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27 Cards in this Set
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Which of the following is the first line treatment of early latent syphilis?
a. Benzathine penicillin G 2.4 million units IM in a single dose b. Benzathine penicillin G 2.4 million units IM times three doses c. Doxycycline 100 mg orally twice daily for 14 days, d. Tetracycline 500 mg orally 4 times daily for 14 days |
a. Benzathine penicillin G 2.4 million units IM in a single dose
Treatment with three doses of Benzathine penicillin G 2.4 million units is for late latent syphilis. The other choices are second line agents for those patients who cannot receive penicillin. |
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What is the drug of choice for Chlamydia trachomatis?
a. Erythromycin base 500 mg orally QID for 7 days b. Erythromycin ethylsuccinate 800mg orally QID for 7 days c. Ceftriaxone 125mg IM single dose d. Azithromycin 1 gram orally as a single dose. |
d. Azithromycin 1 gram orally as a single dose.
Erythromycin is the treatment alternative for Chlamydia and ceftriaxone 125mg single dose is for treatment of GC. |
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Which of the following STDs increases the risk of HIV transmission?
a. Herpes Simplex virus b. Neisseria gonorrhea c. Syphilis d. All of the above |
d. All of the above
All of the above sexually transmitted diseases increase the risk of HIV transmissions due to the upregulation of the immune response (increased number of CD4 cell receptors) in addition to potential breakdown or tears in the mucous membranes that allow easier transmission. |
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What is the drug of choice for Neisseria gonorrhoeae?
A. Ceftriaxone (Rocephin) B. Metronidazole (Flagyl) C. Clindamycin (Cleocin) D. Cephalexin (Keflex) |
A. Ceftriaxone (Rocephin)
Explanation: A is the correct answer The other choices listed do not cover N. gonorrhoeae. |
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KT is a 24 year old college student who comes back from spring break complaining
of symptoms of painful urination and mucus-like discharge from his penis. He goes to the STD clinic at the health department for evaluation. A urethral gram stain shows white blood cells (WBCs) but no gram-negative diplococci seen. The patient is diagnosed with nongonococcal urethritis (NGU). He has no known drug allergies. What is the most appropriate recommendation? A. Ceftriaxone (Rocephin) 125 mg IM x 1 dose PLUS doxycycline 100 mg po bid x 14 days B. Ceftriaxone (Rocephin) 125 mg IM x 1 dose C. Azithromycin (Zithromax) 1 g po qd x 3 days D. Doxycycline 100 mg po bid x 7 days |
D. Doxycycline 100 mg po bid x 7 days
Treatment should be targeted against pathogens mostly likely to cause NGU (e.g. Chlamydia trachomatis). Ceftriaxone is not necessary since gram-negative diplococci not seen on gram stain. Most appropriate therapy is 7 day course of doxycycline. |
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BS is a 32 year old male who was identified as a recent contact (i.e. within the past
year) of a patient who was diagnosed with secondary syphilis. He comes to the health department for evaluation. Syphilis serologies are done and reveal the following: Rapid plasma reagin (RPR + at 1:64) and Treponema pallidum particleagglutination test (TP-PA) +. The patient is asymptomatic. The patient has an allergy to penicillin which caused severe hives and difficulty breathing when he took it as a child. The patient is diagnosed with late latent syphilis. Which of the following would be the most appropriate? A. Patient is asymptomatic, no treatment is indicated at this time, recheck RPR in 3 months and treat at that time if patient is still positive B. Doxycycline 100 mg po bid x 28 days C. Tetracycline 500 mg po qid x 14 days D. Ceftriaxone (Rocephin) 1g IV qd x 21 days |
B. Doxycycline 100 mg po bid x 28 days
Recommended therapy for late latent syphilis is benzathine penicillin IM once per week x 3 weeks. Patient has a pencillin allergy and requires use of an alternative regimen of 28 day course of doxycycline. |
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JK is a 55 year old male with HIV/AIDS. He has had 3 genital herpes episodes in
the past 2 months and has been diagnosed with recurrent genital herpes infections. What therapy is the most appropriate recommendation for daily suppression? A. Acyclovir 400 mg po tid B. Famciclovir 250 mg po qd C. Valacyclovir 500 mg po tid D. Valganciclovir 900 mg po qd |
A. Acyclovir 400 mg po tid
Acyclovir, famciclovir, or valacyclovir may be used for daily suppression of recurrent HSV. Dose of acyclovir is 400 mg tid, famciclovir is 500 mg po bid, and valacyclovir is 500 mg bid. |
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Due to increasing rates of resistance, fluoroquinolones are no longer recommended
as first-line treatment for which of the following sexually transmitted disease? A. Chlamydia B. Syphilis C. Bacterial vaginosis D. Gonorrhea |
D. Gonorrhea
Of the STDs listed, fluoroquinolones are only an option for treatment of gonorrhea. Due to increasing rates of resistance, these agents are no longer recommended as first-line and cefixime or ceftriaxone should be used. |
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Which of the following signs and symptoms would be consistent with a diagnosis of
gonorrhea in a female patient? Select the best answer. A. Dysuria, increased urinary frequency, vaginal discharge presence of WBCs and diplococci seen on gram-stain. B. White vaginal discharge, clue cells on microscopic exam, positive “whiff test” C. Multiple painful vesicular ulcers, dysuria, vaginal itching D. Diffuse, malodorous yellow-green vaginal discharge with vulvar irritation |
