Download STD Exam - Teddie Joe Snodgrass, FNP

Sexually Transmitted Diseases (STDs)
December 21, 2014
14-7 Which of the following statements is true about older men with HIV?
A. They have a slower disease progression when compared with their younger
cohorts.
B. They have a more rapid disease progression when compared with their
younger cohorts.
C. They are rarely if ever injection drug users.
D. They cannot undergo treatment with antiretrovirals.
14-7 Answer B: Men have been affected by HIV/AIDS at a significantly higher rate than
women among both younger and older people but that is slowly changing.
Physiologically, older adults experience a natural decline in their immune systems in
addition to the process of HIV infection; there is a more rapid loss of naive CD4 cells
and decrease in T-lymphocyte proliferation. Consequently, there is a more rapid
disease progression found among older persons. HIV-transmission risk factors in the
late middle-aged and older adult population continue to be injection drug use and samesex relations. Transfusion of blood products has decreased to negligible as a risk factor
in the United States. Recent research finds that older adults are prescribed antiretroviral
therapy at equal proportions to their younger counterparts, and these treatments are
equally as effective. However, persons with liver problems and on certain medications
that affect the liver need to be monitored carefully.
14-8 The bladder tumor antigen test may also be positive with
A. testicular torsion.
B. the use of steroids for bodybuilding.
C. scrotal trauma.
D. symptomatic sexually transmitted disease.
14-8 Answer D: Bladder tumor antigen in urine is a qualitative agglutination test for
bladder cancer that detects basement membrane proteins. It tests positive for
symptomatic sexually transmitted disease and is also positive within 14 days of prostate
biopsy or resection, with renal or bladder calculi, and with genitourinary tract cancers.
14-9 Milton, a 72-year-old unmarried, sexually active white man, presents to your clinic
with complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although
you suspect benign prostatic hypertrophy, what else should your differential diagnoses
include?
A. Antihistamine use
B. Urethral stricture
C. Detrusor hyperreflexia
D. Renal calculi
a sexually active individual no matter what the age. Antihistamine use generally
will result in
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14-9 Answer B: Urethral strictures may develop as a result of sexually transmitted
diseases and should be considered in hesitancy and urinary retention but not in
incontinence. Detrusor hyperreflexia involves urge incontinence characterized by a
strong, sudden urgency (not hesitancy), immediately followed by a bladder contraction,
resulting in an involuntary loss of urine. Renal calculi commonly present as pain.
14-23 Principles of management of genital herpes include which of the following?
A. Antiviral chemotherapy can control the signs and symptoms.
B. Antiviral chemotherapy, if prescribed early in a first clinical episode, is
curative.
C. Antiviral chemotherapy does not control recurrent episodes.
D. Antiviral topical therapy offers minimal clinical benefit.
14-23 Answer A: Antiviral chemotherapy, by mouth, is the mainstay of management of
genital herpes. These drugs are Acyclovir, Famciclovir, and Valacyclovir. They can
partially control the signs and symptoms of herpes when used to treat the first clinical
episode, as well as recurrent episodes. These drugs, however, neither eradicate latent
virus nor affect the risk, frequency, or severity of recurrences after the drug is
discontinued. Counseling about the natural history, sexual transmission, and methods to
reduce transmission is also an important principle of management.
14-29 Herb, who has diabetes, is complaining of a rash on his penis. Before examining
him, you suspect that he may have
A. tinea cruris.
B. genital herpes.
C. Candida .
D. intraepithelial neoplasia.
14-29 Answer C: A Candida infection is fairly common in clients with diabetes.
Candida on the penis appears as multiple, discrete, flat pustules with slight scaling and
surrounding edema. It is a superficial mycotic infection that occurs in moist cutaneous
sites. Other predisposing factors may include moisture, antibiotic therapy, and
immunosuppression. Tinea cruris (jock itch) is a fungal infection of the groin that
appears as erythematous plaques whose scaling, papular lesions have sharp margins
and occasionally clear centers. Genital herpes is caused by skin-to-skin contact with
the herpes simplex virus. It causes epidermal degeneration and erythematous plaques;
the plaques develop into vesicular lesions that may become pustular. Intraepithelial
neoplasia is associated with chronic human papillomavirus (HPV) infection and
presents as multiple red maculopapular plaque – like lesions on the glans and inner
aspect of the foreskin.
