Term
| What percent of their lives do Americans now spend as singles? |
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Definition
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Term
| 26% of girls in what age group have at least one STD? |
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Definition
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Term
| With only one lifetime sexual sexual partner, what percent of people have an STD? |
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Definition
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|
Term
| With 3 or more sexual partners, what percent of people have STD's? |
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Definition
|
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Term
| What percentage of teenage women are infected with at least one of the STD's? |
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Definition
| 3.2 million teenage women |
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Term
| What percent of all syphilis cases appear to be transmitted by oral sex? |
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Definition
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Term
| What percent of orally transmitted syphilis is transmitted among MSM? |
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Definition
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Term
Of the following genital ulcers, which are painful and which are painless?
Chancroid, Genital herpes simplex, and Syphilis |
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Definition
| Painful: Chancroid, Genital herpes simples. Painless: Syphilis |
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Term
| What effort was started by the CDC in 1999? |
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Definition
| National syphilis elimination effort started by CDC in 1999 |
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Term
| How did the rates of syphilis change in 2000? |
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Definition
| Syphilis cases decreased for 10 straight years then increased beginning in 2000. |
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Term
| The ongoing national increase in syphilis is primarily in which population? |
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Definition
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Term
| Syphilis case increased from 7,177 in 2003 to 7,980 in 2004 and a 14% increase from 2004 and 2006. 64% of cases where in which population? |
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Definition
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Term
| Virginia is ranked 21 for syphilis cases in the 50 states. What percentage of syphilis in VA is in the eastern region? |
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Definition
|
|
Term
| What percent increase in the first quarter of 2007 over 2006? |
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Definition
|
|
Term
| What is the late appearance of a syphilitic chancre? |
|
Definition
| clean based, painless, indurated ulcer with smooth firm borders |
|
|
Term
| In what percent of pts is a syphilitic chancre unnoticed? |
|
Definition
| 15-30% (especially vaginal and rectal lesions) |
|
|
Term
| How does the syphilitic chancre progress untreated? |
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Definition
| Resolves in 1-5 weeks w/o tx |
|
|
Term
| What percent of pts exposed to primary or secondary syphilis become infected? |
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Definition
| HIGHLY INFECTIOUS: 50-70% exposed to primary or secondary syphilis become infected |
|
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Term
| How valuable is a darkfield exam for evaluating genital ulcers? |
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Definition
| Darkfield is quick and accurate, but not often available |
|
|
Term
| How sensitive is the serologic test for syphilis? |
|
Definition
| 30% negative at presentation |
|
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Term
| For what STD is a culture/Ag test used? |
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Definition
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Term
| What organism should be cultured in settings where chancroid is prevalent? |
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Definition
|
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Term
| What represents a hematogenous dissemination of spirochetes? |
