STIs

Question 1

What is the name of the agent that causes syphilis?

Answer 1

Treponema pallidum

Question 2

What are the two investigation tests for syphilis?

Answer 2

Non-treponemal tests

RPR (Rapid Plasma Reagin)

VDRL (Venereal Disease Research Laboratory)

Purpose: Quantitative titer; used to monitor treatment response

Treponemal tests (confirmation)

FTA-ABS, TP-PA, EIA

Purpose: Confirms exposure; usually remains positive for life

Can start with a non-treponemal screen followed by a confirmatory treponemal test, or vice versa

Question 3

What is the recommended agent, dose and route for the treatment of primary syphilis?

Answer 3

IM penicillin 2,400,000 IU once

Question 4

What is the recommended agent, dose and route for the treatment of latent syphilis?

Answer 4

Early latent (<1 year):
IM penicillin 2,400,000 IU once

Late latent (>1 year or unknown): IM penicillin 2,400,000 IU once weekly x 3w

Question 5

What is an alternative antibiotic for the treatment of syphilis for someone who is allergic to penicillin?

Answer 5

Doxycycline

Question 6

Name three management steps of syphilis treatment

Answer 6

1. Treat (according to stage)
2. Treat sexual partners
3. Report to Public Health

Question 7

How and how often should you follow a patient with treated syphilis

Answer 7

Non-treponemal titers (RPR/VDRL) at 6, 12, and sometimes 24 months

Question 8

A 26-year-old woman was treated 6 months ago with Benzathine penicillin G 2.4 million units IM single dose for early latent syphilis. Her initial RPR was 1:64. Today, her repeat RPR is 1:16. She reports no new symptoms and no new sexual partners.

Question:
Has she had an adequate serologic response to treatment? Explain why.

Answer 8

A ≥4-fold decline in non-treponemal titer (e.g., 1:64 → 1:16) within 6–12 months indicates successful treatment.

Question 9

Name three risk factors for STIs

Answer 9

Previous STI
Multiple partners (≥2 in the past year)
Inconsistent condom use
IVDU
Sex workers
Victims of sexual assault

Question 10

What are the three STIs that could be prevented with vaccination?

Answer 10

HPV
Hep A
Hep B

Question 11

What are the most common etiologies for epididymitis?

Answer 11

<35 y/o → C&G
>35 y/o → Pseudomonas

Question 12

What is the most important physical exam sign for a patient with epididymitis?

Answer 12

Prehn’s sign (elevation of the affected testicle relieves pain)

Question 13

Name 4 S+S of epididymitis?

Answer 13

Gradual unilateral testicular pain
Urethritis
Urethral discharge
Swelling and pain of the epididymus
Fever
Hydrocele

Question 14

Name three important DDx’s of epididymitis?

Answer 14

Trauma
Torsion
Neoplasm

Question 15

Name two diagnostic modalities of epididymitis

Answer 15

Urethral swab for G+S
First-stream urine NAAT for gonorrhea and chlamydia
Culture of mid-stream

Question 16

What is the preferred medication regimen for epididymitis for a patient < 35 y/o?

Answer 16

Doxycycline 100 mg BID 10 - 14d + IM Ceftriaxone once

Question 17

What is the preferred medication regimen for epididymitis for a patient > 35 y/o?

Answer 17

PO Ofloxacin 200 mg BID x 7 - 14d

Question 18

Name three etiologic agents of PID

Answer 18

Chlamydia
Gonorrhea
HSV
Trichomoniasis

Question 19

Name two complications of PID

Answer 19

↑ risk of ectopic pregnancy
Infertility
Chronic pelvic pain

Question 20

2 S+S of trichomoniasis

Answer 20

White/yellow vaginal discharge
Strawberry cervix
Vulvar erythema

Question 21

Prefered pharmacological management of Trichomoniasis

Answer 21

Metronidazole 2g once
(treat partner too!)

Question 22

Name the outpatient treatment regimen for a patient with mild to moderate pelvic inflammatory disease.

Answer 22

Ceftriaxone 500 mg IM once (or 1 g if >150 kg) PLUS Doxycycline 100 mg PO BID for 14 days ± Metronidazole 500 mg PO BID for 14 days

Question 23

Name the inpatient treatment regimen for a patient with severe PID (unable to tolerate oral therapy, pregnant, or with tubo-ovarian abscess).

Answer 23

Cefoxitin 2 g IV q6–8h (alternative Cefotetan)
Doxycycline 100 mg PO/IV q12h

Question 24

Who should get screening for C&G? (2)

Answer 24

sexually active men and women < 30 year annually
Pregnant women
Those with previous STIs
Sex-trade workers

Question 25

Name 3 S+S of GENITAL Chlamydia infection

Answer 25

Urinary symptoms - dysuria, urethritis Cervicitis Vaginal discharge Dyspareunia Post-coital bleeding Orchitis Epididymitis

Question 26

Name 3 S+S of **NON-**GENITAL Chlamydia infection

Answer 26

Conjunctivitis Pharyngitis Proctitis Reiter’s syndrome (reactive arthritis)

Question 27

Name the triad of Reiter's syndrome or reactive arthritis

Answer 27

Polyarthralgias Conjunctivitis Urethritis

Question 28

Name 3 complications of Chlamydia and gonorrhea infection

Answer 28

PID Ectopic pregnancy Infertility Epididymo-orchitis Reiter syndrome

Question 29

How to diagnose Chlamydia

Answer 29

NAAT - sources: Urine Vaginal Oral Rectal Cervical

Question 30

What are the two first-line meds for chlamydia?

Answer 30

Doxycycline 100 mg BID x 7d Azithromycin 1g once

Question 31

What is the main etiology of Lymphogranuloma Venereum?

Answer 31

Chlamydia trachomatis

Question 32

Name three complications of gonococcal infection

Answer 32

Meningitis Endocarditis Osteomyelitis PID Infertility Reiter syndrome Epididymitis-orchitis

Question 33

Name the two medications used to treat gonorrhea

Answer 33

(combined with chlamydia) Azithromycin 1g once Ceftriaxone 250 mg IM once

Question 34

Name two patient-applied medications for genital warts

Answer 34

Imiquimod cream Podofilox

Question 35

Name three physician-applied medications for genital warts

Answer 35

Cryotherapy Podophylin resin Trichloroacetic acid Laser Surgery (excision)