Module 12

What is the most likely diagnosis based on the following criteria: (a) pH 5.0; (b) clue cells greater than 20% per high power field, (c) potassium hydroxide (KOH) "whiff test" positive with an fishy odor, and (c) homogenous discharge? a) Trichomoniasis b) Candidiasis c) Bacterial vaginosis d) Chlamydia

c) Bacterial vaginosis

Which one of the following is an appropriate plan regarding follow-up for a 19-year-old woman who is diagnosed with Chlamydia trachomatis cervicitis and treated with a recommended regimen? a) Follow-up visit and obtain NAAT for "test of cure" (at 2 weeks from initial visit) b) Follow-up visit and obtain NAAT to evaluate for reinfection (at 4 weeks from initial visit) c) Follow-up visit and obtain NAAT to evaluate reinfection (at 3 months from initial visit) d) No follow-up is needed as long as the patient remains asymptomatic

c) Follow-up visit and obtain NAAT to evaluate reinfection (at 3 months from initial visit)

Which one of the following combinations of clinical and laboratory findings most accurately describes primary HSV-2 infection? a) No lesions or symptoms, HSV-1 antibodies may or may not be present, HSV-2 antibodies are present b) Lesions present, symptoms usually mild, HSV-1 antibodies may or may not be present, HSV-2 antibodies are present c) Lesions present, symptoms usually severe, HSV-1 and HSV-2 antibodies not present d) Lesions present, symptoms usually moderate, HSV-1 antibodies present, HSV-2 antibodies are not present

c) Lesions present, symptoms usually severe, HSV-1 and HSV-2 antibodies not present

Which one of the following is a recommended treatment regimen for non-pregnant women with symptomatic bacterial vaginosis? a) Metronidazole 2 grams orally in a single dose b) Tinidazole gel 0.75%, 5 grams intravaginally as a single application c) Metronidazole 500 mg orally twice a day for 7 days d) Clindamycin 300 mg orally twice a day for 14 days

c) Metronidazole 500 mg orally twice a day for 7 days

Fetal issues associated with Herpes Simplex Virus (HSV)

mortality, sepsis, neural problems

Mother-to-child transmission of HPV can result in

respiratory papillomatosis

Mucocutaneous lesions and rash are most commonly seen during which stage of syphilis?

secondary

syphilis symptoms

ulcer or chancre, macropapular rash

Vaginitis is characterized by

vaginal discharge, vulvar itching and irritation, and a vaginal odor

which age group has the highest rates of infection with Chlamydia trachomatis

women aged 15-24

Women with cervical chlamydia infection most often are

asymptomatic

What is the normal vaginal pH in most healthy women? a) Acidic and less than 2.2 b) Acidic, between 3.8 and 4.5 c) Alkaline, between 5.8 and 6.2 d) Alkaline and greater than 6.2

b) Acidic, between 3.8 and 4.5

Which one of the following best describes the signs and symptoms of trichomoniasis in women? a) Foul, fishy odor and thick, clumpy white vaginal discharge b) Asymptomatic, or frothy gray or yellow-green vaginal discharge c) Dysuria, itching, and thin milky white vaginal discharge d) Mucosal ulcerations associated with pain and radicular symptoms

b) Asymptomatic, or frothy gray or yellow-green vaginal discharge

A 25-year-old pregnant woman is diagnosed with cervicitis at 20 weeks gestatation. She reports increased, foul-smelling discharge and dysuria. A sample of the purulent discharge is sent for nucleic acid amplification testing (NAAT) and the test is positive for gonorrhea but negative for chlamydia. She report no other symptoms and she has no drug allergies. Based on the 2020 updated gonorrhea treatment recommendations from the Centers for Disease Control (CDC), Which one of the following regimens should be given to treat this pregnant woman with cervicitis? a) Ceftriaxone 250 mg intramuscularly in a single dose b) Ceftriaxone 500 mg intramuscularly in a single dose c) Ceftriaxone 250 g intramuscularly in a single dose plus doxycycline 100 mg orally twice a day for 7 days d) Levofloxacin 500 mg orally once a day for 10 days

b) Ceftriaxone 500 mg intramuscularly in a single dose

What percentage of persons infected with HSV-2 are unaware of their serostatus?

85%

How do you treat chlamydia?

Azithromycin (single dose) or Doxycycline 2x/day for 7 days

the most common, non-genetic cause of childhood hearing loss is

CMV

the characteristic "blueberry muffin rash" is symptomatic of

CMV (cytomegalovirus)

What is the preferred agent and widely used to treat gonorrhea?

Ceftriaxone (a cephalosporin)

What site in women is the most common site of infection?

Cervix

most common reportable STD in the US

Chlamydia

Gonorrhea is most resistant to which antibiotic?

