STD practice questions

JM is a 23-year-old woman who is 28 weeks pregnant. She presents to her primary care physician (PCP) with symptoms of dysuria and unusual vaginal discharge. A diagnosis of chlamydia is made. JM has no medication allergies. Select appropriate therapy for JM. A Doxycycline B Amoxicillin C Cefixime D Levofloxacin

b is correct. Amoxicillin is recommended for the treatment of chlamydia in pregnancy and is classified in pregnancy category B.

Ophthalmia neonatorum can result from exposure to A C. trachomatis B T. vaginalis C T. pallidum D A and B only E A, B, and C

A

Penicillin is the drug of choice in which of the following conditions? A Syphilis B Chlamydia C Genital warts D Chancroid

A

SA is a 33-year-old man with no known drug allergies who presents to the local STD clinic with complaints of extreme pain on urination and urethral discharge for 2 days. A diagnosis of gonococcal urethritis is made. Select the most appropriate therapy for SA. A Ceftriaxone + azithromycin B Benzathine penicillin C Azithromycin D Levofloxacin + azithromycin

A is correct. Ceftriaxone plus azithromycin is a recommended agent for the treatment of gonococcal urethritis.

TD is 27-year-old man who presents to a local STD clinic with complaints of painful urination and urethral discharge over the past 4 days. He is sexually active, reporting one partner within the past 30 days. He has no known drug allergies. A diagnosis of chlamydia is made. Select the most appropriate therapy for TD. A Doxycycline B Azithromycin + cefixime C Ceftizoxime D Acyclovir + ofloxacin

A is correct. Doxycycline is a recommended agent for the treatment of chlamydia

Which of the following is a contraindication to doxycycline therapy? Select all that apply. A Age less than 8 years B Concomitant use of QTc interval-prolonging drugs C Diabetes mellitus D Documented penicillin allergy

A is correct. The calcium-binding effects of tetracyclines cause permanent darkening of teeth in children and effects on developing bone. For this reason, tetracyclines are contraindicated in pregnancy and children under the age of eight.

Which of the following is true regarding the treatment of STDs in special populations? A The treatment of STDs in pregnancy can decrease pregnancy complications and prevent disease transmission to the child. B Children diagnosed with congenital or acquired STDs should not be treated until they reach 2 years of age due to antimicrobial toxicities. C In general, adolescent patients require lower doses of recommended antimicrobials for the treatment of STDs. D Management of genital herpes in patients with HIV infection is the same as the management in patient who are HIV negative.

A is correct. The treatment of STDs in pregnancy can decrease pregnancy complications and prevent disease transmission to the child.

Your 23-year-old female patient is pregnant and has gonorrhea. The medical history includes anaphylaxis following exposure to amoxicillin. The most appropriate drug to use is A Azithromycin B Cefixime C Ceftriaxone D Ciprofloxacin E Doxycycline

All of the listed drugs have been used for the treatment of gonorrhea. Cephalosporins should be avoided in patients with a history of severe hypersensitivity to penicillins, and fluoroquinolones (see Chapter 46) should be avoided in pregnancy. Tetracyclines including doxycycline have been used in the past for gonorrhea, but not as single doses, and they too should be avoided in pregnancy. The answer is A.

Of the following treatment regimens, which is (are) recommended by the CDC for treating a patient with trichomoniasis who fails treatment with metronidazole 2 g orally as a single dose and reinfection has been excluded? A Tinidazole 2 g orally as a single dose B Metronidazole 500 mg orally twice a day for 7 days C Metronidazole 2 g orally for 3 to 5 days D A and B only E A, B, and C

B

The CDC recommends that sexually active adolescent females undergo annual screening for which of the following? A Gonorrhea B Chlamydia C Syphilis D Genital herpes E None of the above

B

Which of the following regimens does not consistently eradicate C. trachomatis genital infections? A Ofloxacin 300 mg twice a day for 7 days B Ciprofloxacin 500 mg orally twice a day for 7 days C Azithromycin 1 g orally as a single dose D Doxycycline 100 mg orally twice a day for 7 days E Erythromycin base 500 mg orally four times a day for 7 days

B

Which of the following is true regarding the diagnosis of syphilis? A The diagnosis of syphilis is made through direct techniques such as culture. B Serologic testing is the standard method of detecting primary, secondary, latent, and tertiary syphilis in the United States. C The VDRL-CSF is the standard serologic test for secondary syphilis. D Nontreponemal serologic testing alone is sufficient for a definitive diagnosis of syphilis.

