Quantum Units Education®

Clinical Prevention Guidance

1. The “Five P’s” approach to obtaining a sexual history includes each of the following EXCEPT:

Prevention Methods-Abstinence and Reduction of Number of Sex Partners

2. For persons who are being treated for an STD (or whose partners are undergoing treatment), counseling that encourages absti­nence from sexual intercourse until completion of the entire course of medication is crucial.

Condoms and N-9 Vaginal Spermicides

3. Condoms lubricated with spermicides are significantly more effec­tive than other lubricated condoms in protecting against the transmission of HIV and other STDs.

Reporting and Confidentiality

4. Syphilis, gonorrhea, chlamydia, HIV infection, AIDS, and ___________ are reportable diseases in every state.   

Pregnant Women-Recommended Screening Tests

5. Unless they have been previously vaccinated or tested, pregnant women should be tested for hepa­titis B surface antigen (HBsAg) during early prenatal visits .

Adolescents

6. Which of the following is an accurate statement about adolescents and STDs?

HIV Infection: Detection, Counseling, and Referral

7. In untreated patients, the time between HIV infection and the development of AIDS varies, ranging from a few months to many years with an estimated median time of approximately:

Counseling for Patients with HIV Infection and Referral to Support Services

8. Before leaving the testing site, those persons who test positive for HIV should receive prevention counseling which includes behavioral, psychosocial, and medical implications of HIV infection.

Diseases Characterized by Genital, Anal, or Perianal Ulcers-Genital HSV Infections

9. Genital herpes is a chronic, life-long viral infection, and there are approximately 30 million persons in the United States infected with genital herpes caused by HSV-2.

Management of Genital Herpes

10. Systemic antiviral drugs can partially control the signs and symptoms of herpes episodes when used to treat first clinical and recurrent episodes, or when used as daily suppressive therapy.

HIV Infection

11. Lesions caused by herpes simplex virus (HSV) are common among HIV-infected patients and might be severe, painful, and:

Genital Herpes in Pregnancy

12. The risk for transmission to the neonate from an infected mother is high (50%–70%) among women who acquire genital herpes near the time of delivery.

Syphilis

13. Which of the following is NOT one of the signs or symptoms of secondary syphilis infection?

Diagnostic Considerations

14. Laboratory testing is helpful in supporting the diagnosis of neurosyphilis, although no single test can be used to diagnose neurosyphilis in all instances.

Management of Sex Partners

15. Long-term sex partners of patients who have latent syphilis should be evaluated clinically and serologically for syphilis and treated on the basis of the evaluation findings.

Latent Syphilis-Treatment

16. Latent syphilis is not transmitted sexually, so the objective of treating patients with this stage of disease is to:

Special Considerations-Penicillin Allergy

17. If penicillin cannot be used, the only acceptable alternatives for the treatment of late latent syphilis or latent syphilis of unknown duration are ciprofloxacin or tinidazole.

Syphilis During Pregnancy- Other Management Considerations

18. When syphilis is diagnosed during the second half of pregnancy, medication therapy should be delayed until a sonographic fetal evaluation for congenital syphilis can be administered.

Congenital Syphilis- Evaluation and Treatment of Infants During the First Month of Life

19. Treatment decisions for Congenital Syphilis must be made on the basis of each of the following EXCEPT:

Follow-Up

20. All seroreactive infants should receive careful follow-up examinations and serologic testing every 2–3 months until the test becomes nonreactive or the titer has decreased fourfold.

Diseases Characterized by Urethritis and Cervicitis

21. Urethritis, as characterized by urethral inflammation, can result from infectious and noninfectious conditions and may or may not have symptoms.

Confirmed Urethritis

22. Clinicians should attempt to obtain objective evidence of urethral inflammation, but if clinic-based diagnostic tools are not available, patients should be treated with drug regimens effective against both __________ and chlamydia.

Treatment

23. Treatment should be initiated as soon as possible after diag­nosis, with flucloxacillin being recommended for chlamydial urethritis and doxycycline for infections with M. genitalium.

Cervicitis

24. Although cervicitis is frequently asymptomatic, some women complain of an abnormal vaginal discharge and intermenstrual vaginal bleeding.

Etiology

25. Which of the following accurately describes the etiology of cervicitis? 

Diagnosis

26. Because cervicitis might be a sign of upper-genital–tract infection, women who seek medical treatment for a new episode of cervicitis should be assessed for signs of pelvic inflammatory disease (PID). 

Special Considerations-HIV Infection

27. Treatment of cervicitis in HIV-infected women is vital because cervicitis increases cervical HIV shedding, and proper treatment may reduce HIV transmission to susceptible sex partners. 

Chlamydial Infections in Adolescents and Adults

28. Chlamydial genital infection is the most frequently reported infectious disease in the United States, and chlamydial infections in women can lead to PID, ectopic pregnancy, and:

Treatment

29. A meta-analysis of 12 randomized clinical trials of azithromycin versus doxycycline for the treatment of genital chlamydial infection demonstrated that the treatments were equally efficacious.

Management of Sex Partners

30. Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the ____ days preceding onset of the patient’s symptoms or chlamydia diagnosis.

Special Considerations- Pregnancy

31. Although doxycycline, azithromycin, and levofloxacin are contrain­dicated in pregnant women. clinical experience and published studies suggest that ofloxacin is safe and effective for treating chlamydia.

