Upgrade to remove ads
Kim's FNP Board Review ADULT; STD's
Terms in this set (58)
What is AIDS?
Immunodeficiency disorders in which human immunodeficiency virus uses T4 (CD4) cells as a receptor and reservoir for HIV
What is the epidemiology of AIDS?
1. Modes of transmission similar to those of hepatitis B
but specifically: blood, semen, vaginal secretions &
2. Risk of infection via needle stick is approximately
What are the signs/symptoms of AIDS?
1. Flu-like symptoms: think seroconversion
(process of converting from HIV negative to HIV
positive; the process takes approx 3wks to 6 mos)
2. Early s/s include: fever, night sweats, and weight loss
3. It is a more a constellation of s/s than any single one that is suspicious for AIDS
AIDS=CD4<200 cells/uL &/or presence of opportunistic infection
What are the laboratory/diagnostics for AIDS?
1. ELISA for initial screening; sensitivity >99.9%
(screens for antibodies, not antigens)
2. Western Blot for confirmatory
3. Absolute CD4 lymphocyte count:
Normal >800 cells/uL
4. CD4 lymphocyte percentage
a. risk of progression to AIDS high when <20%
5. Viral load
a. PCR: based quantitative copies of HIV-branched
DNA or RNA
b. results correlate closely w/ progression of HIV
c. Ideally should be Zero or undetectable
What is the management of AIDS?
1. Therapy for opportunistic infections
-treat infection as it occurs
-bactrim for pneymocystitis jirovecii-pneumonia
2. Antiretroviral treatment
a. combination therapy is standar (Active antiretroviral
b. when to start AART remains controversial
c. Monitor for the danger of drug resistance: must be
taken exactly as prescribed
What is the controversy surrounding when to start AART for AIDS?
-Some experts suggest starting meds at time of HIV
-CDC recommends that all pts should be on AART by the time CD4 reaches 350 /uL
What is and what causes a chancroid?
a venereal infection causing ulceration of the lymph nodes in the genitals.
It is caused by Hemphilus ducreyi, a gram negative bacillus
What is the prevalence of a chancroid?
1. Endemic in many areas of the US; must be a part of
differential diagnosis for genital ulcers
2. Well established as a co-factor for HIV transmission
(High rate of HIV identified among individuals presenting with a chancroid.
3. Estimated up to 10% of pts are also infected with syphilis and HSV
What are the signs/symptoms of a chancroid?
1. Women; usually asymptomatic
2. Men: single or multiple superficial , painful ulcer, surrounded by an erythematous halo
3. Ulcers may be necrotic or severely erosive
How is the diagnosis of a chancroid made?
1. Probably diagnosis is usually a matter of exclusion
2. Involves genitalia and unilateral bubo or both
(bubo: a swollen, inflamed lymph node in the armpit or groin)
3. Painful genital ulcers in absence of T. Pallidum and
HSV (by inspection of culture) with coexisting tender
inguinal lymphadenopathy is suggestive of chancroid
4. Definitive diagnosis of chancroid is made morphologically (sensitivity no>80%)
What is sensitivity?
the degree to which those who have a disease screen/test positive
What is specificity?
the degree to which those who do not have a disease screen/test negative
What is the treatment for chancroid?
1. Azithromycin (zithromax) 1g PO x1 dose
2. Ceftriaxone (Rocephin) 250 mg IM x 1 dose or
3. Ciprofloxacin (Cipro) 500 mg by mouth 2x's daily x
What is chlamydia?
A parasitic STD caused by CLamydia trochomatis that produces serious reproductive tract complications in either sex
What is the incidence of chlamydia?
1. the most common bacterial STD in the US
2. Over 4 million new infections annually
What are the STD's which need to be reported to CDC?
Gonorrhea, chlamydia, syphilis, HIV (also tb)
What are the signs/symptoms of chlamydia in females?
2. intramenstrual spotting
3. postcoital bleeding
4. dyspareunia: painful intercourse
5. vaginal discharge
What are the signs/symptoms of chlamydia in males?
