Sexually Transmitted Diseases

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 a macrolide allergy. Select appropriate therapy for JM. A Doxycycline B Amoxicillin C Azithromycin D Levofloxacin

.Amoxicillin is recommended for the treatment of chlamydia in pregnancy and is classified in pregnancy category B. Answer a is incorrect. While tetracyclines are effective agents against chlamydia genital infection, they are contraindicated in pregnancy. Answer c is incorrect. While azithromycin is an effective agent against chlamydia genital infection and is first line for pregnant patients, they are contraindicated in patients with macrolide allergies. Answer d is incorrect. Fluoroquinolones have not adequately been studied in pregnancy, and their use is generally discouraged.

TD is 27-year-old man who presents to a local sexually transmitted diseases (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 Benzathine penicillin G D Acyclovir + ofloxacin

A .Doxycycline is a recommended agent for the treatment of chlamydia. Answer b is incorrect. While azithromycin is a recommended agent for the treatment of chlamydia, cefixime is not necessary to be added. Cefixime in combination with azithromycin is an alternative regimen for the treatment of gonorrhea. *in reality often tx together* Answer c is incorrect. Benzathine penicillin G is not a recommended therapy for chlamydia, although it is a recommended treatment for primary, secondary, and latent syphilis. Answer d is incorrect.Acyclovir is an antiviral agent and would not be effective against a chlamydia bacterial infection. Although ofloxacin is an alternative agent for chlamydia treatment, this combination is inappropriate.

HF is a 29-year-old woman who was diagnosed with genital herpes 6 years ago. She reports approximately one to two recurrences each year since diagnosis. Recently she has experienced an increase in outbreaks, having three in a 6-month period. The decision is made to start HF on daily suppressive therapy. Select the most appropriate therapy for HF. A Valacyclovir po B Erythromycin ointment C Tetracycline po D Acyclovir ointment

A .Valacyclovir is a prodrug of acyclovir that has increased oral bioavailability. It is a recommended agent for daily suppressive therapy. Answer b is incorrect.Erythromycin is an antibacterial agent and would be ineffective against the herpes virus. Answer c is incorrect.Tetracycline is an antibacterial agent and would be ineffective against the herpes virus. Answer d is incorrect. Use of topical antiviral therapy (eg, acyclovir ointment) is discouraged due to limited clinical benefit.

Which of the following is true regarding the treatment of sexually transmitted diseases (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 human immunodeficiency virus (HIV) infection is the same as the management in patient who are HIV-negative.

A Children, including neonates and infants, who are diagnosed with congenital or acquired STDs should be treated according to guideline recommendations. Answer c is incorrect. In general, pharmacologic treatment for STDs in adolescent patients is the same as in adults. Answer d is incorrect. *Because severe or prolonged herpes episodes may occur in immunocompromised patients, doses for patients with HIV infection are typically higher and/or treatment durations longer than in patients who are HIV-negative.*

SA is a 33-year-old man with no known drug allergies who presents to the local sexually transmitted diseases (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 The Centers for Disease Control (CDC) recommends combination therapy AND does not recommend cefixime first line due to the emergence of resistance. Parenteral cephalosporins (intramuscular) in combination with azithromycin or doxycycline is recommended. Fluoroquinolones are no longer recommended for the treatment of gonorrhea in the United States due to increasing rates of fluoroquinolone-resistant N. gonorrhoeae.

ZB is a 30-year-old woman who comes in concerned that her boyfriend is cheating on her. She requests testing for all sexually transmitted diseases. She presents with a chancre on her labia. She is diagnosed with gonorrhea, chlamydia, and primary syphilis. She is prescribed azithromycin, ceftriaxone, and benzathine penicillin G. Which of the following is true regarding ZB's antibiotic prescriptions? Select all that apply. A Benzathine penicillin G has slow absorption and a long duration of action (≥1 week). B If benzathine penicillin G is unavailable, the dose may be substituted with a dose of oral penicillin V potassium. C Due to the high rate of renal clearance, the dose of ceftriaxone would need to be renally adjusted if ZB had poor renal function. D Ceftriaxone is not heavily metabolized by liver enzymes.

A, D Benzathine penicillin G has slow absorption and a long duration of action (≥1 week). Answer d is correct.Ceftriaxone is not heavily metabolized by liver enzymes. Ceftriaxone is minimally metabolized in the intestine after biliary excretion. Answer b is incorrect. One dose of oral penicillin V potassium is NOT a substitute for benzathine penicillin G. Answer c is incorrect. Wh

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

A, D 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 younger than 8 years. Answer d is correct. *Tetracyclines are contraindicated in women who are breast-feeding* as well as women in their second and third trimester of pregnancy. Answer b is incorrect. *This statement refers to fluoroquinolone and macrolide antibiotics, both of which can prolong the QTc interval.* Answer c is incorrect. Diabetes mellitus is not a contraindication to tetracycline therapy. However, 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.