Gonococcal Infections in Adolescents and Adults

32. Gonorrhea is the second most commonly reported bacterial STDs in the United States, and an estimated __________ new N. gonor­rhoeae infections occur each year.

Antimicrobial-Resistant N. Gonorrhoeae

33. Since 2007, cephalosporins have no longer been recom­mended for the treatment of gonorrhea and associated conditions, so only one class of antimicrobials, the quinolones, is recom­mended and available for the treatment of gonorrhea in the United States.

Follow-Up

34. N. gonorrhoeae infection is prevalent among patients who have been diagnosed with and treated for gonorrhea in the preceding several months, although most infections result from reinfection rather than treatment failure.

Gonococcal Infections Among Infants

35. Gonococcal infection among infants usually is caused by exposure to infected cervical exudate, and it usually manifests 6-9 days after birth.

Gonococcal Infections Among Children

36. Sexual abuse is the most frequent cause of gonococcal infection in preadolescent children, and for preadolescent girls, _________ is the most common manifestation of this infection.

Diseases Characterized by Vaginal Discharge- Bacterial Vaginosis (BV)

37. Among women presenting for care of vaginal infection, BV is the most prevalent cause of vaginal discharge or malodor.

38. Providers should consider patient preference, _______________, drug interactions, and other co-infections when selecting a treatment regimen for BV.

Trichomoniasis

39. Diagnosis of vaginal trichomoniasis is usually performed by microscopy of vaginal secretions, but this method has a sensitivity of only approximately 60%–70% and requires immediate evaluation of the preparation slide for optimal results.

40. Metronidazole and tinidazole have been cleared by the FDA for the treatment of trichomoniasis, and recommended metronidazole regimens have resulted in cure rates of approxi­mately ______, while the recommended tinidazole regimen has resulted in cure rates of approximately ______.

Pregnancy

41. Vaginal trichomoniasis has been associated with adverse pregnancy outcomes, particularly premature rupture of membranes, preterm delivery, and low birth weight.

Vulvovaginal Candidiasis (VVC)

42. An estimated 65% of women will have at least one episode of VVC I in their lifetime, and symptoms include  vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge.

Treatment

43. Treatment of VVC with topically applied azole drugs results in relief of symptoms and negative cultures in 80%–90% of patients who complete therapy.

Pelvic Inflammatory Disease (PID)

44. PID comprises a spectrum of inflammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.

Diagnostic Characteristics

45. Which of the following is NOT one of the minimum criteria that must be present on pelvic examination in order to diagnose PID?

Treatment

46. Evidence suggests that adolescents benefit from hospitalization for treatment of PID, as younger women with mild-to-moderate acute PID have better outcomes with inpatient therapy.

Epididymitis

47. Acute epididymitis is a clinical syndrome consisting of pain, swelling, and inflammation of the epididymis that lasts less than ________, while chronic epididymitis is characterized by a longer history of symptoms of discomfort and/or pain in the scrotum, testicle, or epididymis.

Human Papillomavirus (HPV) Infection

48. There are more than 40 types of HPV which can infect the genital area, and oncogenic or high-risk HPV types are the cause of cervical cancers.

Genital Warts-Counseling

49. Which of the following is NOT one of the key counseling messages that should be conveyed to all patients diagnosed with HPV infection? 

Cervical Cancer Screening for Women Who Attend STD Clinics or Have a History of STDs

50. Women attending STD clinics for the treatment of geni­tal infection with high-risk types of Human Papillomavirus (HR-HPV) might be at increased risk for cervical cancer, as demonstrated by one study indicting an HR-HPV prevalence of 27% among women receiving treatment in an STD clinic setting.

Vaccine-Preventable STDs- Hepatitis A (HAV)

51. HAV infection is primarily transmitted by the fecal-oral route, and in the United States, almost half of all persons with hepatitis A report having no risk factor for the disease.

Hepatitis B

52. The incubation period for Hepatitis B from the time of exposure to onset of symptoms is: 

53. The Centers for Disease Control and Prevention (CDC)’s national strategy to eliminate transmission of HBV infection includes:

HIV Infection

54. HIV infection can impair the response to hepatitis B vaccina­tion, so modified dosing regimens, including a doubling of the standard antigen dose and administration of additional doses might increase the response rate.

Hepatitis C

55. Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States, and data indicates that:

HIV Infection

56. Because of the high prevalence of HIV/HCV coinfec­tion and because of critical clinical management issues for coinfected persons, all persons with HIV infection should undergo serologic testing for HCV.

Ectoparasitic Infections- Pediculosis Pubis

57. Pediculosis pubis (pubic lice) is usually transmitted by sexual contact, and partners that have had sexual contact with the patient within the previous month should be treated.

Sexual Assault and STDs

58. Human Papillomavirus, Hepatitis B, PID, and chlamydial infection are the most frequently diagnosed infections among women who have been sexually assaulted.

Evaluating Children for Sexually Transmitted Diseases

59. Examinations of children for sexual assault or abuse should be conducted in a manner designed to minimize pain and trauma to the child, and the decision to obtain genital or other specimens in order to conduct an STD evaluation must be made on an individual basis.

Follow-Up Examination After Assault

60. In circumstances in which transmission of syphilis, HIV, or hepatitis B is a concern but baseline tests are negative, examinations at 3 weeks, 2 months, and 4 months after the last suspected sexual exposure are recommended to allow time for antibodies to infectious agents to develop.