14-30 Which sexually transmitted diseases are cofactors for HIV transmission?
A. Syphilis and chlamydia
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B. Herpes and chlamydia
C. Chancroid and genital herpes
D. Chancroid and gonorrhea
14-30 Answer C: Chancroid (soft chancre and ulcus molle is a bacterial (Haemophilus
ducreyi) sexually transmitted infection characterized by painful sores on the genitalia),
genital herpes, and syphilis are cofactors for HIV transmission. In the United States,
about 10% of persons who have chancroid are co-infected with Treponema pallidum
(syphilis) or HSV (herpes simplex virus). This percentage is higher in persons who have
acquired chancroid outside the United States.
14-33 Jeff, age 20, presents to the college health clinic with complaints of difficulty
passing his urine and a discharge from his penis. Upon further investigation you note
that the discharge is urethral in origin. The most common cause of these symptoms in
the young adult male population is
A. chronic prostatitis.
B. prostatic abscess.
C. acute prostatitis.
D. prostatic hypertrophy.
14-33 Answer C: A client presenting with a urethral discharge or difficulty voiding can
include acute and chronic prostatitis and prostatic abscess. Young adult males in their
20s usually have acute prostatitis from gonorrhea or other bacterial infections.
Chronic prostatitis occurs in middle age males as a result of nonspecific prostatitis or a
previous gonorrhea infection. Older males may have prostatic hypertrophy or prostatic
cancer and these diagnoses are not related with urethral discharge.
14-59 You have just treated Jay’s condylomata acuminata with podophyllum in benzoin.
What instructions do you give him?
A. “Refrain from sexual relations for 48 hours.”
B. “Don’t take a shower until tomorrow morning.”
C. “Wash the medication off within 1 – 2 hours.”
D. “Go into the bathroom now and wash the medication off.”
14-59 Answer C: The treatment of choice for the client with condylomata acuminata
(warts) on the external genitalia is to “paint” them with podophyllum in benzoin. The
client should wash the medication off in 1 – 2 hours because normal tissue may be
destroyed along with the warts. Sometimes a repeat treatment is necessary. Carbon
dioxide laser treatment might be more effective.
14-72 Most lesions of the penis are nontender and painless. Which of the following
conditions begins with a tender, painful lesion?
A. Syphilitic chancre
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B. Genital herpes
C. Carcinoma of the penis
D. Peyronie’s disease
14-72 Answer B: Genital herpes begins with a tender, painful ulcer on the penis. Most
other conditions begin with nontender, painless lesions such as those found with
syphilitic chancre, carcinoma of the penis, Peyronie’s disease, and venereal warts.
14-73 Balanitis may evolve into a chronic problem. If this occurs and the client
experiences severe purulence and phimosis, treatment should involve
A. a stronger topical antifungal ointment.
B. change from an antifungal ointment to a powder.
C. oral antibiotics.
D. an antiviral ointment.
14-73 Answer C: Balanitis is a cutaneous inflammation of the glans penis, and Candida
usually plays a role. Treatment usually involves a topical antifungal ointment as initial
treatment if lesions show mild erythema or shallow erosions. Chronic balanitis suggests
relapse, especially from a sexual partner. This suggests the partner needs to be treated.
Severe purulent balanitis suggests a bacterial cause. If severe enough to cause
phimosis, oral antibiotics are indicated.
14-79 Barry, a 32-year-old gay man, has been diagnosed with acute bacterial
prostatitis. In addition to providing education, you would encourage him to avoid
A. rest.
B. NSAIDs.
C. hydration and stool softeners.
D. engaging in any activity that would elicit prostatic massage.
14-79 Answer D: The prostate should not be massaged in acute bacterial prostatitis
because it may cause bacteremia and sepsis. In homosexual relationships among men,
this is an important educational component. Antibiotics should be ordered, as well as
supportive therapy such as rest, analgesics, hydration, and stool softeners.
