Patho Ch 41 STI
A 22-year-old client has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this diagnostic test may imply infection with: A. Human papillomavirus (HPV) B. Chlamydia trachomatis C. Candida albicans D. Trichomonas vaginalis
A Although a Pap smear does not test directly for HPV, dysplasia of cervical cells is strongly associated with HPV infection. An abnormal Pap smear is not indicative of chlamydial infection, trichomoniasis, or candidiasis.
A female college student is distressed at the recent appearance of genital warts, an assessment finding that her care provider has confirmed as attributable to human papillomavirus (HPV) infection. Which of the following information should the care provider give the client? A. "There is a chance that these will clear up on their own without any treatment." B. "It's important to start treatment soon, so I will prescribe you pills today." C. "Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory disease." D. "I'd like to give you an HPV vaccination if that's okay with you."
A Genital warts may resolve spontaneously, although this does not preclude recurrence. Many individuals will clear the virus and become negative within 1 to 2 years; it is unclear if development of an effective immune response completely clears the infection. Pharmacologic treatments are topical, and vaccination is ineffective after infection has occurred. HPV infection is not correlated with pelvic inflammatory disease (PID).
Men whose sexual partners have been diagnosed with Trichomonas vaginalis will likely exhibit: A. No symptoms of infection B. Copious amounts of frothy discharge from the penis C. Numerous pustules on the penal shaft D. Redness and pain at the urethral meatus
A Men harbor the Trichomonas vaginalis in the urethra and prostate and are largely asymptomatic. Chlamydia, gonorrhea, and syphilis cause active infection and symptoms in both men and women.
The primary reason genital herpes has reached epidemic proportions throughout the world relates to the fact that: A. A large percentage (70%) of those infected experience no symptoms of the disease. B. The lesions (LSILs) occur on the cervix and can only be detected by a Pap test. C. Lesions take a long time to incubate and the small papules are usually located inside the vagina. D. The organism spreads upward to the prostate gland in males and fallopian tubes in females.
A Persons infected with HSV-1 remain at risk for acquiring HSV-2. Most cases of HSV-2 infection are subclinical, manifesting as asymptomatic or symptomatic but unrecognized infections. These subclinical infections can occur in people who have never had a symptomatic outbreak or they can occur between recognized clinical recurrences. Up to 70% of genital herpes is spread through asymptomatic shedding by people who do not realize they have the infection. Transient HPV infections can develop low-grade squamous intraepithelial lesions (LSILs) of the cervix as detected on a Pap test, colposcopy, or biopsy. Lesions of LGV can incubate for a few days to several weeks and thereafter cause small, painless papules or vesicles that may go undetected. If untreated, gonorrhea spreads from its initial sites upward into the genital tract. In males, it spreads to the prostate and epididymis; in females, it commonly moves to the fallopian tubes.
An elderly female has slowly developed dementia and loss of vision. She is being evaluated for nursing home placement. Routine admission blood work reveals that the client tested positive for which STI associated with her current symptoms? A. Tertiary syphilis B. Chlamydial C. Gonorrhea D. Human papillomavirus infection
A Tertiary syphilis is a delayed response of the untreated disease. The symptomatic tertiary stage frequently affects the cardiovascular system, central nervous system, liver, bones, and testes. In women, chlamydial infections may cause urinary frequency, dysuria, and vaginal discharge. In women, gonorrhea has recognizable symptoms, which include unusual genital or urinary discharge, dysuria, dyspareunia, pelvic pain or tenderness, unusual vaginal bleeding (including bleeding after intercourse), and fever. HPV infection is associated with genital warts that typically present as soft, raised, fleshy lesions on the external genitalia, including the penis, vulva, scrotum, perineum, and perianal skin. External warts may appear as small bumps, or they may be flat, rough surfaced, or pedunculated.
