CMN 572 EXAMS EVALUATION TIPS QUESTIONS AND
ANSWERS GRADED A+
✔✔Treatment of Lymphogranuloma Venereum (LGV) - ✔✔caused by C.
trachomatis:The most common clinical manifestation of LGV among heterosexuals is
tender inguinal and/or femoral lymphadenopathy that is typically unilateral.
CDC-recommended regimen
Doxycycline
✔✔Repeat Testing after Chlamydia Treatment - ✔✔Pregnant women: Repeat testing,
preferably by NAAT, 3 weeks after completion of recommended therapy & again in 3
mo.
Non-pregnant women:Test of cure not recommended unless compliance is in question,
symptoms persist, or re-infection is suspected
Repeat testing recommended 3-4 months after treatment, especially adolescents due to
high prevalence of repeated infection
Screen at next health care visit
✔✔Chlamyida Screening Recommendations: Non-pregnant Women - ✔✔Sexually
active women<25 years-annually
Women >25 years: screened if risk factors are present (new partner, > 1 partner,
partner with STD)
Repeat testing of all women 3-4 months after treatment for C. trachomatis infection,
especially adolescents.
Repeat testing of all women treated for C. trachomatis when they next present for care
within 12 months
✔✔Chlaymdia Screening Recommendations: Pregnant Women - ✔✔Screen all
pregnant women at the first prenatal visit.
Pregnant women aged <25 years and those at increased risk for chlamydia should be
screened again in the third trimester.
✔✔Chlamydia partner management & reporting: - ✔✔Sex partners should be
evaluated, tested, and treated if they had sexual contact with the patient during the 60
days prior to onset of symptoms or diagnosis of chlamydia.
Most recent sex partner should be evaluated and treated even if the time of the last
sexual contact was >60 days before symptom onset or diagnosis
,Abstain from sexual intercourse until partners are treated and for 7 days after a single
dose of azithromycin or until completion of a 7-day regimen.
Chlamydia is a reportable STD in all states: Report cases to the local or state STD
program
✔✔Gonorrhea risk factors - ✔✔Multiple or new sex partners
inconsistent condom use
Urban residence areas with disease prevalence
Adolescents, females particularly
Lower socio-economic status
Use of drugs
African Americans
✔✔Gonorrhea transmission - ✔✔Male to female via semen
Female to male urethra
Rectal intercourse
Fellatio (pharyngeal infection)
Perinatal transmission (mother to infant)
*Gonorrhea associated with increased transmission of and susceptibility to HIV
✔✔gonorrhea associated infections in men & women: - ✔✔Urethritis (most women
asymptomatic), Epididymitis, Cervititis
✔✔epididymitis symptoms - ✔✔unilateral testicular pain and swelling
Infrequent, but most common local
complication in males
Usually associated with overt or subclinical urethritis
✔✔Cervicitis symptoms include - ✔✔abnormal vaginal discharge, intermenstrual
bleeding, dysuria, lower abdominal pain, or dyspareunia
Clinical findings: mucopurulent or purulent cervical discharge, easily induced cervical
bleeding
50% of women with clinical cervicitis have no symptoms
Incubation period unclear, but symptoms may occur within 10 days of infection
✔✔gonorrhea associated complications in women: - ✔✔Accessory gland infection
Bartholin's glands (bilat posterior to vaginal
opening)
Skene's glands ( anterior wall of the vagina
, around the lower end of the urethra)
Pelvic Inflammatory Disease (PID)
Fitz-Hugh-Curtis Syndrome (Perihepatitis)
✔✔associated infections with gonorrhea: - ✔✔Anorectal infection-Usually asymptomatic
Symptoms: anal irritation, painful defecation, constipation, scant rectal bleeding,
painless mucopurulent discharge, tenesmus, and anal pruritus
Evaluate utilizing an anoscopic examination
Signs: mucosa may appear normal, or purulent discharge, erythema, or easily induced
bleeding may be observed with anoscopic exam
Pharyngeal infection
May be sole site of infection if oral-genital contact is the only exposure
Most often asymptomatic, but symptoms, if present, may include pharyngitis, tonsillitis,
fever and cervical adenitis
✔✔associated sites of gonorrhea infection in birth/children - ✔✔Perinatal: infections of
the conjunctiva, pharynx, respiratory tract
Older children (>1 year): considered possible evidence of sexual abuse
Vulvovaginitis, not cervicitis, in prepubesient girls
Anorectum or pharynx more commonly infected in boys than urethra
✔✔Diagnostic methods to diagnose gonorrhea - ✔✔culture-pref for legal cases
NAATs
swab: urethra in men, cervix/vagina in women
rectum/pharynx with assoc patient symptoms
✔✔Treatment for Uncomplicated Infections of the Cervix, Urethra, Rectum, Pharynx -
✔✔Ceftriaxone IM in a single dose
PLUS
Azithromycin 1 g orally in a single dose
same tx with pregnancy
✔✔considerations in treatment if patient has penicillin allergy: - ✔✔Cross reaction to
Cephalosporins occurs in <2.5% of penicillin-allergic patients and is less frequent with
3rd generation Cephalosporins(cef-).