14-80 Harris is complaining of crooked, painful erections. He has palpable, nontender,
hard plaques just beneath the skin of his penis. What do you suspect?
A. Carcinoma of the penis
B. Genital herpes
C. Syphilitic chancre
D. Peyronie’s disease
14-80 Answer D: In Peyronie’s disease, the client has palpable, nontender, hard
plaques just beneath the dorsal skin of the penis and usually complains of crooked,
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painful erections. With carcinoma of the penis, there is usually an indurated, nontender
nodule or ulcer, and usually the man is uncircumcised. Genital herpes appears as a
cluster of small vesicles, followed by shallow, painful, nonindurated ulcers on red bases.
They may appear anywhere on the penis, and the initial outbreak is usually the worst. A
syphilitic chancre is an oval or round, dark red, painless erosion or ulcer with an
indurated base. It feels like a button that is lying directly underneath the skin. It may also
be associated with nontender, enlarged inguinal lymph nodes.
15-1 A sexually active woman should be aware that genital herpes simplex virus
A. may be transmitted to a partner or newborn even in the absence of
lesions because of viral shedding.
B. is suppressed during menstruation, physical or emotional stress,
immunosuppression, sexual intercourse, and pregnancy.
C. recurrences usually last the same length of time as the initial outbreak.
D. requires the use of condoms only during outbreaks.
15-1 Answer A: A sexually active woman should be aware that genital herpes simplex
virus may be transmitted to a partner or newborn even in the absence of lesions
because of viral shedding. Genital herpes may be transmitted to a partner at any time;
therefore, condoms should always be used. Menstruation, physical or emotional stress,
immunosuppression, sexual intercourse, and pregnancy may actually trigger herpes
recurrences. Herpes recurrences usually do not last as long as the initial occurrence.
15-8 Which of the following is a sexually transmitted infection?
A. Candida vaginitis
B. Trichomonal vaginitis
C. Atrophic vaginitis
D. Lactobacilli vaginitis
15-8 Answer B: Trichomonal vaginitis is a sexually transmitted infection. Monilial
vaginitis, atrophic vaginitis, and bacterial vaginosis (BV) are all non-sexually transmitted
types of vaginitis. Vulvovaginal candidiasis (formerly Monilia species), although not an
STI, may be transmitted between partners and between mother and newborn. Atrophic
vaginitis is present in postmenopausal women who are not on hormone replacement
therapy. BV is the most common vaginitis in women of reproductive age, of which
almost 50% are asymptomatic. It results in changes in the vaginal bacterial flora with a
loss of lactobacilli, an increase in vaginal pH (pH 4.5), and an increase in multiple
anaerobic and aerobic bacteria. BV may be caused by multiple bacteria and some
cases may be transmitted sexually.
15-9 In a patient diagnosed with cervical gonococcal infection, you would also suspect a
co-infection with
A. candidiasis.
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B. syphilis.
C. trichomoniasis.
D. chlamydia.
15-9 Answer D: Simultaneous chlamydial infections are present in 30% – 50% of
clients who have cervical gonococcal infections. Treatment should automatically be
done for both when one has been diagnosed. The most common therapies are
azithromycin (Zithromax) 1 g PO for one dose for Chlamydia infection and ceftriaxone
(Rocephin) 125 mg IM for one dose for gonorrhea.
15-11 Human papillomavirus may lead to
A. pelvic inflammatory disease.
B. molluscum contagiosum.
C. cervical dysplasia.
D. genital herpes.
15-11 Answer C: When human papillomavirus (Condylomata acuminata) causes
genital warts, it may lead to cervical dysplasia and cervical cancer. Pelvic inflammatory
disease is usually secondary to gonorrhea or Chlamydia infection. Molluscum
contagiosum is a sexually transmitted disease that causes a benign viral skin infection.
Genital herpes is caused by herpes simplex virus.
15-13 A dancer from an adult club down the street comes in for a renewal of her birth
control pill prescription. She says that everything is fine. On examination, you find
grayish-white vaginal discharge, greenish cervical discharge, and cervical motion
tenderness. Which of the following differential diagnosis is most unlikely?
