APEA 3P Prep2-Sexual Health Questions with Answers and explanation,100%CORRECT

APEA 3P Prep2-Sexual Health Questions with Answers and explanation A patient being treated for trichomoniasis receives a prescription for metronidazole. What instructions should she be given? Take this medication with food Do not take this medication if you are pregnant Take this medication on an empty stomach Alcohol should be avoided when taking this medication D. Metronidazole may be associated with a disulfiram reaction when mixed with alcohol. Advice that should be given to all patients who take metronidazole is to avoid alcohol entirely while this medication is being taken. Additionally, alcohol should be avoided for 24 hours after the last dose of medication. The disulfiram reaction is characterized by fever, abdominal pain, nausea, vomiting, and headache. This reaction is called the “Antabuse” reaction. The risk of HIV transmission is increased: when other STDs are present. in females. when patients are aware of their HIV status. in patients with diabetes. A. There are several risk factors for HIV transmission. Viral load is likely the greatest risk factor. The presence of STDs increases the risk of HIV transmission. Specifically, the presence of chlamydia increases the risk of acquiring HIV by 5 times. Lack of circumcision increases the risk of transmission. A patient requests screening for HIV after a sexual exposure. What are CDC’s recommendations for screening for this patient? There are no recommendations for screening. She should be screened today, with repeat screening at 4-6 weeks, and 3 months. She should be rescreened in 6-12 months She only requires screening if she develops symptoms of HIV B. She does require further screening because a negative initial result does not insure that she is not infected. This signifies that she has not seroconverted at this time. The period within 3 months after exposure is termed the “window period” and a negative screen must be confirmed. If a 4th generation assay is used and the screen is negative 3 months after the last exposure, and there is no concern for coinfection with hepatitis C at the time of HIV exposure, she is considered to be negative. HIV screening should be performed in any patient who develops symptoms consistent with HIV after an exposure. A 24-year-old female presents with abdominal pain. What additional finding supports a diagnosis of pelvic inflammatory disease (PID)? Dysuria Vaginal discharge Positive RPR Cervical motion tenderness D. PID is difficult to diagnose and often goes unrecognized because of the varied presenting signs and symptoms in women who have it. Delay in diagnosis contributes to inflammatory sequelae in the upper reproductive tract. Consequently, PID is usually diagnosed on imprecise clinical findings. The CDC recommends that healthcare providers maintain a low threshold for diagnosis of PID. Presumptive treatment should be initiated in sexually active women if they are experiencing pelvic or low abdominal pain (without another identifiable source of illness), and if one or more of the following criteria are present on pelvic exam: cervical motion tenderness, uterine tenderness, or adnexal tenderness. A male patient presents with dysuria and penile discharge. He states that his female partner has an STD, but he is not sure which one. Which of these should be part of the differential? Bacterial vaginosis and trichomonas Chlamydia and gonorrhea HIV and herpes Syphilis and chlamydia B. Bacterial vaginosis and HIV are not associated with dysuria or penile discharge in male patients. Herpes produces lesions that are painful. HIV is not specifically associated with dysuria. Syphilis produces a painless lesion. Chlamydia and gonorrhea are usually associated with dysuria and discharge. Trichomonas is often asymptomatic in males, but can produce dysuria. A 27-year-old asymptomatic male presents with generalized lymphadenopathy. He has multiple sexual partners and infrequently uses condoms. Of the following choices, what test should be performed? HIV test RPR Lymph node biopsy Sedimentation rate A. During asymptomatic HIV infection, patients often have persistent generalized lymphadenopathy (PGL). PGL is defined as enlarged lymph nodes involving at least two noncontiguous sites other than inguinal nodes. The lymphatic tissue serves as a primary reservoir for HIV. Studies of lymph nodes in patients at the asymptomatic phase demonstrate high concentrations of HIV. A 23-year-old female who is homeless presents to the free clinic. She should be screened for: TB, HIV, and hepatitis. pregnancy, headaches, and STDs. urinary tract infection and STDs. diabetes, HIV, and