A. Dysuria, increased urinary frequency, vaginal discharge presence of WBCs and diplococci seen on gram-stain.
A-describes s/s of gonorrhea B-describes s/s of bacterial vaginosis C-describes s/s of herpes C-described s/s of trichomonas |
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LP is a 25 year old male who comes to his primary care provider’s office with his
girlfriend of 4 years. He has recurrent genital herpes (HSV-2) and he is concerned about transmitting this to his girlfriend. He has had 2 outbreaks in the past 6 months. They consistently use condoms and avoid intercourse during the outbreaks. What do you recommend additionally for prevention of transmission of HSV to his girlfriend? A. Valacyclovir (Valtrex) 500 mg po qd B. Acyclovir (Zovirax) 400 mg po qd C. Famciclovir (Famvir) 1000 mg po qd D. Nothing, no regimen has been shown to reduce HSV transmission |
A. Valacyclovir (Valtrex) 500 mg po qd
Valacyclovir has specifically been shown to decrease HSV transmission (likely that other antivirals would work for that as well but B and C are dosed inappropriately). |
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RW is a 43 year-old male who recently tested positive for syphilis. He was notified by
the County Health department that he was identified as a recent contact (within 3 months) of a patient who was diagnosed with primary syphilis. He is asymptomatic. Rapid plasma regain (RPR) is + at 1:32 and Treponema pallidum particulate agglutination test (TP-PA) +. He is diagnosed with early latent syphilis. He has no known drug allergies. 17. What is the most appropriate recommendation? A. Administer benzathine penicillin G 2.4 million units (mu) IM x 1 dose B. Administer procaine penicillin G 2. 4 million units (MU) IM x 1 dose C. Administer benzathine penicillin G 2.4 million units (mu) IM weekly x 3 doses D. Do nothing, treatment patient only if he develops symptoms |
A. Administer benzathine penicillin G 2.4 million units (mu) IM x 1 dose
Appropriate treatment for early latent syphilis is listed in A. Regimen C would be for late latent syphilis. |
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JB is a 23 year old male college student who recently returned from spring break in
California where he went surfing. He met a beautiful surfer girl out at a beach party one night. They had too much to drink, one thing lead to another and they had unprotected sex. One week following his return to Gainesville, JB notices a discharge from his penis and goes to the STD clinic at the County Health Department. He is evaluated and diagnosed with gonorrhea. What oral therapy would be most appropriate to treat this patient’s gonorrhea? A. Ciprofloxacin (Cipro®) 500 mg po x 1 dose B. Azithromycin (Zithromax®) 1 g po x 1 dose C. Cefixime (Suprax®) 400 mg po x 1 dose D. None, patient needs IM ceftriaxone (Rochephin®) 1g x 1 dose |
C. Cefixime (Suprax®) 400 mg po x 1 dose
Patient acquired infection in California so fluoroquinolone is not appropriate. Azithromycin regimen listed would be appropriate for nongonococcal urethritis or Chlamydia. Ceftriaxone dose is inappropriate for gonorrhea. |
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A 23 yo male presents with a 2 day history of severe burning on urination and a cloudy urethral discharge. He had unprotected sex 6 days prior with a new partner. Gram stain of the urethral swab shows gram negative intracellular diplococci consistent with N. gonorrhoeae. He has NKDA. No other information is available and no gene probe was done. How would you treat him?
a. Metronidazole 2 grams PO X 1 (also treat partner) b. Ceftriaxone 125 mg IM X 1 c. Benzathine Penicillin G 2.4 million units IM X 1 d. Ceftriaxone 125 mg IM X 1 plus azithromycin 1 gram PO X 1 e. Benzathine Penicillin G 2.4 million units IM Q week X 3 |
d. Ceftriaxone 125 mg IM X 1 plus azithromycin 1 gram PO X 1
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A 19yo female presents with a painless chancre on her labia minora and serum VDRL is positive at 1:64. She has had a recent (2 weeks ago) sexual contact. She is diagnosed with syphilis. She has NKDA. How would you treat her?