A. Gonorrhea
B. Interstitial cystitis
C. Bacterial vaginosis
D. Chlamydia
15-13 Answer B: Interstitial cystitis is a chronic disease with none of the symptoms
given in the stem of the question. A client who presents with grayish-white vaginal
discharge, greenish cervical discharge, and cervical motion tenderness may have
gonorrhea, bacterial vaginosis, or Chlamydia infection. Gonorrhea may be
asymptomatic or the client may present with yellowish urethral or vaginal discharge.
The discharge of bacterial vaginosis is typically gray-white, malodorous or fishy
smelling, and pruritic. Chlamydia infection may present with or without a vaginal or
urethral discharge.
15-21 The most common type of vaginal infection is
A. candidiasis.
B. trichomoniasis.
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C. gonorrhea.
D. bacterial vaginosis.
15-21 Answer D: Bacterial vaginosis (BV) is the most common vaginal infection (about
40% of all cases). The infecting organisms are identified as Gardnerella vaginalis,
Mobiluncus species, and other anaerobes. Bacterial vaginosis results in an overgrowth
condition within the vagina for as-yet-unknown reasons. The incubation period is 5 – 10
days. About half of all clients with BV are asymptomatic. Those with symptoms typically
describe a gray-white, malodorous or fishy-smelling, pruritic discharge that is
accompanied by burning. It may be scant to profuse and adheres to the vaginal walls.
The differential diagnoses include any other known cause for vaginitis (such as
trichomoniasis or candidiasis) and cervicitis (such as gonorrhea or Chlamydia infection).
Diagnosis is made through microscopic examination of the specimen by wet mount. The
practitioner should look for clue cells; the presence of these cells, which look like pepper
on the surface of cells, is diagnostic of BV.
15-24 Jennifer, a 25-year-old female patient, complains of dysuria. In taking a thorough
history to formulate a diagnosis, it is most important to ask,
A. “Do you have painful intercourse?”
B. “Do you have an associated vaginal discharge or irritation?”
C. “Do you also have a problem with defecation?”
D. “Do you have stress incontinence?”
15-24 Answer B: Women with dysuria should be questioned about an
associated vaginal discharge or irritation. Dysuria often represents a vaginal
infection rather than a urinary tract infection. Women with dysuria from
cystitis usually describe an internal discomfort, whereas women with dysuria from
vaginitis usually describe a more external discomfort with the burning sensation
in the vagina or labia, a result of urine flow over an inflamed vaginal mucosa
15-39 Samantha has a diagnosis of a Chlamydia vaginal infection. You believe that it
is questionable whether she will fill the prescription that you write or take it for 7 days as
ordered. What would you do?
A. Give azithromycin (Zithromax) 1 g PO now.
B. Emphasize the importance of the drug and tell her the consequences of not
taking it.
C. Send out the public health nurse to follow up on whether she takes the drug
for 7 days.
D. Assume that Samantha is an adult and will follow your instructions.
15-39 Answer A: An appropriate first-line drug for a Chlamydia vaginal infection is
azithromycin (Zithromax) 1 g PO. Although doxycycline (Vibramycin) 100 mg PO twice
daily for 7 days is the most tried-and-true and least expensive treatment, azithromycin is
the most convenient option for single-dose administration. Azithromycin is
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contraindicated in pregnant women. For this population, erythromycin 500 mg PO four
times a day for 7 days should be ordered.
15-41 Reiter’s syndrome is a complication of
A. bacterial vaginosis.
B. syphilis.
C. chlamydia.
D. gonorrhea.
15-41 Answer D: Gonorrhea may precipitate Reiter’s syndrome (reactive arthritis).
Bacterial vaginosis seldom results in complications. Syphilis may result in disseminated
disease, but not Reiter’s syndrome. Left untreated in women, Chlamydia infections may
cause scarring in the uterine tubes, leading to infertility and ectopic (tubal) pregnancies.
15-43 A 21-year-old woman comes to your office and reports a history of genital warts.
