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2015 Sexually Transmitted Diseases Treatment Guidelines

Clinical Prevention Guidance

1. The prevention and control of STDs are based each of the following strategies EXCEPT:

A. Accurate risk assessment, education, and counseling of persons at risk on ways to avoid STD’s through changes in sexual behaviors and use of recommended prevention services

B. Pre-exposure vaccination of persons at risk for vaccine-preventable STDs, and identification of asymptomatically infected persons and persons with symptoms associated with STDs

C. Effective diagnosis, treatment, counseling, and follow up of infected persons

D. Alleviation of signs through the most cost effective system available


STD/HIV Prevention Counseling

2. After obtaining a sexual history from their patients, all health providers should encourage risk reduction by providing prevention counseling in a nonjudgmental and empathetic manner.  

A. True

B. False


Female Condoms

3. The use of female condoms can provide protection from acquisition and transmission of STDs and although they are more costly comparted with male condoms, they offer the advantage of being a female-controlled STD/HIV prevention method.  

A. True

B. False


Special Populations-Pregnant Women

4. All pregnant women in the United States should be screened for HIV infection at the first prenatal visit, unless they have been tested within the previous six months.

A. True

B. False


Children

5. In children, when certain STD’s such as gonorrhea, syphilis and chlamydia are acquired after the neonatal period, it is likely that sexual contact has occurred, although with diseases such as _____________________, association with sexual activity is not as clear.

A. Herpes and urethritis

B. HPV infection and vaginitis

C. Cervicitis and trichomoniasis

D. Pelvic inflammatory disease (PID) and epididymitis


Transgender Men

6. The few studies of HIV prevalence and incidence in transgender man suggest that they tend to engage in risky behavior and that they have higher prevalence of HIV than transgender women.

A. True

B. False


Emerging Issues-Hepatitis C

7. Which of the following is NOT a correct statement about HCV infection?

A. Studies of HCV transmissions between heterosexual or homosexual couples have found either no or very minimally increased rates of HCV infection in partners of persons with HCV infection compared with those whose partners are not HCV-infected

B. Sexual transmission of HCV can occur, especially among persons with HIV infection

C. Even HCV infected persons with one long-term, steady sex partner need to change their sexual practices in order to protect themselves

D. Practices associated with new cases of HCV include high-risk sex among MSM, group sex, and use of cocaine during sex


HIV Infection: Detection, Counseling and Referral

8. Despite the availability of effective antiretroviral therapy, many cases of HIV infection continue to be diagnosed at advanced stages, as evidenced by low CD4 cell counts.

A. True

B. False


Diagnosing HIV Infection

9. Specific recommendations that apply to testing for HIV infection include:  

A. HIV screening is recommended for all persons who seek evaluation or treatment and should be performed at the time of STD diagnosis

B. HIV testing must be voluntary and free from coercion, and HIV screening opt-out is recommended in all health-care setting

C. Specific signed consent for HIV testing should not be required, as general informed consent for medical care is considered sufficient to encompass informed consent for HIV testing

D. All of the above


Management of Sex Partners and Injection-Drug Partners

10. Partner notification is an important component of HIV disease management, because early diagnosis and treatment of HIV reduces risk for HIV transmission, decreases individual morbidity and mortality risk, and provides the opportunity to modify risk behaviors.

A. True

B. False


Diseases Characterized by Genital, Anal, or Perianal Ulcers

11. In the United States, most young sexually active patients who have genital, anal, or perianal ulcers have genital herpes or:

A. Syphilis

B. HPV

C. Gonorrhea

D. Candida Vaginitis


Genital HSV Infections

12. Genital herpes is caused by HSV-1 and HSV-2, and while most cases are caused by HSV-1, an increasing proportion of anogenital herpetic infections have been attributed to HSV-2, which is especially common in adolescent males and MSM.

A. True

B. False


13. In addition to antiviral chemotherapy, which offers clinical benefits to most symptomatic patients with genital herpes, counseling is recommended to discuss the natural history of genital herpes, sexual and perinatal transmission, and methods to reduce transmission.