a. Metronidazole 2 grams PO X 1 (also treat partner) b. Ceftriaxone 125 mg IM X 1 c. Benzathine Penicillin G 2.4 million units IM X 1 d. Ceftriaxone 125 mg IM X 1 plus azithromycin 1 gram PO X 1 e. Benzathine Penicillin G 2.4 million units IM Q week X 3 |
c. Benzathine Penicillin G 2.4 million units IM X 1
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KS is a 18 year old college freshman who reports to the infirmary with a 1 week history of vaginal itching. The patient is otherwise healthy. On physical exam, she is noted to have visible warts on her vulva. She reports that she only recently became sexually active and has had only 1 partner but has had unprotected sex with this
partner. She is diagnosed with genital warts. What is the most appropriate recommendation? A. Do nothing, genital warts are self-limiting in immunocompetent patients and do not warrant treatment B. Patient-applied therapy of podophyllin resin 10-25% C. Patient-administered therapy of valacyclovir (Valtrex®) D. Patient-applied therapy of imiquimod (Aldara®) 5% cream |
D. Patient-applied therapy of imiquimod (Aldara®) 5% cream
Options for treatment of genital warts are patient applied therapy of podofilox 0.5% or imiquimod 5%. Podophyllin resin 10-25% is a provider-applied therapy. Valacyclovir is not active vs the human papilloma virus (HPV) that causes genital warts. |
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RJ is a 32 year-old female who presents to the health department with a 2 week history of mucopurulent vaginal discharge and a 1 day history of fever (current temperature 39°C). On physical exam, she is found to have cervical motion tenderness and WBCs are seen on microscopic exam of vaginal secretions. She is admitted to the hospital with a diagnosis of pelvic inflammatory disease and is found to have a tubo-ovarian absecss. She is treated initially with intravenous therapy and responds within 2 days. She is now to be discharged on oral therapy. What is the most appropriate recommendation?
A. Azithromycin (Zithromax®) 500 mg po x 1, then 250 mg po qd B. Doxycycline (Vibramycin®) 100 mg po bid + metronidazole (Flagyl®) 500 mg po bid C. Ciprofloxacin (Cipro®) 500 mg po bid + clindamycin (Cleocin®) 300 mg po bid D. Doxycycline (Vibramycin®) 100 mg po bid |
B. Doxycycline (Vibramycin®) 100 mg po bid + metronidazole (Flagyl®) 500 mg po bid
Following initial inpatient treatment for PID, recommended therapy includes doxycycline + (clindamycin or metronidazole if tubo-ovarian abscess is present). |
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RB is a 25 year-old HIV-infected male who reports to his physican’s office with a genital herpes outbreak. He noticed tingling and itching 2 days ago and now has multiple vesicular lesions on his penis. He has had 6 previous episodes in the past 12 months. What is the most appropriate recommendation?
A. Place pt on valacyclovir (Valtex®) 500 mg po bid x 3 days followed by valacyclovir (Valtrex®) 1g po qd B. Place pt on famciclovir (Famvir®) 500 mg po bid x 5 days followed by famciclvoir (Famvir) 500 mg po qd C. Place pt on acyclovir (Zovirax®) 400 mg po tid x 5 days followed by acyclovir (Zovirax) 400 mg po qd D. Place pt on valacyclovir (Valtrex®) 1 g po bid x 7 days followed by valacyclovir (Valtrex®) 500 mg po bid |
D. Place pt on valacyclovir (Valtrex®) 1 g po bid x 7 days followed by valacyclovir (Valtrex®) 500 mg po bid
Recommended duration of episodic HSV therapy in HIV-infected patients is 5-10 days so A is incorrect. B and C are incorrect since famciclovir and acyclovir cannot be dosed qd. |
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PM is a 25 year old homosexual male who reports to the health department having recently found out that he has HIV infection. He is asymptomatic and has no known drug allergies. Baseline laboratory tests reveal the following: RPR positive: 1:4, confirmatory TP-PA (Treponema pallidum particule agglutination test) He reports never being diagnosed or treated for syphilis in the past. He is diagnosed with latent syphilis of unknown duration. What is the most appropriate recommendation?