Which of the following is true regarding genital herpes infection? A Genital herpes is an acute, self-limiting disease. B Genital lesions are typically vesicular in nature and accompanied by pain, itching, and burning. C The rate of recurrence increases over time in most patients. D Transmission risk in a mother with recurrent disease but no visible lesions is high.

B Clinical manifestations of genital herpes include the development of papular and vesicular lesions on the external genitalia which are accompanied by pain, itching, and burning. Involvement may also include perianal, buttock, and thigh areas. Answer a is incorrect. Genital herpes is a chronic, lifelong viral infection. Answer c is incorrect. The rate of genital herpes recurrence generally decreases over time. Answer d is incorrect. The risk of transmission in a mother with recurrent disease but no visible lesions is thought to be low.

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 Tetracyclines bind to the 30S bacterial ribosomal subunit, ultimately inhibiting bacterial protein synthesis. Answer c is incorrect. Fluoroquinolones bind and stabilize DNA complexes with topoisomerase II and topoisomerase IV enzymes, causing DNA-strand breakage and cell death. Answer d is incorrect. *Macrolides bind to the 23S component of the 50S ribosomal subunit, inhibiting RNA-dependent protein synthesis.*

A mother brings her 12-year-old son, FR, to the pediatrician. She requests a Gardasil 9 vaccination for her son. Which of the following is true regarding Gardasil 9? Select all that apply. A It is only recommended for females. B It should be stored in the refrigerator. C It should be shaken well before use and administered by IM injection. D It is approved in patients between ages 9 and 45 years.

B, C, D

Which of the following is true regarding azithromycin suspension. Select all that apply. A Store constituted suspension in the freezer. B Store constituted suspension between 5°C and 30°C. C Shake azithromycin suspension well before measuring dose. D Before constitution, store dry powder below 30°C.

B, C, D After constitution, azithromycin suspension should be stored between 5°C and 30°C. Answer c is correct. It is important to shake azithromycin suspension well before measuring the dose. Answer d is correct. Before constitution, dry powder should be stored at below 30°C. Answer a is incorrect. After constitution, azithromycin suspension should be stored between 5°C and 30°C.

TE is a 33-year-old patient with genital herpes simplex virus (HSV) herpes. Which of the following describes a current goal of therapy for genital herpes infection? Select all that apply. A Disease eradication B Viral suppression C Transmission prevention D Decrease recurrence frequency

B, C, D Since genital herpes cannot currently be eradicated, this is not a goal of therapy.

Select the brand name for benzathine penicillin. A Bicillin C-R B Wycillin C Bicillin L-A D Pen-VK

Bicillin L-A is the brand name for benzathine penicillin. Answer a is incorrect. Bicillin C-R is the brand name for a procaine-benzathine penicillin mix. Answer b is incorrect. Wycillin is the brand name for procaine penicillin. Answer d is incorrect. Pen-VK is the brand name for oral penicillin V potassium.

Which of the following represents an adverse effect associated with fluoroquinolone use? A Permanent tooth darkening B Esophageal ulceration C Dysglycemia D Jarisch-Herxheimer reaction

C

ZB is a 30-year-old woman who comes in concerned that her boyfriend is cheating on her. She requests testing for all sexually transmitted diseases. She presents with a chancre on her labia. She is diagnosed with gonorrhea, chlamydia, and primary syphilis. She is prescribed azithromycin, ceftriaxone, and benzathine penicillin G. Which of the following is true regarding ZB's azithromycin prescription? A It is the primary antibiotic active against ZB's primary syphilis. B It must be given IM due to its poor oral absorption. C It has a long half-life allowing for a one-dose administration. D It is excreted primarily in the urine.

C .Azithromycin has a long half-life of 68 to 72 hours and is administered in a single dose for treatment of chlamydia and as part of combination therapy for gonorrhea. Answer a is incorrect.Azithromycin is recommended for treatment of chlamydia and as part of combination therapy for gonorrhea. The primary antibiotic active against ZB's syphilis is benzathine penicillin G. Answer b is incorrect.Azithromycin has rapid absorption from the gastrointestinal (GI) tract and is typically administered orally for treatment of chlamydia and as part of combination therapy for gonorrhea. Answer d is incorrect. Only 6% to 14% of azithromycin is excreted in the urine. It is primarily excreted via the biliary tract.

PB is a 50-year-old man who comes to the clinic with dysuria and urethral discharge and is diagnosed with gonococcal urethritis. His home medications include amiodarone 200 mg daily, apixaban 5 mg twice a day, and a multivitamin daily. His physician wants to prescribe ceftriaxone and azithromycin. Which drug interaction is the main concern for PB? A Ceftriaxone and amiodarone B Ceftriaxone and apixaban C Azithromycin and amiodarone D Azithromycin and multivitamin

C Concurrent use of azithromycin and amiodarone may result in an increased risk of cardiotoxicity (QT prolongation, torsades de pointes).