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Definition
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Term
| How long after the chancre appears does secondary syphilis present? |
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Definition
| 2-8 weeks after the chancre appears |
|
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Term
| What are the clinical findings of secondary syphilis? |
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Definition
| Rash-whole body (includes palms/soles), hyperkeratosis is typical, patchy alopecia, loss of eyebrows. Mucous patches. Condyomata lata- HIGHLY INFECTIOUS. Constitutional symptoms. |
|
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Term
| In how long do s/s resolve in secondary syphilis without tx? |
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Definition
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Term
| What serologic test for syphilis is non-treponemal, with screening and monitoring response to therapy, and is titered? |
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Definition
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Term
| What serologic tests for syphilis is treponemal confirmatory, with no titer? |
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Definition
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Term
| What percent of pts with primary, secondary, and late syphilis have a true positive with VDR? |
|
Definition
| Primary: 70%. Secondary: 99%. Late: 1% |
|
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Term
| What percent of primary, secondary, and late syphilis cases show true positives with RPR? |
|
Definition
| Primary: 80%. Secondary: 99%. Late: 0% |
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Term
| What percent of primary, secondary, and late syphilis cases show true positives with FTA-ABS? |
|
Definition
| Primary: 85%. Secondary: 100%. Late: 98%. |
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Term
| What percent of primary, secondary, and late syphilis cases show true positives with MHA-TP? |
|
Definition
| Primary: 65%. Secondary: 100%. Late: 95% |
|
|
Term
| What is the recommended regimen for syphilis? |
|
Definition
| Benzathine Penicillin G, 2.4 million units IM once |
|
|
Term
| Which product is preferable for tx of syphilis: Bicillin L-A or Bicillin C-R? |
|
Definition
| Make sure product is Bicillin L-A NOT Bicillin C-R, a mix of procaine and benzathine |
|
|
Term
| When is doxycycline, ceftriaxone, and azythromycin indicated for syphilis? |
|
Definition
| Penicilin Allergy *Use in HIV-infection has not been studied |
|
|
Term
| What is a Jarisch-Herxheimer Rxn and when does it occur? |
|
Definition
| Systemic rxn occuring 1-2 hrs after tx: Abrupt onset of fever, chills, myalgias, HA, flushing, hyperventilation, and mild hypotension |
|
|
Term
| In what percentage of secondary syphilis pts will a Jarisch-Herxheimer rxn occur? |
|
Definition
| May occur in 70-90% of persons with secondary syphilis but 10-25% with any stage |
|
|
Term
| How is response to primary/secondary syphilis tx monitored? |
|
Definition
| Re-examine clinically and serologically (RPR) at 6 and 12 mos (15% will not decrease titer 2-fold after 1 yr) |
|
|
Term
| When should *tx failure* be considered with primary/secondary syphilis? |
|
Definition
| if s/s persist or sustained *4-fold increase* in nontreponemal test (RPR) |
|
|
Term
| What should be done in tx failure to primary/secondary syphilis? |
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Definition
| Tx failure: HIV test, CSF analysis; administer benzathine pcn weekly x 3 wks |
|
|
Term
| When is syphilis designated *early latent*? |
|
Definition
| documented infection w/in 1 yr |
|
|
Term
| When is syphilis designated *late latent*? |
|
Definition
| seropositive w/o other evience of disease |
|
|
Term
| How is latent syphilis designated tertiary? |
|
Definition
| clinical evaluation for tertiary disease (aoritis, gumma, iritis) |
|
|
Term
| When is CSF *analysis* for syphilis indicated? |
|
Definition
| if neurologic or opthalmic s/s, active tertiary disease, therapeutic failure, HIV infection |
|
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Term
| What do some experts recommend in pts with nontreponemal titer of equal or greater than 1:32? |
|
Definition
|
|
Term
| What is the recommended regimen for latent syphilis? |
|
Definition
| Benzathine penicillin G 2.4 million units IM at one week intervals x 3 doses |