A. Do nothing, patient is asymptomatic and was likely infected several years ago so no treatment is indicated at this time B. Treat patient with benzathine penicillin G 2.4 mu IM x 1 dose C. Treat patient with benzathine penicillin G 2.5 mu IM once weekly x 3 doses D. Admit patient to the hospital and treat with penicillin G 3 mu IV q8h since he is HIV-infected and neurosyphilis is likely |
C. Treat patient with benzathine penicillin G 2.5 mu IM once weekly x 3 doses
All patients with syphilis regardless of the stage should be treated if past treatment for syphilis is not documented. Recommended regimen for late latent syphilis or syphilis of unknown duration is penicillin G IM once weekly x 3 doses. Neurosyphilis should be ruled out (if possible, may not be able to get an LP if patient does not have insurance). If neurosyphilis is diagnosed, regimen in penicillin G 3-4 mu IV q4h. |
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FS is a 38 year old male who was recently diagnosed with HIV. He is asymptomatic. Baseline tests performed at his physician’s office are as follows: CMV IgG (+), Toxo IgG (+), PPD (-), RPR 1:32, FTA-ABS (+). A lumbar puncture is performed and rules out neurosyphilis. He has never been treated for syphilis and has latent syphilis of unknown duration. Which of the following is most appropriate for this patient at this time?
A. Patient is asymptomatic and treatment is not required; however, potential contacts should be identified and tested. B. Administer ceftriaxone (Rocephin®) 250 mg IM q week x 3 doses C. Administer penicilling G benzathine 500 mg IM x 1 dose D. Admiinister penicillin G benzathine 2.4 mU IM q week x 3 doses |
D. Admiinister penicillin G benzathine 2.4 mU IM q week x 3 doses
Three weekly doses of benazathine penicillin G are recommended for treatment of late latent syphilis or syphilis of unknown duration. Therefore, option D is the correct answer. |
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RK is a 28 year old male who reports to the health department with a 3 days history of mucoid urethral discharge and dysuria. He reports having unprotected sex 10 days ago. A gram stain of the urethral secretion reveals WBCs and no bacteria. He is diagnosed with nongonococcal urethritis. Which of the following is most appropriate for this patient at this time?
A. Azithromycin (Zithromax®) 1 g po x 1 dose B. Doxycycline (Vibramycin®) 100 mg po qd x 7 days+ ceftriaxone (Rocephin®) 125 mg IM x 1 dose for likely co-infection with Neisseria gonorrhea C. Levofloxacin (Levaquin®) 500 mg po x 1 dose D. Azithromycin (Zithromax®) 1 g po x 1 dose + ceftriaxone (Rocephin®) 125 mg IM x 1 dose for likely co-infection with Neisseria gonorrhea |
A. Azithromycin (Zithromax®) 1 g po x 1 dose
Patient has non-gonococcal urethritis so therapy should consist of azithromycin or doxycycline. Although all cases of gonorrhea should provide coverage for likely co-infection of Chlamydia, the reverse is not true. Therefore, option A is the correct answer. |
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KB is a 19 year old female who is seen at the health department with a 2 day history of dysuria, vaginal itching, and painful genital sores. She states that she had unprotected sex 1 week prior when she was on a cruise for spring break. She was treated last year for Chlamydia infection but has been otherwise healthy. Upon physical exam, the clinician notes multiple vesicular lesions on the patient’s labia. She is diagnosed with probable genital herpes and a specimen is sent for confirmatory testing. Which of the following is most appropriate for this patient at this time?
A. Do nothing, antivirals are ineffective if not initiated within 1st day of lesion onset B. Acyclovir (Zovirax®) 800 mg qd x 10 days C. Valacyclovir (Valtrex®) 1000 mg bid x 7 days D. Famciclovir (Famvir®) 250 mg bid x 5 days E. Valacyclovir (Valtrex®) 500 mg qd x 3 days |
C. Valacyclovir (Valtrex®) 1000 mg bid x 7 days
Treatment of a first clinical episode of genital herpes should consist of a 7-10 day course of acyclovir, famciclovir, or valacyclovir. Dose for acyclovir in B is incorrect, dose and duration of thearapy in D and E are incorrect. |
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SB is a 25 year old female who is seen at the health department with a 3 day history of diffuse malodorous vaginal discharge. Microscopic examination of the discharge reveals protozoa consistent with Trichomona vaginalis. Which of the following is most appropriate for this patient at this time?