2. Thick, cloudy, penile discharge
3. Testicular pain
What are the laboratory/diagnostics for Chlamydia?
1. Chlamydia culture is the most definitive test
(3-9 days for results)
2. Enzyme immunoassay (EIA) methods preferred-
low cost 30-120 minutes for results
What is the treatment for chlamydia?
1. Azithromycin (Zithromax) 1 g PO x1 dose or
2. Doxycycline (Vibramycin) 100 mg po 2x's dly x7 days
3. Alternatives: Erythromycin, ofloxacin, levofloxacin
4. Report to the health department
What causes genital warts (condyloma acuminata)?
Human papillomavirus (HPV)
What is the prevalence of genital warts (condyloma acuminata)?
1. The most common viral STD in the US
2. An estimated 3 million cases of HPV (including
cervical HPV) are reported annually
What are the symptoms of genital warts (condyloma acuminata)?
Singel (or multiple) soft, fleshy, papillary, or sessile,
painless keratinized growth around anus, vulvovaginal area, penis, urethra, or perineum
How is the diagnosis made for genital warts (condyloma acuminata)?
1. Clinical presentation: atypical squamous cell of
undetermined significance (ASCUS) or squamous
intraepithelial lesion (SIL) on pap smear
2. Colonoscopy useful in diagnosing flat lesion
3. May need biopsy if at risk for cervical intraepithelial neoplasia (CIN)
What is the treatment for genital warts (condyloma acuminata)?
1. Kertaolytic agents: podophyllin (Pododerm),
trichloroacetic acid (TCA) or bichloracetic acid (BCA)
2. Referral for cryotherapy, laser therapy, electrocautery, or excision
What is the prevention of genital warts (condyloma acuminata)?
1. Gardasil (HPV Quadrivalent- types 6, 11, 16 & 18)
a. indicated for females & males 9-26 yrs
b. given in 3 injections
2. Cervarix (HPV Bivalent - types 16 (oncologic strain) & 18
a. indicated for females ages 10-25 years
b. given in 3 injections
What is Gonorrhea?
a bacterial STD caused by Neisseria gonorrhoeae (gram negative diplococci): causative organism may be cultured from the GU tract, oropharynx, and/or anorectum
What is the incidence/general concepts of Gonorrhea?
1. Produces urethritis in men and cervicitis in women
2. a leading cause of infertility among females in US
3. Affects 1-2% of populations
4. Male to female transmission is 80-80% after exposure
What are the signs/symptoms of gonorrhea in females?
females often asymptomatic 80%
2 Urinary frequency
3. Mucopurulent vaginal discharge (green)
4. Labial pain & swelling
5. Lower abdominal pain
7. Abnormal menstrual periods
What are the signs/symptoms of gonorrhea in males?
3. White/yellow-green penile discharge
4. Testicular pain
What are the laboratory/diagnostics for gonorrhea?
1. Gram stain of discharge smear shows gram negative
diplococci and WBC
2. Cervical culture for N gonorrhoeae using modified
What is the treatment for Gonorrhea?
1. Ceftriaxone (Rocephin) 250 mg IMx1 dose to treat
2. Azithromycin (Zithromax) 1 gm po x1 dose to cover
3. Report to health departent
What causes Hepatitis B?
Hepatitis B virus (HBV)
What is the prevention of Hepatitis B?
Two commercially available hepatitis B preventive vaccines administer at 0, 1, & 6 months.
Recombivax HB & Engerix-B
What is the treatment for Hepatitis B?
1. Supportive and symptomatic care
2. Hepatitis B immune globullin (HBIG) 0.06 ml/kg IM
in single dose within 14 days of exposure --earlier administration may be more effective
What is herpes?
a recurrent viral STD with no cure, associated with painful genital lesions.
What causes herpes?
1. Herpes simplex virus Type 1: associated with
infection of lips, face, mucosa
2. Herpes Simplex virus type 2: associated w/genitalia
3. Transmission: direct contact with active lesions or
virus containing fluid (saliva or cervical secretions)
What are the signs/symptoms of herpes?