|
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Term
| Pharmacologic considerations suggest an interval of how many days between benzathine pen doses may be acceptable for those who miss a dose before restarting tx course in non-pregnant pts? |
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Definition
|
|
Term
| How should latent syphilis be tx in pts with penicillin allergies? |
|
Definition
| doxycycline 100 mg po bid; tetracycline 500 mg po qid |
|
|
Term
| What is the duration of doxycycline and tetracycline therapy for latent syphilis? |
|
Definition
| duration of therapy 28 days; close clinical and serologic follow-up; data to support alternatives to penicillin are limited |
|
|
Term
| Regarding latent syphilis and HIV, When is CSF exam before tx indicated? |
|
Definition
|
|
Term
| What percent of pts with genital herpes do not know they are infected? |
|
Definition
|
|
Term
| Are most herpes cases clinical or subclinical? |
|
Definition
|
|
Term
| From what type of infection is genital herpes primarily transmitted? |
|
Definition
|
|
Term
| What are complications of genital herpes? |
|
Definition
| neonatal transmission, enhanced HIV transmission, psychosocial issues |
|
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Term
| What is the progression of genital herpes simplex? |
|
Definition
| vesicles to painful ulcerations to crusting |
|
|
Term
| What percent of genital herpes pts have viral shedding w/o symptoms? |
|
Definition
|
|
Term
| What percent of genital herpes pts have a history of prior symptoms? |
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Definition
|
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Term
| HSV Serologic Tests: Type-Specific. What tests are now available for HSV-specific type one and type 2? |
|
Definition
| *glycoprotein G2* and *glycoprotein G1* |
|
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Term
| What are the tx options for the 1st clinical episode of genital herpes and for 6 or more recurrences per year? |
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Definition
| acyclovir 400 mg tid; gamciclyovir 250 mg tid; valacyclovir 500-1000mg bid. Duration of therapy: 7-10 days. If 6 or more recurerences per year, daily suppression. |
|
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Term
| What is the risk of transmission to the neonate among women who acquire HSV near delivery? |
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Definition
|
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Term
| How should genital herpes pts be educated about the illness? |
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Definition
| natural hx of infection, recurrences, asymptomatic shedding, transmission risk |
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|
Term
| How should genital herpes pts be educated about therapy? |
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Definition
| Individualize use of episodic or suppressive therapy (6 or more recurrences/yr) |
|
|
Term
| How should genital herpes pts be educated about sex? |
|
Definition
| Abstain from sexual activity when lesions or prodromal symptoms present |
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Term
| How should genital herpes pts be educated about pregnancy? |
|
Definition
| risk of neonatal infection |
|
|
Term
| The proportion of gonococcal infections caused by what organisms is increasing? |
|
Definition
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|
Term
| What class of antibiotics is no longer recommended as tx for MSM with gonorrhea? |
|
Definition
|
|
Term
| What is the greatest disparity of all STD's? |
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Definition
| gonorrhea, VA: black male is 39x and a black female 17x more likely than a white to be dx with gonorrhea |
|
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Term
| What % of cases of gonorrhea in VA are in the eastern region? |
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Definition
|
|
Term
| What are the sx of gonorrhea urethritis in a male? |
|
Definition
| dysuria and urethral discharge (5% asymptomatic) |
|
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Term
| How is gonorrheal urethritis dx in a male? |
|
Definition
| gram stain urethral smear (+) in >98% of those with a (+) culture |
|
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Term
| What % of males with gonorrheal urethritis are coninfecte with c. trachomatis? |
|
Definition
|
|