A. True

B. False


HIV Infection

14. Immunocompromised patients can have prolonged or severe episodes of genital, perianal, or oral herpes, and persons with HIV may have lesions caused by HSV that can be severe, painful and:

A. Fast-growing

B. Inflamed

C. Atypical

D. Fluid-filled


Syphilis

15. Neurological clinical manifestations of syphilis such as cranial nerve dysfunction, meningitis, stroke and acute mental status usually appear:

A. 3-6 months after infection

B. Within the first few months or years

C. Approximately 5-10 years after infection

D. 10-20 years after infection


Management of Sex Partners

16. Individuals who have had sexual contact with a person who receives a diagnosis of primary, secondary, or early latent syphilis within ________ preceding the diagnosis should be treated presumptively for early syphilis even if serologic test results are negative.

A. 30 days

B. 60 days

C. 90 days

D. 120 days


Tertiary Syphilis

17. Tertiary syphilis refers to gummas and cardiovascular syphilis but not to neurosyphilis, and all persons who have tertiary syphilis should be tested for HIV Infection and should receive a CSF examination before therapy is initiated.

A. True

B. False


Syphilis During Pregnancy-Diagnostic Considerations

18. In general, the risk for antepartum fetal infection or congenital syphilis at delivery is related to the stage of syphilis during pregnancy, with the highest risk occurring with the tertiary stage.

A. True

B. False


Special Considerations-Penicillin Allergy

19. Infants and children who require treatment for congenital syphilis but who have a history of penicillin allergy or develop an allergic reaction presumed secondary to penicillin should be desensitized and then treated with penicillin.

A. True

B. False


Diseases Characterized by Urethritis and Cervicitis

20. Urethritis, as characterized by urethral inflammation, can result from infectious and noninfectious conditions, and may accompany gonorrhea or chlamydial infection.

A. True

B. False


Chlamydial Infections in Adults and Adolescents

21. Chlamydial infection is the most frequently reported infectious disease in the United States, with the prevalence being the highest in persons aged 25-32 years.

A. True

B. False


Management of Sexual Partners

22. Each of the following accurately describes the management of sexual partners of individuals with chlamydial infection EXCEPT:

A. Sexual partners should be referred for evaluation, testing, and presumptive treatment if they had sexual contact with the partner during the 90 days preceding the patient’s onset of symptoms or chlamydia diagnosis

B. Among heterosexual patients, if health department partner management strategies are impractical or not available for persons with chlamydia and a provider is concerned that sex partners are unable to promptly access evaluation and treatment services, Expatiated Partner Therapy (EPT) should be considered as permitted by law

C. Providers should provide patients with written educational materials to give to their partner(s) about chlamydia in general, to include notification that partner(s) have been exposed, and information about the importance of treatment

D. EPT is not routinely recommended for MSM with chlamydia because of a high risk for coexisting infections among their partners, and because data are limited regarding the effectiveness of this approach in reducing persistent or recurrent chlamydia among MSM


Gonococcal Infections

23. Urethral infections caused by N. gonorrhoeae among men can produce symptoms that cause them to seek treatment, but often not soon enough to prevent transmission to others, and among women, gonococcal infections are commonly asymptomatic or might not produce recognizable symptoms until complications have occurred.

A. True

B. False


Other Management Considerations

24. To minimize disease transmission, persons treated for gonorrhea should be instructed to abstain from sexual activity for _____ after treatment and until all sexual partners are adequately treated.

A. 30 days

B. 21 days

C. 14 days

D. 7 days


Gonococcal Infections among Neonates

25. The most severe manifestations of N. gonorrhoeae infection in newborns are ophthalmic neonatorum and sepsis, which can include arthritis and:

A. Seizures

B. Meningitis

C. Infantile colic

D. All of the above


Diseases Characterized by Vaginal Discharge

26. Obtaining a medical history alone has been shown to be insufficient for accurate diagnosis of vaginitis, and can lead to the inappropriate administration of medication, so a careful history, examination, and laboratory testing to determine the etiology of vaginal symptoms are warranted.

A. True

B. False


Trichomoniasis

27. Trichomoniasis is the most prevalent nonviral sexually transmitted infection in the United States, and most infected persons have minimal or no symptoms and may go untreated for months or years.  