1. Initial: fever, malaise, dysuria, painful/pruritic
ulcers for usually 12 days
2. Recurrent: less painful/pruritus ulcers for 5 days
What are the laboratory/diagnostics for Herpes?
1. Papanicolaou or Tzanck stain
2. Most definitive test is viral culture
What is the management for Herpes?
1. No treatment for cure
2. Symptomatic treatment w/ drying and
3. Acyclovir (Zovirax) recommended for topical, oral, and IV use
5. Valacyclovir: especially useful for asymptomatic
viral shedding of HSV2
What is the cause lymphogranuloma Venereum (LGV)?
Immunotypes L1, L2, or L3 of Chlamydia trachomatis
What are the signs/Symptoms oflymphogranuloma Venereum (LGV)?
1. 2-3mm painless vesicle, bubo or non-indurated ulcer
2. Regional adenopathy follows in approximately 1 month & is the most common finding
3. Stiffness & aching in groin followed by a unilateral swelling of inguinal region
How is the diagnosis made for lymphogranuloma Venereum (LGV)?
1. May by confused with chancroid
2. Definitive diagnosis requires isolating C. trachomatis from an appropriate specimen
What is the treatment for lymphogranuloma Venereum (LGV)?
1. Doxycycline (Vibramycin) 100mg PO 2xs dly x21 days
2. Aspirate buboes to prevent ulcerations
What is the prevalence of Molluscum Contagiosum and what causes it?
It is caused by Molluscum Contagiosum virus
it occurs infrequently about 1 for every 100 cases
What are the signs/symptoms of molluscum contagious?
1. Lesions are 1-5mm, smooth, rounded, firm, shiny flesh-colored to pearly white papules
2. Commons seen on trunk & anogenital region
What is the diagnosis for molluscum Contagiosum?
Inspection & microscopic exam
What is the treatment for Molluscum Contagiosum?
Cryoanesthesia with liquid nitrogen: most popular method; may resolve without scarring
What is syphilis?
STD involving multiple organ systems
What is the cause of syphilis?
Treponema pallidum, a spirochete with 6-14 regular spirals
What is the incidence of syphilis?
1. Third most commonly reported infectious disease in
2. Approximately 200,000 new cases reported annually
What are the four clinical stages of Syphilis?
What is the primary stage of Syphilis?
1. Chancre is painless
2. Indurated ulcer
3. Located at the site of exposure
What is the secondary stage of Syphilis?
1. Flu-like symptoms
2. Highly variable skin rash on palmar and plantar surfaces; mucous patches
What is the latent stage of syphilis?
Seropositive, but aysmptomatic
What is the tertiary stage of syphilis?
2. Cardiac insufficiency
3. aortic aneurysm
What are the serologic tests for syphilis?
1. Nontremponemal: VDRL/RPR
a. fluorescent treponemal antibody absorption
(FTA-ABS); confirms positive 85-95% of primary cases and 100% of secondary cases
b. microhemagglutenation assay for antibody to
T. Pallidum (MHA-TP)
What is the treatment of syphilis?
1. Primary, secondary, or early syphilis of less than
1 year duration
a. Benzathine penicillin G 2.4 million units IM
2. Late, latent, & indeterminate length;
a. Benzathine penicillin G 2.4 million units IM wkly x3wks
3. Penicillin allergic
a. doxycycline 100 mg PO 2xs dly or
b. erythromycin 500 mg PO 4xs dly
4. Report to health department
THIS SET IS OFTEN IN FOLDERS WITH...
Top 50 Drugs q FNP MUST KNOW
Part II - MUST Know NURSING FACTS (Neurosensory sy…
Kim's FNP Leik System Review
ATI Comprehensive/ NCLEX Review
YOU MIGHT ALSO LIKE...
Ch. 40 Sexually Transmited Diseases
Chapter 27 Genitourinary Tract Infections
Infectious Disease Lecture 18 STIs
Microbiology Test #2 Medical Moments Ndaluka
OTHER SETS BY THIS CREATOR
Top 50 Drugs q FNP MUST KNOW
Pharmacology Antibiotic "Cheat Sheet"
DEVELOPMENTAL MILESTONES MADE EASY