Term
| What is the primary site for urogenital infection of gonorrhea in females? |
|
Definition
| endocervical canal primary site. 70-90% also colonize urethra |
|
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Term
| What are the sx of gonorrheal urogenital infections in females? |
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Definition
| majority *asymptomatic*; may have vaginal discharge, dysuria, pain on urination, (labial pain/swelling, abdominal pain) |
|
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Term
| As of 2007, when are FQ recommended for GC? |
|
Definition
| FQ no longer recommended for any GC |
|
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Term
| What are tx options for Gonorrhea of the cervix, urethra, and rectum? |
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Definition
| cefixime 400 mg (available as tablet or suspension) or Ceftriaxone 125 IM *PLUS Chlamydial therapy if infection not ruled out* |
|
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Term
| Spectinomycin 2 grams IM in a single dose or single dose cephalosporin (cefotaxime 500 mg IM) or Azythromycin 2 gm single dose are *alternative regimens* for what disease? |
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Definition
| Gonorrhea: cervix, urethra, rectum *(PLUS Chlamydial therapy (azithro 1 gm or doxy 100 mg bid x 7 days) if infection not ruled out)* |
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Term
| How should ceftriaxone 125 IM in a single dose be given to tx gonorrhea of the pharynx? |
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Definition
| *PLUS Chlamydial therapy if infection not ruled out* |
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Term
| Pustular skin lesions on the hands or feet, tenoxynovitis, and acute infections arthritis (most common cause in sexually active adults) are signs of what disease? |
|
Definition
|
|
Term
| How should disseminated gonorrhea be tx? |
|
Definition
| Ceftriaxone 1 gm IV x 7 days |
|
|
Term
| Cefotaxime or Ceftizoxime 1 gm IV q8 hr or Ciprofloxacin 400 mg IV q 12 for 7 days are alternative regimens for what disease? |
|
Definition
| disseminated gonococcal infection |
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Term
| Pts who have been dx with gonorrhoea should refer all sex partners in what time period for evaluation and tx of what? |
|
Definition
| preceeding 60 days for eval and tx of gonorrhoea *and* C. trachomatis |
|
|
Term
| How long should pts with gonorrhoea avoid sex? |
|
Definition
| until tx is completed for themselves and sex partner and symptoms have resolved |
|
|
Term
| What percentage of nongonococcal urethritis is C. trachomatis? |
|
Definition
|
|
Term
| What percentage of nongonococcal urethritis are genital mycomplasms (Ureaplasma urealyticum, Mycoplasma genitalium) |
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Definition
|
|
Term
| What organisms occasionaly cause nongonococcal urethritis? |
|
Definition
| Trichomonas vaginalis, HSV |
|
|
Term
| What are the Sx of nongonococcal urethritis? |
|
Definition
| mild dysuria, mucoid discharge |
|
|
Term
| How is nongonococcal urethritis dx? |
|
Definition
| Urethral smear over or equal to 5 PMNs (usually more than 15/OI field). Urine microscopic over or equal to 10 PMNs/HPF. Leukocyte esterase (+). |
|
|
Term
| How should nongonococal urethritis (NGU) be tx? |
|
Definition
| Azithromycin 1 gm in single dose or Doxycycline 100 mg bid for 7 days |
|
|
Term
| For recurrent or persistent urethritis, metronidazole should be given in 2gm single dose *PLUS* what 2 meds? |
|
Definition
| erythromycin base 500 mg qid x 7d or erythromycin ethylsuccinate 800 mg qid x 7d |
|
|
Term
| What is the most frequently reported STD in US? |
|
Definition
|
|
Term
| Is chlamydia more prevalent in males or females? |
|
Definition
| rates 4x higher in females |
|
|
Term
| What is the prevalence of coinfection in partners with chlamydia? |
|
Definition
|
|
Term
| What has been the standard lab test for chlamydia? |
|
Definition
|
|
Term
| How can nucleic acid hybridization (NA Probe) detect gonorrhea and chlamydia? |
|
Definition
| able to detect gonorrhea and chlamydia from one swab |
|
|
Term
| PCR and LCR are examples of what type of lab tests for chlamydia? |
|
Definition
| *DNA amplification assays* |
|
|
Term
| For what populations is an annual screening recommended for chlamydia trachomatis? |
|
Definition