Use of Cephalosporins is only contraindicated in those with severe reactions to
Penicillin (anaphylaxis, Stevens-Johnson Syndrome or TEN)
✔✔follow-up recommendations post gonorrhea treatment - ✔✔A test of cure is not
recommended if a recommended regimen is administered
ANSWERS GRADED A+
✔✔Treatment of Lymphogranuloma Venereum (LGV) - ✔✔caused by C.
trachomatis:The most common clinical manifestation of LGV among heterosexuals is
tender inguinal and/or femoral lymphadenopathy that is typically unilateral.
CDC-recommended regimen
Doxycycline
✔✔Repeat Testing after Chlamydia Treatment - ✔✔Pregnant women: Repeat testing,
preferably by NAAT, 3 weeks after completion of recommended therapy & again in 3
mo.
Non-pregnant women:Test of cure not recommended unless compliance is in question,
symptoms persist, or re-infection is suspected
Repeat testing recommended 3-4 months after treatment, especially adolescents due to
high prevalence of repeated infection
Screen at next health care visit
✔✔Chlamyida Screening Recommendations: Non-pregnant Women - ✔✔Sexually
active women<25 years-annually
Women >25 years: screened if risk factors are present (new partner, > 1 partner,
partner with STD)
Repeat testing of all women 3-4 months after treatment for C. trachomatis infection,
especially adolescents.
Repeat testing of all women treated for C. trachomatis when they next present for care
within 12 months
✔✔Chlaymdia Screening Recommendations: Pregnant Women - ✔✔Screen all
pregnant women at the first prenatal visit.
Pregnant women aged <25 years and those at increased risk for chlamydia should be
screened again in the third trimester.
✔✔Chlamydia partner management & reporting: - ✔✔Sex partners should be
evaluated, tested, and treated if they had sexual contact with the patient during the 60
days prior to onset of symptoms or diagnosis of chlamydia.
Most recent sex partner should be evaluated and treated even if the time of the last
sexual contact was >60 days before symptom onset or diagnosis
,Abstain from sexual intercourse until partners are treated and for 7 days after a single
dose of azithromycin or until completion of a 7-day regimen.
Chlamydia is a reportable STD in all states: Report cases to the local or state STD
program
✔✔Gonorrhea risk factors - ✔✔Multiple or new sex partners
inconsistent condom use
Urban residence areas with disease prevalence
Adolescents, females particularly
Lower socio-economic status
Use of drugs
African Americans
✔✔Gonorrhea transmission - ✔✔Male to female via semen
Female to male urethra
Rectal intercourse
Fellatio (pharyngeal infection)
Perinatal transmission (mother to infant)
*Gonorrhea associated with increased transmission of and susceptibility to HIV
✔✔gonorrhea associated infections in men & women: - ✔✔Urethritis (most women
asymptomatic), Epididymitis, Cervititis
✔✔epididymitis symptoms - ✔✔unilateral testicular pain and swelling
Infrequent, but most common local
complication in males
Usually associated with overt or subclinical urethritis
✔✔Cervicitis symptoms include - ✔✔abnormal vaginal discharge, intermenstrual
bleeding, dysuria, lower abdominal pain, or dyspareunia
Clinical findings: mucopurulent or purulent cervical discharge, easily induced cervical
bleeding
50% of women with clinical cervicitis have no symptoms
Incubation period unclear, but symptoms may occur within 10 days of infection
✔✔gonorrhea associated complications in women: - ✔✔Accessory gland infection
Bartholin's glands (bilat posterior to vaginal
opening)
Skene's glands ( anterior wall of the vagina
, around the lower end of the urethra)
Pelvic Inflammatory Disease (PID)
Fitz-Hugh-Curtis Syndrome (Perihepatitis)
✔✔associated infections with gonorrhea: - ✔✔Anorectal infection-Usually asymptomatic
Symptoms: anal irritation, painful defecation, constipation, scant rectal bleeding,
painless mucopurulent discharge, tenesmus, and anal pruritus
Evaluate utilizing an anoscopic examination
Signs: mucosa may appear normal, or purulent discharge, erythema, or easily induced
bleeding may be observed with anoscopic exam
Pharyngeal infection
May be sole site of infection if oral-genital contact is the only exposure
Most often asymptomatic, but symptoms, if present, may include pharyngitis, tonsillitis,
fever and cervical adenitis
✔✔associated sites of gonorrhea infection in birth/children - ✔✔Perinatal: infections of
the conjunctiva, pharynx, respiratory tract
Older children (>1 year): considered possible evidence of sexual abuse
Vulvovaginitis, not cervicitis, in prepubesient girls
Anorectum or pharynx more commonly infected in boys than urethra
✔✔Diagnostic methods to diagnose gonorrhea - ✔✔culture-pref for legal cases
NAATs
swab: urethra in men, cervix/vagina in women
rectum/pharynx with assoc patient symptoms
✔✔Treatment for Uncomplicated Infections of the Cervix, Urethra, Rectum, Pharynx -
✔✔Ceftriaxone IM in a single dose
PLUS
Azithromycin 1 g orally in a single dose
same tx with pregnancy
✔✔considerations in treatment if patient has penicillin allergy: - ✔✔Cross reaction to
Cephalosporins occurs in <2.5% of penicillin-allergic patients and is less frequent with
3rd generation Cephalosporins(cef-).
Use of Cephalosporins is only contraindicated in those with severe reactions to
Penicillin (anaphylaxis, Stevens-Johnson Syndrome or TEN)
✔✔follow-up recommendations post gonorrhea treatment - ✔✔A test of cure is not
recommended if a recommended regimen is administered
