CMN 572 UNIT 1 REVIEW
EXAMINATIOND QUESTIONS WITH
COMPLETE SOLUTIONS GRADED
A+
most common pathogens causing PID: - Answer-Neisseria gonorrhea and chlamydia
trachomatis
Minimum Criteria in the Diagnosis of PID - Answer-Uterine tenderness, or
Adnexal tenderness, or
Cervical motion tenderness
Additional Diagnostic Criteria to Increase Specificity of PID Diagnosis - Answer-
Temperature >38.3°C (101°F)
Abnormal cervical or vaginal mucopurulent discharge
Presence of abundant numbers of WBCs on saline microscopy of vaginal secretions
Elevated erythrocyte sedimentation rate (ESR)
Elevated C-reactive protein (CRP)
Gonorrhea or chlamydia test positive
First-line Treatment for PID - Answer-CDC-recommended oral regimen A:
Ceftriaxone IM + Doxycycline BID for 14 days
With or Without
Metronidazole BID for 14 days
Presumptive treatment for PID should be initiated in sexually active young women & at
risk for STDs if experiencing pelvic or lower abdominal pain and no cause for the illness
other than PID can be identified.
Post PID treatment follow up guidelines - Answer-Patients should demonstrate
substantial improvement within 72 hours.
Patients who do not improve usually require hospitalization, additional diagnostic tests,
and surgical intervention.
All women who tested + chlamydia & gonorrhea should be retested 3 months after
completion of treatment & offered HIV testing.
,screening recommendations PID - Answer-To reduce the incidence of PID, screen and
treat for chlamydia.
Annual chlamydia screening is recommended for:
Sexually active women 25 and under
Sexually active women >25 at high risk
Screen pregnant women in the 1st trimester.
Herpes Simplex Virus (HSV) Pathology - Answer-The HSV-2 virus remains latent
indefinitely
Reactivation is precipitated by multiple known and unknown factors and induces viral
replication causing outbreak herpetic lesions or sub clinical viral shedding
HSV-2 infection increases the risk of acquiring HIV infection
Types/stages of HSV infections: - Answer-First Clinical Episode-Primary infection
First infection ever with either HSV-1 or HSV-2
No antibody present when symptoms appear
Disease is more severe than recurrent disease
Non-primary infection:
Newly acquired HSV-1 or HSV-2 infection in an individual previously seropositive to the
other virus
Symptoms usually milder than primary infection
Antibody to new infection may take several weeks to a few months to appear
Recurrent symptomatic infection:
Antibody present when symptoms appear
Disease usually mild and short in duration
Asymptomatic infection:
Serum antibody is present
No known history of clinical outbreaks
First Episode Primary Infection without Treatment - Answer-Characterized by multiple
lesions that are more severe, last longer, and have higher titers of virus than recurrent
infections
Numerous, bilateral painful genital lesions; last an average of 11-12 days
Local symptoms include pain, itching, dysuria, vaginal or urethral discharge, and tender
inguinal adenopathy
Typical lesion progression:
papules ,vesicles,pustules,ulcers,crusts,healed
,Often associated with systemic symptoms including fever, headache, malaise, and
myalgia
Illness lasts 2-4 weeks
Median duration of viral shedding detected by culture (from the onset of lesions to the
last positive culture) is ~12 days
Recurrent Infection Without Treatment - Answer-Prodromal symptoms are common
(localized tingling, irritation) - begin 12-24 hours before lesions
Illness lasts 5-10 days
Symptoms tend to be less severe than in primary infection
Usually no systemic symptoms
HSV-2 primary infection more prone to recur than HSV-1
HSV - Viral shedding: common sites, highest prevalence & transmission - Answer-Most
HSV-2 is transmitted during asymptomatic shedding which are shorter in duration
compared to viral shedding during clinical symptoms
Rates of asymptomatic shedding are highest in HSV-2 new infections (<2 years) and
gradually decrease over time
Most common sites of asymptomatic shedding: are vulva and perianal areas in women
and penile skin and perianal area in men
HSV diagnostic tests: viralogic - Answer-Clinical diagnosis should be confirmed by
laboratory testing:Virologic tests