A. Clindamycin (Cleocin®) 2% cream intravaginally qd x 7 days B. Metronidazole (Flagyl®) 2000 mg po x 1 dose C. Imiquimod (Aldara®) 5% cream applied 3 times per week x 4 weeks D. Clindamycin (Cleocin®) 450 mg po tid E. Levofloxacin (Levaquin®) 500 mg po x 1 dose |
B. Metronidazole (Flagyl®) 2000 mg po x 1 dose
Recommended regimen for Trichomonas vaginalis is single dose metronidazole or 7 day course of metronidazole; therefore, option B is the correct answer. |
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SJ is a 19 year old female sophomore at the University of Florida who recently returned from a Spring Break trip in Key West. Two days after returning, she reports to the Alachua County Health Department with a 1 day history of dysuria, vaginal itching, and multiple painful vaginal ulcers. The clinician sends a swab of the vaginal ulcers for culture and empirically begins treatment for genital herpes. What treatment is most appropriate?
A. Valacyclovir (Valtrex) 1g po bid x 7 days B. Famciclovir (Famvir) 500 mg po qd x 5 days C. Valganciclovir (Valcyte) 900 mg po bid x 7 days D. Acyclovir (Zovirax) 400 mg po bid x 5 days |
A. Valacyclovir (Valtrex) 1g po bid x 7 days
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2. JK is a 23 year old who reports to her physicians office for a routine yearly pelvic exam. She reports having vaginal itching and a “fishy” smell from her vagina. The physician observed the following: homogenous, white, noninflammatory discharge that coats the vaginal walls, clue cells on microscopic exam of vaginal discharge, and positive “whiff test” (fishy odor of vaginal discharge after addition of 10% KOH). JK’s physician believe that she has bacterial vaginosis. Which of the following is the most appropriate recommendation?
A. Do nothing, no treatment necessary B. Doxycycline (Vibramycin) 100 mg po bid x 7 days C. Azithromycin (Zithromax) 1 g po x 1 dose D. Metronidazole (Flagyl) 500 mg po bid x 7 days |
D. Metronidazole (Flagyl) 500 mg po bid x 7 days
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PJ is a 26 year old male who reports to the health department with a 5 day history of mucopurulent penile discharge. A gram stain of the penile discharge reveals 15 WBCs (white blood cells) per oil immersion field and no diplococci. The penile discharge is sent for culture. PJ’s physician believes that he has non-gonoccocal urethritis. Which of the following is the most appropriate recommendation?
A. Doxycyline (Vibramycin) 100 mg po bid x 7 days PLUS ceftriaxone (Rocephin) 125 mg IM x 1 dose for probable co-infection with Gonorrhea B. Azithromycin (Zithromax) 1g po x 1 dose C. Metronidazole (Flagyl) 2 g po x 1 dose D. Azithromycin (Zithromax) 1g po x 1 dose PLUS levofloxacin (Levaquin) 250 mg po x 1 dose for probable co-infection with Gonorrhea |
B. Azithromycin (Zithromax) 1g po x 1 dose
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RW is a 43 year-old who recently found out that he has HIV infection. He is asymptomatic. Baseline tests performed at his physicians office are as follows: CMV IgG (+), Toxo IgG (+), PPD (-), RPR (rapid plasma reagent) 1:32, FTA-ABS (fluorescent treponemal antibody absorbed) (+). A lumbar puncture is performed and shows WBCs 50 cells/mm3, protein 100 mg/dL, and positive CSF-VDRL (veneral disease research laboratory). He is allergic to penicillin (reported anaphylaxis as a child). RW’s physician believes that he has syphilis. Which of the following is the most appropriate recommendation?
A. Do nothing, patient is asymptomatic and treatment is not required B. Perform penicillin skin test, desensitize if positive, and give aqueous penicillin G 24 million units (mu) per day via continuous infusion pump C. Place patient on ceftriaxone (Rocephin) 2 gm IM qd x 7 days (monitor for allergic reaction) D. Perform penicillin skin test, desensitize if positive, and give benazthine penicillin G 2.4 million units (mu) IM q week x 3 weeks |
B. Perform penicillin skin test, desensitize if positive, and give aqueous penicillin G 24 million units (mu) per day via continuous infusion pump
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JK is a 23 year old who reports to her physicians office for a routine yearly pelvic exam. A week later she is called to return to the physician’s office. Her vaginal culture showed Trichomonas vaginalis. Which of the following is the most appropriate recommendation?
A. Metronidazole (Flagyl) 2g po x 1 dose B. Doxycycline (Vibramycin) 100 mg po bid x 7 days C. Azithromycin (Zithromax) 1 g po x 1 dose D. Metronidazole (Flagyl) 500 mg po qid x 5 days |
A. Metronidazole (Flagyl) 2g po x 1 dose
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