neuropathy. A. The most common diseases in the homeless population are not seen in the same proportion in the general population. These include hepatitis, HIV, STDs, pregnancy in females, TB, skin and foot problems, and late immunizations, especially tetanus. When given the opportunity, screenings and treatment should take place when appropriate. A female patient and her male partner are diagnosed with trichomonas. She has complaints of vulval itching and discharge. He is asymptomatic. How should they be treated? She should receive metronidazole; he does not need treatment. They both should receive metronidazole. She should be treated with ceftriaxone; he should receive ciprofloxacin. They both should be treated with azithromycin and doxycycline. B. Metronidazole is considered the drug of choice to treat males and females. Even though he is asymptomatic, he needs treatment too. Neither partner should resume sexual intercourse until both have been treated. Tinidazole can also be used for treatment. 2 grams of either agent may be given as a single-dose treatment. Alcohol should be avoided for 24 hours if metronidazole is taken; 72 hours if tinidazole is taken. How long should a patient be treated with antibiotics if he has prostatitis secondary to an STD? 3 days 5 days 7-10 days 14 days or longer D. The prostate gland does not absorb antibiotics very readily. Consequently, antibiotics must be given for 2-6 weeks to enable the gland to achieve high enough concentrations to treat and effectively eradicate the organism causing prostatitis. Treatment can be expensive depending on the antibiotic used. A 30-year-old male who is sexually active complains of pain during bowel movements. The digital rectal examination is negative for hemorrhoids, but the prostate gland is tender. What should be suspected? Acute bacterial prostatitis Prostate cancer Benign prostatic hyperplasia Trichomoniasis A. This patient probably has acute bacterial prostatitis. A common presenting symptom is prostate tenderness, especially with bowel movements. A common cause in a 30-year-old male who is sexually active is infection with chlamydia or gonorrhea. He should be screened for sexually transmitted diseases. If these are negative, a urinary pathogen is the likely cause. Which of the following statements regarding HIV is correct? There are few conditions that cause depletion of CD4 cells other than HIV. CD4 cell counts vary greatly in immunocompetent individuals A normal CD4 count is < 200/mm3 CD4 counts are the first abnormality seen in patients with HIV A. HIV specifically attacks the number of circulating CD4 cells. There is little variability in CD4 counts in immunocompetent adults. There are a number of factors that will cause minor fluctuation in counts. These include things like seasonal and diurnal variations, infections, and steroid intake. The normal CD4 cell count ranges from 800-1050/mm3. Every year after infection with HIV, the CD4 cell count decreases by about 50/mm3 per year. There is great variation in individual decreases. Some patients experience very little decrease in counts, other patients experience great decreases in counts. Oral antiretroviral agents slow down the CD4 decreases. A 26-year-old HIV-positive patient presents with photophobia and a temperature of 103.2° F. He complains of a headache. On exam, he is unable to demonstrate full extension of the knee when his hip is flexed. Which choice below is the most likely diagnosis? Pneumocystis infection Meningitis Septic bursitis Septic arthritis B. The inability to demonstrate full extension of the knee when the hip is flexed is a positive Brudzinski's sign. This is present in patients who have meningitis. It is not present in patients who have septic bursitis or septic arthritis. HIV-positive patients are more likely to exhibit pneumonia secondary to pneumocystis infection, but he has no respiratory symptoms. Which of the following describes the most common clinical presentation of trichomonas in a male? No clinical symptoms Urethritis Burning with urination Testicular pain A. Trichomonas produces classic symptoms in females of itching and discharge. In males, there are usually no symptoms. Less than 10% of time, men present with symptoms. However, when symptoms occur in males, they include urethritis with clear or mucopurulent urethral discharge and dysuria. Metronidazole can be used to treat this in symptomatic and asymptomatic patients. Prostatodynia, also known as prostatitis, is an inflammation of the prostate gland. Sometimes males with trichomonas infections present with prostatodynia, but this is not the usual presentation. In a private NP clinic, a patient presents with trichomonas. State