Term
| What are two drugs used for syphilis tx? |
|
Definition
| Procaine penicillin G IM (dose depends on stage), Doxycycline BID x 28 days (primary and secondary stages only). |
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Term
| What amount of RPR/VDRL drop best indicates successful tx of syphilis? |
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Definition
| A four-fold decrease in the pre adn posttreatment titers. |
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Term
| Lay term for Condyloma acuminata. |
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Definition
|
|
Term
| What's the most common criterion clinicians use to dx PID? |
|
Definition
| Cervical motion tenderness (CMT). |
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|
Term
| What's the standard screening test for HIV infection? |
|
Definition
| ELISA test (enzyme-linked immunosorbent assay). |
|
|
Term
|
Definition
| antibodies, not viral RNA |
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|
Term
| ELISA has a sensitivity/specificity > 99% for HIV screen. What does this indicate? |
|
Definition
| too sensitive, with higher rates of false positives). |
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|
Term
| If ELISA is positive twice, what will most labs automatically check? |
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Definition
|
|
Term
| What is the confirmatory test for HIV? |
|
Definition
|
|
Term
|
Definition
| Polymerase chain reaction. Diagnostic test for HIV infection. Detects viral RNA (actual viral presence). |
|
|
Term
|
Definition
| Number of RNA copies in 1 mL plasma. Test measures actively replicating HIV virus; progression of dz and response to antiretroviral tx. |
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|
Term
| Describe the P24 antigen test. |
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Definition
| Indicates active HIV replication. |
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|
Term
| Receiving blood products between what years is high risk for HIV infection? |
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Definition
|
|
Term
| What vaccines are indicated in the HIV+ patient? |
|
Definition
| Annual flu shot, Hep B x 3, Hep A, Td every 10 years. |
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|
Term
| If the CD4 lymphocyte count is < 200 cells/mcL, prophylaxis will be needed for what dz? |
|
Definition
| Pneumocystis carinii pneumonia. |
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|
Term
| What are Pneumocystis carinii pneumonia (PCP) treatment drugs? |
|
Definition
| TMP-SMX (Bactrim) 1st, dapson or pentamidine (pent if allergic to sulfas) by nebulizer. |
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Term
| HIV education includes pts not handling cat litter to prevent what infection? |
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Definition
|
|
Term
| HIV education includes pts not handling bird stool to prevent transmission of what spores? |
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Definition
|
|
Term
| Turtles and amphibians may be infected with what bacteria? |
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Definition
|
|
Term
| HIV education includes what about eating meat? |
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Definition
| Do not eat undercooked meat. |
|
|
Term
| HIV education includes what about partners? |
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Definition
| Get tested, use safe sex practices. |
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|
Term
| HIV infected pregnant women should start what drug in what trimester? |
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Definition
|
|
Term
| If an HIV+ pregnant female does not seek tx, what's the likelihood of vertical transmission? |
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Definition
|
|
Term
| What's the breastfeeding transmission rate of HIV? |
|
Definition
|
|
Term
| What drug should be started in newborns born to HIV+ mothers & in what timeframe? |
|
Definition
| zidovudine (AZT) within 1st 48 hours. |
|
|
Term
| How much does zidovudine (AZT) reduce perinatal transmission of HIV? |
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Definition
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