B is correct. Serologic testing, including treponemal and nontreponemal tests, provides a presumptive diagnosis and is the standard method of detecting primary, secondary, latent, and tertiary syphilis in the United States.

TD is 27-year-old man who presents to a local STD clinic with complaints of painful urination and urethral discharge over the past 4 days. He is sexually active, reporting three partners within the past 30 days. He has no known drug allergies. A diagnosis of chlamydia is made. Select the most appropriate therapy for TD. A Doxycycline B Azithromycin + cefixime C Ceftizoxime D Acyclovir + ofloxacin

B is correct. This is the most appropriate therapy for TD, which includes treatment for chlamydia and gonorrhea. Because coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae commonly occurs, presumptive therapy for gonorrhea should be considered when treating chlamydia.

Which of the following is the preferred parenteral treatment for PID? A Cephalexin IV four times a day B Cefaclor by mouth three times a day C Cefotetan IV twice a day D Vaccine given in four injections over a period of 9 months

C

Which of the following is true regarding gonococcal urethritis and/or cervicitis? AGonorrhea infections are treated with oral vancomycin. BMen are typically asymptomatic or have minor symptoms. CIncreased transmission of HIV infection is associated with gonococcal infection. D Antibiotic susceptibility data can be obtained using nonculture diagnostic tests for gonorrhea.

C is correct. In both men and women, gonorrhea can cause increased susceptibility to and transmission of human immunodeficiency virus (HIV) infection

AS is a 27-year-old patient with a new diagnosis of a chlamydia infection. The patient is concerned about the infection, the treatment, and complications from the infection. Complications of chlamydia genital infection include which of the following? A Granulomatous and cardiovascular diseases B Vesicular lesions on the external genitalia C Pelvic inflammatory disease and infertility D General paresis, dementia, and sensory ataxia

C is correct. Without appropriate and timely treatment for chlamydia, complications such as PID, ectopic pregnancy, premature delivery, and infertility can result.

Which of the following represents an adverse effect associated with fluoroquinolone use? Select all that apply. A Permanent tooth darkening B Neurologic toxicity C Dysglycemia D Jarisch-Herxheimer reaction

C. is correct. Fluoroquinolones have the potential to cause dysglycemia (hypo- or hyperglycemia), and this adverse effect has been most commonly reported in patients with underlying diabetes mellitus.

A 26-year-old woman was treated for a suspected chlamydial infection at a neighborhood clinic. She was given a prescription for oral doxycycline to be taken for 14 d. Three weeks later, she returned to the clinic with a mucopurulent cervicitis. On questioning she admitted not having the prescription filled. The best course of action at this point would be to A Delay drug treatment until the infecting organism is identified B Rewrite the original prescription for oral doxycycline C Treat her in the clinic with a single oral dose of azithromycin D Treat her in the clinic with an intravenous dose of amoxicillin E Write a prescription for oral erythromycin for 10 d

Cervicitis or urethritis is often caused by C trachomatis. Such infections may develop slowly because of the long incubation period of chlamydial infection. Treatment with oral doxycycline for 14 d (as originally prescribed) would have eradicated C trachomatis and most other organisms commonly associated with nongonococcal cervicitis or urethritis. Given the limited compliance of this patient, the best course of action would be the administration (in the clinic) of a single oral dose of azithromycin. The answer is C.