Cipro (a fluoroquinolone)

TORCH infections are

a group of diseases that cause congenital conditions if a fetus is exposed to them in utero - cause significant mortality and morbidity in neonates

Which of the following is the most common cause of vaginitis in reproductive-aged women? a) Bacterial vaginosis b) Trichomoniasis c) Candidiasis d) Atrophic vaginitis

a) Bacterial vaginosis

Which one of the following options is a preferred therapy for both episodic and suppressive treatment of recurrent genital herpes infections? a) Oral acyclovir b) Oral valganciclovir c) Topical cidofovir d) Topical imiquimod

a) Oral acyclovir

A 22-year-old woman is diagnosed with cervicitis caused by Neisseria gonorrhoeae. What are known potential complications of genitourinary gonococcal infection in women? a) Pelvic inflammatory disease, accessory gland infection, and perihepatitis (Fitz-Hugh-Curtis Syndrome) b) Pelvic inflammatory disease, acute renal failure, and perihepatitis (Fitz-Hugh-Curtis Syndrome) c) Pelvic inflammatory disease, accessory gland infection, and neurologic sequelae d) Perinephric abscess, accessory gland infection, and severe vaginal hemorrhage

a) Pelvic inflammatory disease, accessory gland infection, and perihepatitis (Fitz-Hugh-Curtis Syndrome)

T/F: Breastfeeding is contraindicated Hepatitis C

FALSE

T/F: Gonorrhea is associated with an decreased susceptibility to HIV acquisition as well as an decreased risk of HIV transmission

FALSE - Gonorrhea is associated with an increased susceptibility to HIV acquisition as well as an increased risk of HIV transmission

What is the leading cause of genital ulcer disease worldwide?

Genital herpes

_____ is characterized by periods of latency punctuated by periods of viral shedding.

Genital herpes

Most cases of genital herpes are caused by

HSV-2

Is bacterial vaginosis an STD?

No, but patients with it have increased risk for acquiring some STDs

The preferred treatment for syphilis is

Penicillin G

In the United States, which is the most common clinical condition caused by chlamydial infection among neonates

Perinatal eye infection causing inclusion conjunctivitis

bacterial vaginosis and trichomoniasis have been linked to

Premature rupture of membranes Preterm labor Increased risk of HIV acquisition and transmission

What is most consistent with current CDC recommendation for screening for chlamydial infection?

Routine annual screening for all sexually active females younger than 25 years of age

T/F: Antimicrobial resistance remains an important consideration in the treatment of gonorrhea

TRUE

T/F: Prophylactic therapy with acyclovir or valacyclovir beginning at 36 weeks gestation should be offered to all women with a history of genital herpes

TRUE

What is the disease pregnant women can get from cleaning litter boxes?

Toxoplasmosis

Which one of the following statements most accurately reflects recommendations for syphilis screening in pregnant women? a) Routine screening is not recommended unless the woman has HIV infection. b) Routine screening is not recommended unless the woman has a prior documented sexually transmitted disease. c) Routine screening is recommended and should be performed at the first prenatal visit; repeat syphilis screening may be indicated in the early third trimester and at delivery. d) Routine screening is recommended and should be performed only at delivery

c) Routine screening is recommended and should be performed at the first prenatal visit; repeat syphilis screening may be indicated in the early third trimester and at delivery.

A pregnant women has multiple vulvar warts that she wants to have treated. Which one of the following choices is considered an acceptable option for this woman? a) Imiquimod b) Podofilox c) Trichloroacetic acid d) Topical cidofovir

c) Trichloroacetic acid

Which one of the following statements is TRUE regarding the organism herpes simplex virus type 2? a) Herpes simplex virus type 2 is an RNA virus that causes transient infection b) Herpes simplex virus type 2 is an RNA virus that causes chronic infection c) Herpes simplex virus type 2 is a DNA virus that causes transient infection d) Herpes simplex virus type 2 is a DNA virus that causes chronic infection

d) Herpes simplex virus type 2 is a DNA virus that causes chronic infection

On which one of the following patients would it be reasonable to perform type-specific serologic testing for HSV? a) In an asymptomatic woman presenting for her first prenatal care visit b) In a symptomatic patient in whom very early HSV-2 infection is suspected c) In a symptomatic patient with a positive viral cell culture for HSV-2 d) In an asymptomatic patient with recurrent genital symptoms but negative HSV cultures

d) In an asymptomatic patient with recurrent genital symptoms but negative HSV cultures

Which one of the following adverse clinical outcomes is associated with Trichomonas vaginalisinfection in women? a) Ectopic pregnancy b) Infertility c) Ovarian cancer d) Premature rupture of membranes and preterm labor

d) Premature rupture of membranes and preterm labor

Which one of the following statements regarding anogenital human papillomavirus transmission is TRUE? a) Transmission occurs predominantly via sexual activity and only in persons with visible genital lesions. b) Transmission via fomites accounts for up to 25% of cases. c) Approximately 50% of mothers with genital HPV at the time of delivery transmit HPV to their newborn. d) Use of condoms reduces, but does not eliminate the risk of sexual transmission of HPV.

d) Use of condoms reduces, but does not eliminate the risk of sexual transmission of HPV.

In which one of the following groups is screening for bacterial vaginosis indicated? a) Women with HIV infection b) Pregnant women with a history of preterm birth c) Sex partners of persons diagnosed with bacterial vaginosis d) Women undergoing surgical abortion or hysterectomy

d) Women undergoing surgical abortion or hysterectomy