EV is a 29-year-old pregnant patient with a past medical history of genital herpes simplex virus (HSV) herpes. Which of the following is true regarding genital herpes infection and pregnancy? A The risk of herpes transmission is lowest in mothers who have the initial outbreak at the time of delivery. B Acyclovir, famciclovir, and valacyclovir are classified in pregnancy category D. C Use of antiviral therapy late in pregnancy decreases herpes transmission to the neonate. D Herpes disease in the neonate commonly manifests as a scalp abscess or ophthalmic infection.

C Herpes transmission from an infected mother can cause symptomatic disease in the neonate. Use of antiviral therapy late in pregnancy decreases herpes recurrences near term as well as transmission to the neonate. Answer a is incorrect. The risk of herpes transmission is highest in mothers who have the initial outbreak at the time of delivery. Answer b is incorrect.Acyclovir, famciclovir, and valacyclovir are classified in pregnancy category B. Answer d is incorrect. *Gonococcal disease in the neonate commonly manifests as a scalp abscess or ophthalmic infection.*

Select the answer that correctly ranks the diseases from those that require the least total number of doses of penicillin to the most. A Late latent syphilis, secondary syphilis, neurosyphilis B Neurosyphilis, late latent syphilis, secondary syphilis C Secondary syphilis, late latent syphilis, neurosyphilis D Secondary syphilis, neurosyphilis, late latent syphilis

C Secondary syphilis is treated with benzathine penicillin G 2.4 MU IM × one dose. Late latent syphilis is treated with benzathine penicillin G 2.4 MU IM once weekly × three doses. Neurosyphilis is treated with aqueous crystalline penicillin G 18 to 24 MU IV daily (3-4 MU IV every 4 hours or by CI) × 10 to 14 days.

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 Without appropriate and timely treatment for chlamydia, complications such as pelvic inflammatory disease (PID), ectopic pregnancy, premature delivery, and infertility can result. Answer a is incorrect. Granulomatous and cardiovascular diseases are manifestations of tertiary syphilis and represent some of the long-term complications of syphilis. Answer b is incorrect. Vesicular lesions on the external genitalia are manifestations of genital herpes infection. Answer d is incorrect. *General paresis, dementia, and sensory ataxia are clinical manifestations of late neurosyphilis, a form of tertiary 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 sexually transmitted diseases (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 but not STDs. D Condom use reduces the acquisition and transmission of STDs.

C, D

Which of the following is true regarding the stages of syphilis infection? A The 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 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.* Answer a is incorrect. The characteristic lesion of primary syphilis is the chancre (ulcer). The chancre is usually painless and appears at the site of T. pallidum entrance into the body approximately 3 weeks after transmission. Answer b is incorrect. Latent syphilis refers to patients with a positive serologic diagnosis for syphilis, but no clinical symptoms. This stage occurs after secondary syphilis symptoms have subsided and there are two possible outcomes: progression to tertiary syphilis or clinical cure. Answer c is incorrect. Tertiary syphilis encompasses the long-term complications of syphilitic disease such as granulomatous disease (also called gummatous syphilis) and cardiovascular syphilis. Tertiary syphilis is now uncommon due to antibiotic treatment and is not transmissible.

HP is a 48-year-old woman with an allergy to azithromycin and sulfa that is diagnosed with chlamydia. She currently takes lisinopril 10 mg daily, hydrochlorothiazide 12.5 mg daily, simvastatin 40 mg daily, and calcium carbonate as needed for heartburn. She is prescribed doxycycline 100 mg q12h × 7 days. Which medication are you most concerned may cause a drug interaction with her antibiotic prescription? A Lisinopril B Hydrochlorothiazide C Simvastatin D Calcium carbonate

D Concurrent administration of any of the tetracyclines and aluminum-, calcium-, or magnesium-containing products is not recommended. If concurrent use cannot be avoided, tetracyclines should be taken at least 1 to 2 hours before aluminum-, calcium-, or magnesium-containing products.

DW is a 32-year-old man who is diagnosed with early latent syphilis. The provider orders one dose of benzathine penicillin G 2.4 MU to be administered. What is the appropriate route of administration? A Oral B Subcutaneous C Intravenous D Intramuscular

D Early latent syphilis is treated with benzathine penicillin G 2.4 MU × one dose via the intramuscular route. Inadvertent IV administration has resulted in thrombosis, severe neurovascular damage, cardiac arrest, and death.

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 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. Answer a is incorrect. While doxycycline is an appropriate choice for the treatment of secondary syphilis in the setting of penicillin allergy, tetracyclines are contraindicated in pregnancy.

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 labs and cultures. A Gram stain reveals gram-negative diplococci. 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 T. pallidum is a spiral-shaped organism that is invisible on light microscopy. Answer b is incorrect. C. trachomatis is an obligate intracellular pathogen. (*atypical*) Answer c is incorrect. Herpes is a viral organism.

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 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.