If a patient has been diagnosed with neurosyphilis and pleocytosis is present, how often should one reexamine the patient's cerebral spinal fluid? A Every 3 months B Every 4 months C Every 5 month D Every 6 months

D

The greatest risk factor for contracting a sexually transmitted disease (STD) is A Practice of unprotected anal-genital intercourse B Practice of unprotected anal-oral intercourse C Practice of unprotected oral-genital intercourse D Number of sexual partners E Illicit drug use

D

IT is a patient who reports to her primary care provider for evaluation of a vaginal discharge, dysuria, and vaginal bleeding. The provider orders several laboratory tests and cultures. A Gram stain reveals gram-negative diplococcic. The presence of gram-negative diplococci on Gram stain is suggestive of which organism? A Treponema pallidum B Chlamydia trachomatis C Herpes simplex virus-2 D Neisseria gonorrhoeae

D is correct.Neisseria gonorrhoeae is a gram-negative Diplococcus.

The Jarisch-Herxheimer reaction is an acute febrile reaction associated with therapy for which STD? A Genital herpes B Gonorrhea C Chlamydia D Syphilis

D. is correct. The Jarisch-Herxheimer reaction is an acute febrile reaction that may occur within hours of initiation of therapy for syphilis. It is most common in patients with early syphilis and usually subsides within a 24-hour period. Complications of the Jarisch-Herxheimer reaction include induction of early labor and fetal distress in pregnant women.

A false-positive VDRL slide test or RPR card test for syphilis can occur in patients who have A Chronic infections B Autoimmune diseases C Malignancies D A and B only E A, B, and C

E

The CDC recommends that a penicillin-allergic pregnant patient with a diagnosis of primary syphilis should be treated with A Azithromycin B Doxycycline C Erythromycin D Ofloxacin E None of the above

E

Which of the following statement regarding trichomoniasis is (are) true? A Nonvenereal transmission of trichomoniasis is possible B The majority of infected men are asymptomatic C Infection during pregnancy can result in preterm labor and delivery D Wet-mount specimen examination is less sensitive in diagnosing infections in males than in females E All of the above are true

E

Select the mechanism of action for cephalosporin antibiotics. A Bind to the 30S bacterial ribosomal subunit, ultimately inhibiting bacterial protein synthesis B Bind and inactivate a family of enzymes required for bacterial cell wall synthesis, causing cell death C Bind and stabilize DNA complexes with topoisomerase II and topoisomerase IV enzymes, causing DNA-strand breakage and cell death D Bind to the 23S component of the 50S ribosomal subunit, inhibiting RNA-dependent protein synthesis

b is correct. Cephalosporins bind and inactivate a family of enzymes, called penicillin-binding proteins, which are required for bacterial cell wall synthesis. This action causes cell death and is bactericidal.

A 33-year-old man was seen in a clinic with a complaint of dysuria and urethral discharge of yellow pus. He had a painless clean-based ulcer on the penis and nontender enlargement of the regional lymph nodes. Gram stain of the urethral exudate showed Gram-negative diplococci within polymorphonucleocytes. The patient informed the clinic staff that he was unemployed and had not eaten a meal for 2 d. The most appropriate treatment of gonorrhea in this patient is A A single intramuscular dose of ceftriaxone B Amoxicillin orally for 7 d C Procaine penicillin G intramuscularly as a single dose plus oral probenecid D Meropenem orally for 7 d E Vancomycin intramuscularly as a single dose

treatments of choice for gonorrhea include a single dose of ceftriaxone (intramuscularly). Because of the high incidence of beta-lactamase-producing gonococci, the use of penicillin G or amoxicillin is no longer appropriate for gonorrhea. Similarly, many strains of gonococci are resistant to tetracyclines. Alternative drugs (not listed) for gonorrhea include cefixime, azithromycinor spectinomycin The answer is A

A 22-year-old man with gonorrhea is to be treated with cefixime and will need another drug to provide coverage for possible urethritis caused by C trachomatis. Which of the following drugs is least likely to be effective in nongonococcal urethritis? A Azithromycin B Ciprofloxacin C Erythromycin D Nitrofurantoin E Tetracycline

urinary tract infections resulting from C trachomatis are likely to respond to all of the drugs listed except nitrofurantoin. However, nitrofurantoin is effective against many bacterial urinary tract pathogens with the exception of Pseudomonas aeruginosa and strains of Proteus. The answer is D.