A. True

B. False


Special Considerations

28. Which of the following is NOT one of the likely adverse pregnancy outcomes associated with T. vaginitis?

A. Stillbirth

B. Premature rupture of membranes

C. Preterm delivery

D. Delivery of low birth weight infant


Pelvic Inflammatory Disease

29. Sexually transmitted organisms, especially N. gonorrhoeae and C. trachomatis, are implicated in many cases of PID, and recent studies suggest that the proportion of PID attributed to these organisms is rapidly increasing.

A. True

B. False


Treatment

30. The decision of whether hospitalization is necessary with PID should be based on provider judgment and whether the woman has surgical emergencies, tubo-ovarian abscess, pregnancy, severe illness, nausea, vomiting, high fever, or:

A. Is an adolescent or elderly woman

B. Has intolerable pain

C. Has a previous history of PID

D. Has an inability to follow or tolerate an outpatient oral regimen


Epididymitis

31. Acute epididymitis is a clinical syndrome consisting of pain, swelling, and inflammation of the epididymis, and among sexually active men younger than 35 years, acute epididymitis is most frequently caused by C. trachomatis or N. gonorrhoeae.

A. True

B. False


Human Papillomavirus Infection

32. Approximately 100 types of human papillomavirus infection (HPV) have been identified, most sexually active people become infected with HPV at least once in their lifetime, and most HPV infections are:  

A. Atypical but minor

B. Pruritic

C. Asymptomatic or unrecognized

D. Observable and treatable


Counseling

33. Anogenital HPV infection is very common, and the most prevalent types of HPV that cause genital warts are the same that can cause cancer of the cervix, anus, penis, vulva, and vagina.  

A. True

B. False


Anogenital Warts-Treatment

34. While treatment will generally result in resolution of anogenital warts, if left untreated they may resolve spontaneously, remain unchanged, or increase in size or number.

A. True

B. False


Follow-Up

35. Most anogenital warts respond within 3 months of therapy, but such response may be impacted by immunosuppression and treatment compliance.

A. True

B. False


HPV-Associated Cancers and Precancers

36. Once women have been diagnosed with external genital warts, they will need Pap tests more frequently than women who do not have warts.

A. True

B. False


Adolescents

37. Lesions caused by HPV in young girls are less likely to regress than those in older women, so cervical cancer screening and HPV testing are routinely recommended for adolescent females.

A. True

B. False


Viral Hepatitis-Hepatitis A

38. Hepatits A, caused by infection with the hepatitis A virus (HAV), has an incubation period of approximately ______, and it is a self-limited disease that does not result in chronic infection.  

A. 35 days

B. 28 days

C. 21 days

D. 14 days


Hepatitis B

39. In adults, approximately one third of newly acquired HBV infections are symptomatic, and approximately 5% of reported cases result in acute liver failure and death.

A. True

B. False


HIV Infection

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

A. True

B. False


41. To prevent or reduce the risk for transmission to others, in addition to vaccination, persons with Hepatitis B should be advised to:

A. Use methods to protect nonimmune sex partners from acquiring HBV infection through sexual activity until the partner can be vaccinated and immunity documented

B. Cover cuts and skin lesions to prevent spread by infectious secretions or blood

C. Refrain from donating blood, plasma, body organs, other tissue, or semen, and from sharing household articles

D. All of the above


Sexual Assault and Abuse and STDs

42. Trichomoniasis, bacterial vaginosis (BV), gonorrhea, and chlamydial infection are the most frequently diagnosed infections among women who have been sexually assaulted, although detection of these infections after an assault does not necessarily imply acquisition during the attack.

A. True

B. False


Risk for Acquiring HIV Infection

43. Which of the following is NOT one of the circumstances of sexual assault that may increase risk for HIV transmission in cases involving vaginal, anal, or oral presentation?

A. Site of exposure to ejaculate

B. Viral load of ejaculate

C. Autoimmune health of victim

D. Presence of an STD or genital lesions


Sexual Assault or Abuse of Children

44. When a child has an HBV infection, a sexual assault investigation must be initiated, as most of those cases involve sexual abuse.

A. True

B. False


Risk for Acquiring HIV Infection

45. Childen might be at higher risk for HIV acquisition than adolescent and adult sexual abuse survivors because the sexual abuse of children is frequently associated with multiple episodes of assault, and mucosal trauma might be more likely.

A. True

B. False


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