law requires reporting of STDs to the public health department. The patient asks the NP not to report it because her husband works in the public health department. How should this be managed by the NP? Respect the patient’s right to privacy and not report it Tell the patient that it won’t be reported, but report it anyway Report it to public health as required by law. Report it to public health but don’t divulge all the details C. If state law requires reporting of the STD, it should be reported. Patient names or other identifying data are not part of the reporting process, so the NP’s patient should not worry about being identified and associated with this finding. If the NP does not report it, the NP has violated state law. If the NP reports it but doesn’t tell the patient, the NP is not being honest with the patient. Reporting data to public health with deliberate elimination of required illness details is inaccurate reporting and doesn’t meet state law. Which risk factor has the greatest impact on HIV transmission? Viral load Type of sexual activity Presence of other STDs Patient gender A. Viral load at the time of infection is the greatest risk factor in contracting HIV. It also is the greatest predictor of prognosis. High levels of viremia correspond to higher rates of infection. There are equal rates of transmission in sexual intercourse between same and opposite sex couples. The presence of STDs at the time of infection does increase risk of transmission, but not to as great an extent as viral load. A female patient has been diagnosed with chlamydia. How should this be managed? Treat with azithromycin Treat with ceftriaxone by injection Treat with doxycycline Treat for gonorrhea also A. Chlamydia is commonly treated with a single dose of azithromycin (1 gram). This patient should be screened for other STDs now, including hepatitis B, C and HIV. According to the 2015 STD guidelines, this patient should not be treated for gonorrhea unless this is diagnosed too. A 26-year-old female patient has been diagnosed with gonorrhea. How should she be managed? Ceftriaxone only Ceftriaxone and azithromycin Cefixime and azithromycin Penicillin G B. In 2015, the CDC released its most recent guidelines for management of STDs. Cefixime is no longer recommended as a cephalosporin for treatment of gonorrhea because of cephalosporin-resistant strains of gonorrhea. 250 mg ceftriaxone should be given IM in conjunction with 1 gram azithromycin by mouth when gonorrhea is diagnosed. Treatment failure should be reported to CDC. A 32-year-old female was exposed to HIV after sexual intercourse. When do the majority of patients seroconvert if they are going to do so? 1 week Within 4 weeks Within 4-6 weeks Within 3 months D. Seroconversion within 3 months is likely to occur in patients who are immunocompetent. Seroconversion may be delayed up to 6 months in patients who concurrently acquired hepatitis C at the time of HIV exposure. A male with gonorrhea might complain of: dysuria. a penile lesion. abdominal pain. fatigue. A. In males, gonorrhea can have a varied presentation. Gonorrhea produces a purulent inflammation of the mucous membranes, urethral discharge, and dysuria. It can be diagnosed with a urethral culture, a urine screen, or nucleic acid tests. Urine screens are first choice in males; vaginal swabs are preferred in females. Urine screens are used in adolescents or pediatric patients because of ease of specimen collection. The greatest risk of transmitting HIV is during: the acute phase. the time that detectable antibody is present. high viral load periods. late infection phase. C. The period of time that risk of transmission is greatest is when the viral load is high. Many times this is before a patient has been diagnosed; thus he is capable of transmitting this disease without knowledge that he is doing so. The highest viral load may occur during the earliest stages of HIV and before there is detectable antibody. A 35-year-old patient is HIV positive. Which finding on an oral swab may be indicative of thrush? Epithelial cells Yeast Spores Red blood cells B. The visualization of yeast in saliva usually indicates Candida species. Yeast are commonly seen in patients who have thrush, vaginitis secondary to yeast, or intertrigo. While thrush is uncommon in adults, it is not uncommon in patients who are immunocompromised, such as a patient with HIV. A 25-year-old female presents with lower abdominal pain. Which finding would indicate the etiology as a pelvic inflammatory disease? Presence of hyphae Hematuria Temperature > 101°F Normal sedimentation rate C. Symptoms of pelvic inflammatory disorder (PID) include oral temperature > 101° F (38.8° C), abnormal cervical or vaginal mucopurulent discharge, presence of abundant WBCs on microscopy or vaginal secretions, elevated sedimentation rate or C-reactive protein. The CDC recommends empiric treatment for PID if lower abdominal pain or pelvic pain is present concurrently with cervical motion tenderness or uterine/adnexal tenderness. An example of primary prevention is: using a condom to prevent infection with an STD. diagnosis of chlamydia prior to symptom development. treatment of chlamydia concurrently with gonorrhea. early treatment of sexual partners. A. Primary prevention refers to preventing an event prior to its occurrence. Using a condom to prevent infection from an STD is primary prevention. Early diagnosis refers to secondary prevention. Tertiary prevention refers to an intervention that has the potential to prevent worsening of the disease. Chancroid is considered a cofactor for transmission of: HIV. gonorrhea. chlamydia. trichomoniasis. A. Chancroid is an STD caused by Haemophilus ducreyi. It is spread by sexual contact or by contacting pus from an infected lesion. This is common in tropical countries but can occur in the US. The ulcer is usually very painful in men, but not usually painful in women. The ulcer begins as a papule, fills with pus, and becomes an open, eroded area. Chancroid is a cofactor in the transmission of HIV. In patients with HIV, the chancroid heals much more slowly than in patients who are immunocompetent. A patient with newly diagnosed genital herpes would appropriately receive a prescription for: cryotherapy. ceftriaxone. Imiquimod. famciclovir. D. Genital herpes is a viral infection affecting the mucous membranes. Some learned authorities consider this to be the most common STD in the United States. Herpes is treated with an oral antiviral agent like valacyclovir, acyclovir, or famciclovir. It is initially prescribed for 7-14 days. Shorter dosing periods may be given after the initial infection has been treated. Suppressive therapy is initiated when patients have multiple outbreaks. The oral antiviral agents are dosed daily for suppressive therapy and given for at least 1 year. A 21-year-old female presents with six 0.5-cm human papillomavirus (HPV) lesions on her vulva. An appropriate treatment option for this patient would be: acetic acid. Colposcopy podophyllin. acyclovir. C. This patient has HPV. This is a viral infection that increases a woman’s risk of cervical cancer. In males, HPV causes an increased risk of cancer of the anus and penis. Warts that are produced are painless and usually appear within weeks of infection. There are several topical treatments for HPV, including imiquimod, podophyllin, and trichloroacetic acid (TCA). One of these agents may be applied to warts. Treatments are generally well tolerated. TCA may cause burning. Warts will slough off after one or more treatments. There are no oral antiviral agents indicated for the treatment of HPV. Syphilis may present as: a discharge. a rash. a painful lesion. dysuria. B. Secondary syphilis can present as a rash on the body, but more commonly as a rash on the palms of the hands or soles of the feet. This can persist for up to 6 weeks. It will resolve without treatment, however, the patient will still be infected with syphilis. Primary syphilis is characterized by a chancre. This is a painless lesion that can persist for 1-5 weeks. It will resolve without treatment. A patient was exposed to HIV through sexual intercourse last night. He was screened and found to be negative for HIV. When should he be screened again? 4-6 weeks 8 weeks 3 months 6 months A. According to the 2016 CDC recommendations for non-occupational HIV exposure, a screening interval of 4-6 weeks is recommended following initial negative testing. Repeat testing 3 months after exposure should take place to determine if HIV seroconversion has occurred. Seroconversion within 3 months is likely to occur in patients who are immunocompetent. Seroconversion may be delayed up to 6 months in patients who concurrently acquired hepatitis C at the time of HIV exposure. How should a patient with suspected syphilis be screened? Ask about symptoms in the patient Ask about symptoms of sexual partners A urethral swab for culture A serum assessment D. Patients can be screened for syphilis in three ways. The nontreponemal tests are VDRL (venereal disease research laboratory), RPR (rapid plasma reagin) or TRUST (toluidine red unheated serum test) tests. The main use of the treponemal tests is to confirm positive nontreponemal tests. These results are reported as reactive or nonreactive and are quantitative in nature, which is why they are used as confirmatory tests.