Which dose of metronidazole should be administered for 7 days to treat trichomoniasis? A 250 mg orally two times daily B 500 mg orally two times daily C 250 mg orally three times daily D 500 mg orally three times daily

D

Which of the following agents should not be prescribed for MSM or patients with a history of recent foreign travel and a positive diagnosis of Neisseria gonorrhoeae? A Doxycycline B Azithromycin C Penicillin G D Ofloxacin

D

Which of the following is (are) the recommended treatment for neonatal gonococcal ophthalmia? A Silver nitrate ophthalmic solution B Erythromycin ophthalmic solution C Tetracycline ophthalmic solution D Ceftriaxone E A, B, and C

D

Which of the following is (are) true regarding the use of nucleic acid amplification tests (NAATs) in the diagnosis of gonorrhea? A Can test for N. gonorrhoeae and C. trachomatis using a single specimen B Can provide a diagnosis of gonorrhea using noninvasive specimens such as urine samples C Can provide information on antibiotic resistance in diagnosed strains of N. gonorrhoeae D A and B only E A, B, and C

D

Which of the following is associated with possible development of pelvic inflammatory disease? A Syphilis B Genital herpes infection C Trichomoniasis D Genital chlamydial infection E None of the above

D

Which of the following regimens is considered to be effective treatment for Disseminated Gonococcal Infection? A Ofloxacin 400 mg orally three times daily for 14 days B Benzathine Penicillin 2.4 million units once weekly for 3 weeks C Azithromycin 1 g as a one time dose D Ceftriaxone 1 g IM or IV every 24 hours until improvement is noted

D

Which of the following is true regarding the stages of syphilis infection? AThe characteristic lesion of primary syphilis is a diffuse rash, usually affecting the palms and soles. B Manifestations of latent syphilis include regional lymphadenopathy and meningitis. C Tertiary syphilis is highly transmissible. D Neurosyphilis can present at any stage of syphilis.

D is correct. CNS involvement can present at any stage of syphilis. Early neurosyphilis occurs within first few years of infection and usually coexists with primary or secondary syphilis. Late neurosyphilis occurs years to decades after the initial infection and represents a tertiary manifestation of syphilis.

AF is a 19-year-old college student who is considering becoming sexually active. During her annual Pap smear she asks her gynecologist for information on STD and pregnancy prevention. Which of the following statements is true regarding STD prevention? Select all that apply. A Vaccines are currently available for chlamydia, gonorrhea, and syphilis. B Diaphragm use is a reliable method of STD prevention. C Hormonal contraception is effective in preventing pregnancy and STDs. D Condom use reduces the acquisition and transmission of STDs.

D is correct. Condom use and STD/HIV counseling have been shown to be effective in reducing the acquisition and transmission of STDs.

TP is a 26-year-old woman who is 31 weeks pregnant. She visits her obstetrician-gynecologist because of a sore throat, generalized weakness, and a rash on her palms and soles for the past week. Testing is performed and a diagnosis of secondary syphilis is made. The treating physician requests pharmacist consultation because the patient is allergic to penicillin. Select the most appropriate therapy for TP. A Doxycycline B Cefoxitin + probenecid C Levofloxacin D Desensitization + benzathine penicillin G

D is correct. Penicillin regimens, appropriate for the stage of disease, are recommended for the treatment of syphilis in pregnant women. No proven alternatives to penicillin exist for the treatment of syphilis during pregnancy. It is recommended that pregnant patients with a penicillin allergy undergo desensitization and subsequent treatment with penicillin.