A female client presents an STD clinic. She is in the first trimester of pregnancy and has tested positive for gonorrhea. Because strains of N. gonorrhoeae have become resistant to penicillin, the current treatment recommendation includes: A. High-dose cefixime given in a single dose B. Ten-day supply of Flagyl C. Doxycycline over the course of 1 week D. No treatment until after the baby is born
A The current treatment recommendation to combat penicillin- and tetracycline-resistant strains of gonorrhea is ceftriaxone or cefixime in a single injection. While a single injection of cefixime is still the standard treatment, some strains of N. gonorrhoeae have begun to show resistance to this dose. Metronidazole (Flagyl) is one treatment of choice against anaerobic protozoans, which can cure Trichomonas vaginalis. The treatment of choice for syphilis is penicillin. Tetracycline or doxycycline is used for treatment in persons who are sensitive to penicillin, but these medications cannot be used in pregnancy. Obviously, the client will receive treatment. However, at time of delivery, the infant will be tested and treated as necessary.
A client presents to a STI clinic. Her primary complaint is related to purulent exudate and bleeding after intercourse. The health care worker will primarily focus on the diagnosis of which STI? A. Gonorrhea B. Chlamydial infection C. Human papillomavirus infection D. Genital herpes simplex virus infection
A The gonococcus is a pyogenic (i.e., pus-forming), gram-negative diplococcus that evokes inflammatory reactions characterized by purulent exudates. Internal human papillomavirus (HPV) condylomata acuminata warts are cauliflower-shaped lesions that affect the mucous membranes of the vagina, urethra, anus, or mouth. The initial symptoms of primary genital herpes (herpes simplex virus, HSV) infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles.
A couple presents to an infertility clinic. The health care provider will focus testing on which of the following sexually transmitted infections (STIs) that is very damaging to the reproductive system but rarely exhibits symptoms of infection? A. Chlamydial infection B. Herpes simplex virus infection C. Gonorrhea D. Syphilis
A Women with chlamydial infection may be asymptomatic and may unknowingly experience damage to the reproductive system. A large number of cases go unreported because most people with chlamydial infection are asymptomatic and do not seek testing. Herpes simplex virus (HSV), syphilis, and gonorrhea consistently produce symptoms in infected women.
A male diagnosed with gonorrhea will likely complain of which of the following clinical manifestations? Select all that apply. A. Creamy, yellow discharge B. Pain in the urethra with urination C. Difficulty starting a stream of urine D. "Fish"-smelling discharge from the penis E. Diffuse pelvic pain
A, B In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody, discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted, and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress to pustules, and then rupture.
A woman who has developed vulvovaginal candidiasis will likely go to her health care provider complaining of: Select all that apply. A. Redness B. Edema C. Frothy, foul-smelling discharge D. Painful urination E. Pustules on labia
A, B, D Women with vulvovaginal candidiasis commonly complain of vulvovaginal pruritus accompanied by irritation, erythema, swelling, dysuria, and dyspareunia. The characteristic discharge, when present, is usually thick, white, and odorless. Trichomoniasis manifestations include presentation with copious, frothy, malodorous green or yellow discharge.
A female receives a PAP smear result indicating she has human papillomavirus (HPV) infection. As part of her education, the nurse will emphasize the need for continued follow-up since HPV is directly associated with: A. Uterine cancer B. Cervical dysplasia C. Genital herpes lesions D. Urinary tract infections
B A relation between HPV and genital neoplasms has become increasingly apparent since the mid-1970s. HPV infection can be detected in cervical Papanicolaou (Pap) smears, with the first neoplastic changes noted on the Pap smear termed dysplasia. Testicular cancer is not associated with HPV. Although genital herpes (HSV) is also a sexually transmitted disease, it is a common cause of genital ulcers rather than cancer. Bacteria are the usual cause of urinary tract infections, rather than anogenital warts.
When educating a teenager diagnosed with genital herpes (herpes simplex virus type 2, HSV-2), the health care provider needs to inform her of the importance of careful follow-up since she may be at greater risk for future development of: A. Cervical cancer B. HIV transmission C. Localized necrosis D. Urinary tract infection
B As with other ulcerative STIs, genital herpes (HSV-2) increases the risk of HIV transmission and is believed to play an important role in the heterosexual spread of HIV. There is no known cure for genital herpes, and the methods of treatment are largely symptomatic. Human papillomavirus (HPV), rather than HSV, is considered a cause of cervical cancer. Although HSV can reoccur, the lesions resolve and heal completely without tissue necrosis or scarring. Urinary tract infections are associated with bacterial vaginosis/vaginitis STIs.