Viral culture (gold standard)
Preferred test if genital ulcers or other mucocutaneous lesions are present
Highly specific (>99%)
Sensitivity depends on stage of lesion; declines rapidly as lesions begin to heal
Positive more often in primary infection (80%-90%) than with recurrences (30%)
Cultures should be typed
Antigen detection (DFA or EIA)
Fairly sensitive (>85%) in symptomatic shedders
Rapid (2-12 hours)
May be better than culture for detecting HSV in healing lesions
HSV diagnostic tests: type specific serologic tests - Answer-Type-specific and
nonspecific antibodies to HSV develop during the first several weeks to few months
following infection and persist indefinitely
, Type-specific serologic assays might be useful in the following scenarios:
Recurrent or atypical genital symptoms with negative HSV cultures
A clinical diagnosis of genital herpes without laboratory confirmation
A sex partner with herpes
As part of a comprehensive evaluation for STDs among persons with multiple sex
partners, HIV infection, and among MSM at increased risk for HIV acquisition
Treatment of HSV - Answer-Antiviral chemotherapy:
Partially controls symptoms of herpes
Does not eradicate latent virus or
affect risk, frequency or severity of recurrences after drug is discontinued
Systemic antiviral chemotherapy includes 3 oral medications:
Acyclovir
Valacyclovir
Famciclovir
risk reduction of transmission of HSV during delivery - Answer-Risk for transmission to
neonate is high (30%-50%) among women who acquire genital herpes near the time of
delivery
Prevention of neonatal herpes depends on:
avoiding acquisition of HSV during late pregnancy
Women without symptoms or signs of genital herpes or its prodrome can deliver
vaginally
Suppressive acyclovir late in pregnancy reduces frequency of cesarean sections in
women with recurrent genital herpes; many specialists recommend it
HSV patient teaching regarding outbreaks, transmission & prevention - Answer-
Recurrent episodes likely following a first episode; with HSV-2 more than HSV-1
Frequency of outbreaks may decrease over time
Stressful events may trigger recurrences
Prodromal symptoms may precede outbreaks
Asymptomatic viral shedding is common and HSV transmission can occur during
asymptomatic periods
Abstain from sexual activity with uninfected partners when lesions or prodrome present
Correct and consistent use of latex condoms might reduce the risk of HSV transmission
Valacyclovir suppressive therapy decreases HSV-2 transmission in heterosexual
couples in which source partner has recurrent herpes
EXAMINATIOND QUESTIONS WITH
COMPLETE SOLUTIONS GRADED
A+
most common pathogens causing PID: - Answer-Neisseria gonorrhea and chlamydia
trachomatis
Minimum Criteria in the Diagnosis of PID - Answer-Uterine tenderness, or
Adnexal tenderness, or
Cervical motion tenderness
Additional Diagnostic Criteria to Increase Specificity of PID Diagnosis - Answer-
Temperature >38.3°C (101°F)
Abnormal cervical or vaginal mucopurulent discharge
Presence of abundant numbers of WBCs on saline microscopy of vaginal secretions
Elevated erythrocyte sedimentation rate (ESR)
Elevated C-reactive protein (CRP)
Gonorrhea or chlamydia test positive
First-line Treatment for PID - Answer-CDC-recommended oral regimen A:
Ceftriaxone IM + Doxycycline BID for 14 days
With or Without
Metronidazole BID for 14 days
Presumptive treatment for PID should be initiated in sexually active young women & at
risk for STDs if experiencing pelvic or lower abdominal pain and no cause for the illness
other than PID can be identified.
Post PID treatment follow up guidelines - Answer-Patients should demonstrate
substantial improvement within 72 hours.
Patients who do not improve usually require hospitalization, additional diagnostic tests,
and surgical intervention.
All women who tested + chlamydia & gonorrhea should be retested 3 months after
completion of treatment & offered HIV testing.
,screening recommendations PID - Answer-To reduce the incidence of PID, screen and
treat for chlamydia.
Annual chlamydia screening is recommended for:
Sexually active women 25 and under
Sexually active women >25 at high risk
Screen pregnant women in the 1st trimester.