In reference to the HPV vaccination (Gardasil or Cervarix), she should be educated that
A. she is not in the correct age group and is not a candidate for the vaccination.
B. she should receive the HPV vaccination.
C. she already has been exposed to HPV; therefore, she is not a candidate for
the vaccine.
D. there is a vaccine coming out shortly specifically for those who have been
exposed. She should wait.
15-43 Answer B: The human papillomavirus is the most common sexually transmitted
infection (STI). There are more than 40 HPV types that can infect the genital areas,
mouth, and throat of males and females. According to the Centers for Disease Control
and Prevention (CDC), females should get the vaccine before they become sexually
active and prior to becoming exposed to HPV. Females who are sexually active may
also benefit from the vaccine, but they may get less benefit from it. Women who have
an existing history of genital warts have generally been exposed to HPV types 6 and 11,
which are not oncogenic (tumor formation). However, few sexually active young women
are infected with all HPV types prevented by the vaccines, so most young women could
still get protection by getting vaccinated.
15-48 You’ve just finished a Pap smear on Sadie, age 39. During the wet mount, you
see cells with bacteria adherent to the cell wall giving it a stippled, granular appearance.
What do you suspect?
A. Candidiasis
B. Bacterial vaginosis
C. Trichomoniasis
D. Cervicitis
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15-48 Answer B: With the wet mount for bacterial vaginosis (BV), you will see clue cells
— characteristic epithelial cells with bacteria adherent to the cell wall giving a stippled,
granular appearance. BV is the most prevalent form of vaginitis among childbearing
women. With candidiasis, the microscopic examination of the vaginal solution diluted
with saline or 10% KOH (potassium hydroxide) preparations will demonstrate hyphal
forms or budding yeast cells in 50% – 70% of infected women. With trichomoniasis, you
will visualize motile flagellated trichomonads.
15-57 Emotional support is best given to the client with a sexually transmitted infection
by
A. offering many alternatives.
B. authentic active listening.
C. assuring the client that everything will be okay.
D. emphasizing the duration of the disease.
15-57 Answer B: Emotional support is best given to the client with a sexually
transmitted infection (STI) by authentic active listening. During times of increased
psychological stress, minimizing choices is better than offering too many choices. The
client with an STI needs support from others, and emphasis should focus on the
prevention of recurrences rather than the specifics of the duration of the disease.
15-60 Herpes simplex virus can be potentially acquired through maternal transmission.
This is least likely to occur
A. before labor.
B. during delivery.
C. postnatally.
D. during the neonatal period.
15-60 Answer D: Herpes simplex virus may be acquired before labor, during delivery,
or postnatally (occurring after birth). About 5% of infants with neonatal herpes acquire
the virus before labor (intrauterine infection) and 85% by direct contact with the
maternal genitalia or secretions during delivery. Postnatal acquisition occurs by direct
contact with an infected caretaker and accounts for the other 10% of neonatal herpes
infections.
15-66 Janice, age 26, who has genital herpes, asks if her partner has to use a condom
during sexual intercourse even if she does not have a visible lesion. How do you
respond?
A. “Yes, we’re not sure if it’s still transmitted when the lesions are not visible, so
it’s better to be on the safe side.”
B. “No, you’re not ‘contagious’ when the lesions are not visible.”
C. “No, use of a spermicidal agent is all that is required.”
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D. “Yes, shedding of the herpes simplex virus from mucocutaneous
surfaces in the absence of visible lesions is a primary mode of
transmission.”
15-66 Answer D: A condom should be worn during sexual intercourse when one
partner has genital herpes, even though there may not be a visible lesion. Shedding of
the herpes simplex virus from mucocutaneous surfaces in the absence of visible lesions
is a primary mode of transmission both horizontally (to sexual partners) and vertically (to
the fetus).
15-70 The Mobiluncus species is responsible for which sexually transmitted infection?
A. Condylomata acuminata
B. Bacterial vaginosis
C. Human papillomavirus
D. Lymphogranuloma venereum
15-70 Answer B: The Mobiluncus species causes bacterial vaginosis. The human
papillomavirus is responsible for condylomata acuminata (genital warts).