The most prevalent vaginal infection to be spread through sexual contact is: A. Candidiasis B. Trichomoniasis C. Vulvovaginitis D. Bacterial vaginosis
B Candidiasis is a yeast infection with a white cheesy discharge that causes vulvovaginitis. Bacterial vaginosis is a nonspecific type of infection that produces a characteristic fishy-smelling discharge, the result of an imbalance of the normal vaginal flora. These infections are not normally spread by sexual contact. Trichomoniasis is usually spread through sexual contact.
During infertility workup, the client is diagnosed with chlamydial infection. The health care provider will especially be looking for which complication of chlamydial infections that can interfere with egg transportation? A. Uterine cancer B. Fallopian tube damage C. Amenorrhea D. Vaginal adhesions
B Chlamydia causes a wide variety of genitourinary infections; Chlamydia trachomatis infection is the most common reportable sexually transmitted infection (STI) in the United States. In women, untreated infection can lead to severe reproductive complications, including infertility, pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain, and in men, it can cause prostatitis and epididymitis with subsequent infertility. Chlamydial infections are not associated with any reproductive cancers or amenorrhea.
Which of the following assessment questions is most likely to address the causation of a woman's new case of candidiasis? A. "Have you recently begun a new sexual relationship?" B. "Have you been on antibiotics recently?" C. "Have you noticed any new growths on your vagina in recent months?" D. "Do you use condoms during sexual activity?"
B Recent antibiotic therapy frequently underlies causes of candidiasis. The disease is not normally transmitted by sexual contact, and tissue growth is not an associated sign.
A client with herpes simplex virus (HSV) presents to the clinic stating, "I can stop taking my drugs because I'm cured. My lesions are gone." The health care provider bases his or her response knowing the pathophysiology behind the disappearance of HSV symptoms infection relates to: A. Replication of the squamous epithelium B. Periods of latency in the nervous system C. Inhibition of cell-mediated immunity D. Production of exotoxins
B The clinical course of HSV infection is a product of the virus's ability to remain latent in the dorsal root ganglia for long periods. Latency refers to the ability to maintain disease potential in the absence of clinical signs and symptoms. When latent, the immune system is ineffective, but the virus does not actively inhibit the cell-mediated immune system. HSV does not produce exotoxins, and replication of squamous epithelium accounts for the warts caused by HSV.
The physiological reasoning behind giving acyclovir, an antiviral medication, to a client diagnosed with genital herpes would include the fact that these drugs: A. Attack the cell wall and totally destroy the virus, thus curing the client B. Interfere with viral DNA replication, which can decrease the frequency of recurrences C. Will prevent the organism from developing a resistance to the treatment protocols D. Can be obtained without a prescription and usually applied topically
B There is no known cure for genital herpes, and the methods of treatment are largely symptomatic. The oral antiviral drugs acyclovir, valacyclovir, and famciclovir have become the cornerstone for management of genital herpes. By interfering with viral DNA replication, these drugs decrease the frequency of recurrences, shorten the duration of active lesions, reduce the number of new lesions formed, and decrease viral shedding. There are no FDA-approved PCR tests for chancroids. The chancroid organism has shown resistance to treatment with sulfamethoxazole alone and to tetracycline. Uncomplicated cases of candidiasis (not herpes) are treated with antifungal medications (e.g., clotrimazole, miconazole) that are available as topical preparations (creams or suppositories) that can be obtained without a prescription.
A client presents to the GYN clinic complaining of large amounts of frothy yellow-green discharge that smells very foul. Immediately, the health care provider is thinking this client most likely has: A. Candidiasis B. Trichomoniasis C. Bacterial vaginosis D. Chlamydial infection
B Trichomoniasis causes a copious, frothy, malodorous, green or yellow discharge. The characteristic vaginal discharge of candidiasis, when present, is usually odorless, thick, and cheesy. The predominant symptom of bacterial vaginosis is a thin, grayish white discharge that has a foul, fishy odor. Chlamydial STD may be asymptomatic, but most women have mucopurulent drainage or hypertrophic cervical changes on examination.