Herpes Simplex Virus (HSV) Pathology - Answer-The HSV-2 virus remains latent
indefinitely
Reactivation is precipitated by multiple known and unknown factors and induces viral
replication causing outbreak herpetic lesions or sub clinical viral shedding
HSV-2 infection increases the risk of acquiring HIV infection
Types/stages of HSV infections: - Answer-First Clinical Episode-Primary infection
First infection ever with either HSV-1 or HSV-2
No antibody present when symptoms appear
Disease is more severe than recurrent disease
Non-primary infection:
Newly acquired HSV-1 or HSV-2 infection in an individual previously seropositive to the
other virus
Symptoms usually milder than primary infection
Antibody to new infection may take several weeks to a few months to appear
Recurrent symptomatic infection:
Antibody present when symptoms appear
Disease usually mild and short in duration
Asymptomatic infection:
Serum antibody is present
No known history of clinical outbreaks
First Episode Primary Infection without Treatment - Answer-Characterized by multiple
lesions that are more severe, last longer, and have higher titers of virus than recurrent
infections
Numerous, bilateral painful genital lesions; last an average of 11-12 days
Local symptoms include pain, itching, dysuria, vaginal or urethral discharge, and tender
inguinal adenopathy
Typical lesion progression:
papules ,vesicles,pustules,ulcers,crusts,healed
,Often associated with systemic symptoms including fever, headache, malaise, and
myalgia
Illness lasts 2-4 weeks
Median duration of viral shedding detected by culture (from the onset of lesions to the
last positive culture) is ~12 days
Recurrent Infection Without Treatment - Answer-Prodromal symptoms are common
(localized tingling, irritation) - begin 12-24 hours before lesions
Illness lasts 5-10 days
Symptoms tend to be less severe than in primary infection
Usually no systemic symptoms
HSV-2 primary infection more prone to recur than HSV-1
HSV - Viral shedding: common sites, highest prevalence & transmission - Answer-Most
HSV-2 is transmitted during asymptomatic shedding which are shorter in duration
compared to viral shedding during clinical symptoms
Rates of asymptomatic shedding are highest in HSV-2 new infections (<2 years) and
gradually decrease over time
Most common sites of asymptomatic shedding: are vulva and perianal areas in women
and penile skin and perianal area in men
HSV diagnostic tests: viralogic - Answer-Clinical diagnosis should be confirmed by
laboratory testing:Virologic tests
Viral culture (gold standard)
Preferred test if genital ulcers or other mucocutaneous lesions are present
Highly specific (>99%)
Sensitivity depends on stage of lesion; declines rapidly as lesions begin to heal
Positive more often in primary infection (80%-90%) than with recurrences (30%)
Cultures should be typed
Antigen detection (DFA or EIA)
Fairly sensitive (>85%) in symptomatic shedders
Rapid (2-12 hours)
May be better than culture for detecting HSV in healing lesions
HSV diagnostic tests: type specific serologic tests - Answer-Type-specific and
nonspecific antibodies to HSV develop during the first several weeks to few months
following infection and persist indefinitely
, Type-specific serologic assays might be useful in the following scenarios:
Recurrent or atypical genital symptoms with negative HSV cultures
A clinical diagnosis of genital herpes without laboratory confirmation
A sex partner with herpes
As part of a comprehensive evaluation for STDs among persons with multiple sex
partners, HIV infection, and among MSM at increased risk for HIV acquisition
Treatment of HSV - Answer-Antiviral chemotherapy:
Partially controls symptoms of herpes
Does not eradicate latent virus or
affect risk, frequency or severity of recurrences after drug is discontinued
Systemic antiviral chemotherapy includes 3 oral medications:
Acyclovir
Valacyclovir
Famciclovir
risk reduction of transmission of HSV during delivery - Answer-Risk for transmission to
neonate is high (30%-50%) among women who acquire genital herpes near the time of
delivery
Prevention of neonatal herpes depends on:
avoiding acquisition of HSV during late pregnancy
Women without symptoms or signs of genital herpes or its prodrome can deliver
vaginally
Suppressive acyclovir late in pregnancy reduces frequency of cesarean sections in
women with recurrent genital herpes; many specialists recommend it
HSV patient teaching regarding outbreaks, transmission & prevention - Answer-
Recurrent episodes likely following a first episode; with HSV-2 more than HSV-1
Frequency of outbreaks may decrease over time
Stressful events may trigger recurrences
Prodromal symptoms may precede outbreaks
Asymptomatic viral shedding is common and HSV transmission can occur during
asymptomatic periods
Abstain from sexual activity with uninfected partners when lesions or prodrome present
Correct and consistent use of latex condoms might reduce the risk of HSV transmission
Valacyclovir suppressive therapy decreases HSV-2 transmission in heterosexual
couples in which source partner has recurrent herpes