Lymphogranuloma venereum is a sexually transmitted infection characterized by
localized lymphatic infection with a Chlamydia origin.
15-71 An occurrence of genital herpes is
A. cured with acyclovir (Zovirax).
B. best managed with trichloroacetic acid 80% – 90% applied directly to the
lesion.
C. expected to be completely resolved within 21 days (for the primary
lesion).
D. not a factor in continuing with intercourse.
15-71 Answer C: Although the primary lesion of genital herpes normally resolves within
21 days, the client usually has recurrent episodes. Acyclovir (Zovirax) is a palliative
management option, but the drug does not cure herpes simplex. Topical
trichloroacetic acid is the treatment for genital warts, not herpes. Intercourse should
be avoided when a lesion is present.
15-77 What is the most common virus to be transmitted in-utero?
A. Cytomegalovirus
B. Rubella
C. Varicella
D. Toxoplasmosis
15-77 Answer A: The most common virus known to be transmitted in-utero is
cytomegalovirus (CMV). Transmission of CMV can take place as a consequence of
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either primary or reactivated infection in the mother. Children in day-care settings can
also transmit the virus to their mothers or day-care workers.
15-82 Brianne, age 24, complains of urgency, frequency, and dysuria. Your dipstick test
shows no hematuria, and her urine culture shows no growth. What is your next action?
A. You suspect a sexually transmitted infection, so you obtain a culture of
the urethra, do a potassium hydroxide wet prep, and obtain another urine
culture.
B. You suspect urethra irritation, so you tell her to take showers, not bubble
baths, and wear white, dry underwear and loose-fitting clothing.
C. You suspect a urinary tract infection not visible yet on culture, so you start her
on Bactrim DS.
D. You suspect that the vulva is irritated. You tell her to take a relaxing shower
and dry the area well and come back in 1 week if there is no improvement.
15-82 Answer A: You suspect an sexually transmitted infection (STI) because although
the symptoms are suspicious for a urinary tract infection (UTI), the diagnosis is not
supported by the dipstick and urine culture results. Your next action for Brianne is to
obtain a culture of the urethra, do a potassium hydroxide wet prep to test for bacterial
vaginosis, and obtain another urine culture. Doing so is the most efficient way of treating
Brianne now. Discussing her social history might help you determine which course of
action is most appropriate. However, if you do only one test now and it is negative, you
might have to perform another diagnostic test, thereby delaying treatment again. A
diagnosis of Chlamydia infection is accomplished by culture or smears for Gram
staining, but this is expensive and takes 2 – 6 days to obtain results. Other techniques
include direct immunofluorescence assay and enzyme immunoassay. Diagnosis of
gonorrhea is accomplished through cultures of the discharge (urethral, endocervical,
rectal, pharyngeal, or conjunctive) using a modified Thayer-Martin medium or by Gram
staining to look for typical gram-negative intracellular diplococci. Diagnosis of herpes
simplex viruses is accomplished by the enzyme-linked immunosorbent assay
technique or viral cultures. Another, less reliable method of diagnosis consists of
serological antibody testing. The diagnosis of human papillomavirus infection is made
by colposcopy. Trichomoniasis is diagnosed by pH that, as in bacterial vaginosis, is
greater than 4.5 and by a microscopic finding of flagellated motile organisms resembling
whips that are larger than white blood cells. By just treating the symptoms as a UTI or
irritation, you could be ignoring the true problem, giving an STI time to spread.
Medicating with antibiotics without identifying a definitive organism leads to antibiotic
resistance.
15-89 Candidiasis is more common in
A. teenage girls.
B. women on low-fat diets.
C. women with diabetes.
D. women with frequent urinary tract infections.
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15-89 Answer C: Candida albicans infection is more common in women with diabetes,
as well as those who are pregnant, immunosuppressed, or using antibiotics or oral
contraceptives.
15-110 Which of the following signs and/or symptoms of a genital herpes infection
usually occurs first?