Which of the following phenomena is thought to underlie the decreased reported incidence of some sexually transmitted infections (STIs)? A. Increased knowledge of the correct use of condoms B. Increased public funding for health promotion activities C. Decreased reporting of cases of certain STIs D. Decreased numbers of sexual partners among young adults
C The actual incidence and prevalence of some STIs are thought to exceed reported rates. Consequently, apparent decreases are not thought to reflect reality. This trend in reported incidence is not attributed to changes in condom use, health promotion, or decreased numbers of sexual partners.
A client presents to the out-client clinic complaining of gray discharge that has a fishy odor. The health care provider sees "clue cells" on wet-mount microscopic exam. This would most likely lead to the diagnosis of: A. Trichomonas vaginalis B. Chlamydial C. Bacterial vaginosis D. Syphilis
C The diagnosis of bacterial vaginosis is made when at least three of the following signs or symptoms are present: abnormal gray discharge, vaginal pH above 4.5 (usually 5.0-6.0), positive fishy odor of vaginal discharge on addition of 10% potassium hydroxide, and appearance of characteristic "clue cells" on wet-mount microscopic studies. T. vaginalis is an anaerobic protozoan that is shaped like a turnip and has three or four anterior flagella. Chlamydia exists in two morphologically distinct forms during its unique life—a small infectious elementary body and a large noninfectious reticulate body. The diagnosis of syphilis can be made rapidly by dark-field microscopic examination of the exudate from skin lesions. However, the test is reliable only when a specimen with actively motile T. pallidum is examined immediately by a trained microscopist. It does, however, evoke a humoral immune response and production of antibodies that provide the basis for serologic tests.
Which of the following signs and symptoms is most clearly suggestive of primary genital herpes in a male client? A. Presence of purulent, whitish discharge from the penis B. Emergence of hard, painless nodules on the shaft of the penis C. Itching, pain, and the emergence of pustules on the penis D. Production of cloudy, foul-smelling urine
C The initial symptoms of primary genital herpes infection include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. In men, the infection can cause urethritis and lesions of the penis and scrotum. Rectal and perianal infections are possible with anal contact. Firm, subcutaneous nodules are not associated with herpes simplex virus (HSV), and the production of penile discharge and cloudy urine is not suggestive of the disease.
Of the following STIs, for which STI should the nurse anticipate a prescription for antibiotics such as tetracycline or doxycycline since this infection will respond to antibiotic treatment? A. Human papillomavirus (HPV) infection B. Herpes simplex virus type 2 (HSV-2) infection C. Candidiasis D. Lymphogranuloma venereum (LGV)
D Because HSV-2 and HPV infections and candidiasis have nonbacterial etiologies, these infections are insensitive to antibiotics. Lymphogranuloma venereum (LGV) is an acute and chronic venereal disease caused by Chlamydia trachomatis and is consequently sensitive to antibiotics.
A sexually transmitted infection that is caused by a microorganism with two morphologically distinct forms is: A. Chancroid B. Candidiasis C. Trichomonas vaginalis D. Chlamydia
D Chlamydia exists in two morphologically distinct forms during its unique life—a small infectious elementary body and a large noninfectious reticulate body. T. vaginalis is a large anaerobic, pear-shaped, flagellated protozoan. Chancroid is a disease of the external genitalia and lymph nodes caused by the gram-negative bacterium Haemophilus ducreyi. Candida albicans is the most commonly identified organism in vaginal candidiasis (yeast infection), but other candidal species, such as Candida glabrata and Candida tropicalis may also be present.
While in its dormant state, herpes simplex virus resides and replicates in the: A. Local lymph nodes B. Subcutaneous tissue C. Mucous membrane D. Dorsal root ganglia
D In genital herpes, the virus ascends through the peripheral nerves to the sacral dorsal root ganglia. The virus can remain dormant in the dorsal root ganglia, or it can reactivate, in which case the viral particles are transported back down the nerve root to the skin, where they multiply and cause a lesion to develop. During the dormant or latent period, the virus replicates in a different manner so that the immune system or available treatments have no effect on it. Local lymph nodes respond to the inflammation of reactivation; the mucous membrane becomes erythematous and painful when lesions form; subcutaneous tissue is not damaged by the vesicles and shallow ulcerations.
Which of the following events is associated with the primary stage of syphilis? A. Development of gummas B. Development of central nervous system lesions C. Palmar rash D. Genital chancres
D Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.