| annual screening of sexually active less than or equal to 25 yrs. annual screening of sexually active women over 25 yrs with risk factors (new or multiple sex partners). Sexual risk assessment may indicate more frequent screening for some women. Rescreen women 3-4 mos after x due to high prevalence of repeat infection |
|
|
Term
| How should chlamydia trachomatis be tx? |
|
Definition
| Azithromycin 1 gm single dose or doxycycline 100 mg bid x 7d |
|
|
Term
| What percent of women with GC develop PID? |
|
Definition
|
|
Term
| In Europe and North America, what is the correlation between C. trachomatis, N. Gonorrhoeae, and PID symptoms? |
|
Definition
| Higher proportion of C. tracchomatis than N. gonorrhoeae in women with symptoms of PID |
|
|
Term
| What are the CDC minimal criteria for PID? |
|
Definition
| uterine adnexal tenderness, cervical motion tenderness. other sx inlcude: endocervical discharge, fever, lower abdominal pain |
|
|
Term
| What are complications of PID? |
|
Definition
| infertility: 15-24% with 1 episode PID secondary to GC or chlamydia. 7x risk of ectopic pregnancy with 1 episode of PID. Chronic pelvic pain in 18%. |
|
|
Term
| PID can be tx orally with Ofloxacin or Levofloxacin WITH OR WITHOUT what? |
|
Definition
|
|
Term
| PID can be tx orally with Ceftriaxone or Cefoxitin PLUS what medication WITH OR WITHOUT what medication? |
|
Definition
| PLUS Doxycycline WITH OR WITHOUT Metronidazole |
|
|
Term
| PID can be tx parenterally with Ofloxacin or Levofloxacin WITH OR WITHOUT what meds PLUS what med? |
|
Definition
| WITH OR WITHOUT Metronidazole or Ampicillin/Sulbactam PLUS Doxycyline |
|
|
Term
| Regarding PID, sex partners should be tx how with regimens effective against what organisms? |
|
Definition
| Sex partners should be tx empirically with reimens effective against both C. trachomatis and GC |
|
|
Term
| Regarding epididymitis, if less than 35, infection likely due to what? |
|
Definition
|
|
Term
| Regarding epididymitis, if age > 35, infection likely due to |
|
Definition
| enteric organimsm (E. coli) |
|
|
Term
| What organism causes Trichomoniasis? |
|
Definition
| Trichomonas vaginalis, an anaeroic flagellated protozoa |
|
|
Term
| What is the regimen for trichomoniasis? |
|
Definition
|
|
Term
| What are 3 types of warts caused by papillomavirus? |
|
Definition
| vaginal warts, urethral meatal warts, anal warts |
|
|
Term
| How should pts be reassured when taking a sexual history |
|
Definition
Let your pt know that a sexual history is a routine part of every adult history regardless of age, sex, gender or marital status.
Assure will be kept in strict confidence. |
|
|
Term
|
Definition
| Partners: No., gender (never make assumptions) and partner risk factors. Practices: oral, vaginal, anal. Protection from STDs: condoms. Past history of STDs: Include testing and partners. Prevention of pregnancy. |
|
|
Term
| Despite adolexcents greater risk of STDs, providers often fail to do what? |
|
Definition
| Inquire about sexual behavior, assess risk, counsel about risk reduction, screen for asymptomatic infection |
|
|
Term
| How did abstinence only education differ from control groups? |
|
Definition
|
|
Term
| Consistent/correct use of latex condoms reduce HIV risk by what percent? |
|
Definition
|
|
Term
| On what surfaces are male condoms most likely to prevent infection transmission? |
|
Definition
| Mucosal (gonorrhea, chlamydia, trichomonas, HIV) more than skin-skin (HSV, HPV< syphilis, chancroid) |
|
|
Term
| What is the difference in HIV transmission with consistent versus inconsistent condom use? |
|
Definition
| HIV transmission with consistent condom use: 1.1 per 100 person-yrs. HIV transmission with inconsistent condom use: 9.7 per 100 person-yrs. |
|
|
Term
| Vaginal spermicides, vaginal contraceptive sponges, and a diaphragm all reduce risk of what? |
|
Definition
| All reduce riks for cervical gonorrhea and chlamydia. HIV and other pathogens may infect the vagina or vulva; there is no data on ability to protect from these infections. |
|
|
Term
| Noxonyl 9 vaginal spermicides are NOT effective in preventing what infections? |
|
Definition
|
|
Term
| Spermicides alone are NOT recommended for what? |
|
Definition
|
|
Term
| By what percentage is HIV transmission reduced by adult circumcision with no behavioral risk compensation? |
|
Definition
|
|
Term
| How does circumcision affect *HPV*, *HSV-2*, and syphilis? |
|
Definition
| *HPV* reduced by 35%, *HSV-2* reduced by 25%, but no effect on syphilis |
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