A. Painful or pruritic vesicles
B. Dysuria
C. Prodromal tingling or pruritus of the genital region
D. White, curdlike plaques on a red base in the vagina
15-110 Answer C: Signs and symptoms of a genital herpes infection include tender
inguinal lymph nodes, as well as painful or pruritic vesicles, dysuria, prodromal tingling
or pruritus of the genital region (which usually occurs first), and cervical ulcerations.
White, curdlike plaques on a red base in the vagina are seen with monilial vaginitis.
15-111 A 17-year-old female presents to your office with the complaint of lower
abdominal pain since her period ended 2 days ago. She has a new sexual partner in the
past 3 months and does not use condoms. On physical examination, you find that she
has cervical motion tenderness. You are concerned that she may have pelvic
inflammatory disease (PID). To meet the Centers for Disease Control and Preventions
minimum criteria for empiric treatment of PID, she must also have
A. an oral temperature greater than 101° F and mucopurulent cervicitis.
B. a positive test for cervical infection and an adnexal mass.
C. lower abdominal tenderness and adnexal tenderness.
D. mucopurulent cervicitis and an elevated white blood cell count.
15-111 Answer C: Pelvic inflammatory disease (PID) comprises a spectrum of
inflammatory disorders of the upper female genital tract. Sexually transmitted
organisms, especially Neisseria gonorrhoeae and Chlamydia trachomatis, are
implicated in many cases. Empiric treatment for PID should be initiated in sexually
active young women and other women at risk for sexually transmitted infections if they
are experiencing pelvic or lower abdominal pain, if no cause for the illness other than
PID can be identified, and if one or more of the following minimum criteria are present
on pelvic examination: cervical motion tenderness, uterine tenderness, adnexal
tenderness.
6-83 Primary prevention measures for sexually transmitted diseases and unwanted
pregnancies should be based on an understanding of which of the following
psychosocial determinants?
A. Informing adolescents of disease risk is an essential component of primary
prevention.
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B. There must be multiple approaches, and these should begin in middle
childhood.
C. Working for personality change encourages adolescents to give up destructive
behaviors.
D. Handing out latex condoms and showing people how to use them is the best
defense against sexually transmitted diseases and unwanted pregnancies.
6-83 Answer B: Although many sources cite the condom as the most essential form of
primary prevention against sexually transmitted diseases and unwanted pregnancies, in
reality the best prevention tool is the brain. For this reason, an adequate understanding
of psychosocial and cultural determinants underlying sexual behaviors is essential to
individualize counseling approaches depending on the client. Teaching should begin
before puberty. Middle childhood is a “rationale period” for children. Sex education has
vocal opposition in many subcultures. However, preventive teaching and participatory
discussion need not focus on sex specifically. Teaching can be centered on making
positive future choices and impulse control. This teaching should address girls in
particular because of the lifelong consequences of unintended pregnancy and sexually
transmitted diseases in women. Although sharing disease-specific information may
help, it is only one prong of what should be a multipronged approach to prevention.
Likewise, your job as a health counselor is not to change your client’s personality or
world view nor to solve their deep conflicts; rather, you should offer better and healthier
ways for clients to get what they want.
Issues in Primary Care
19-78 You have seen a client who has tested positive for syphilis. You have treated the
client, tested the client for other potential sexually transmitted diseases including HIV
infection, counseled the client about safe sexual practices, and scheduled the client to
return at 3 and 6 months for repeat serological testing. The tests at those times
demonstrated that no further syphilis was present. Should you have taken any other
action?
A. No, you have treated the client appropriately.
B. Yes, you must report the case to the local health authorities.
C. Yes, you need to notify all sexual contacts.
D. Yes, you must follow up on the client’s HIV status.
19-78 Answer B: The practitioner is also responsible for reporting the case of syphilis
to the local health authorities. All sexual partners of the client should be contacted;
however, it is the health department that has trained staff who will perform the
investigation of contacts and follow-up. Syphilis is easily treated and controllable if its
presence is reported. It is not necessary to retest the client’s HIV status unless there is
a new clinical reason on subsequent visits.
Not transmittable or reproducible with written permission of Teddie Joe Snodgrass, MBA, MSN, FNP
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