1. Rebecca is visiting the clinic seeking birth control pills. She had sexual intercourse for the first time 8 weeks ago. Subjective data:  Her partner does not use a condom or spermicide with intercourse  Her last menstrual period was 2 weeks ago  Denies any symptoms other than frequent urination and some dysuria.  Interested in using oral contraceptives  Very nervous Rebecca, a 16 year old white female

2. The Health Care provider after talking with her does a physical exam including a pelvic exam. Lab work is also drawn.

3. Objective data obtained from examination and lab results: ◦ Cervical ectopy noted during Pap test ◦ Mucopurulent cervical discharge ◦ Urine pregnancy test is negative ◦ Nucleic acid amplification test is suspect for Chlamydia and gonorrhea.

4.  After gathering this data, what conclusions can be drawn?  Why did she not suspect that she might have a STD?   What risk factors were present?  What do you think is the next step? Explain.

5.  Endocervical Culture is completed – came back positive for Chlamydia and gonorrhea.  Why was a endocervical culture done?  Explain why smears, the nucleic acid amplification test and EIA tests are not used in confirming the diagnosis in a female.

6. Health Care Providers Orders: ◦ Doxycycline 100mg bid for 7 days ◦ Ceftriaxone 250mg IM once  When you see above medications ordered, what did this tell you?  What are the side effects of these medications?  What medication would be ordered if Rebecca only had gonorrhea?

7.  What does she need to know about other STD’s What other testing would you recommend.  What is important to teach regarding Health Prevention?  What complications can occur is she does not follow the health teaching?

8.  What symptoms might her sexual partner exhibit of chlamydia or gonorrhea?  Where is the initial site of infection in the male?  Why does the male seek medical care early?  How is the male diagnosis confirmed?  Does the partner need to be treated? Explain.

9. a. doxycycline (Vibramycin) b. Cefixime (Suprax) c. levofloxacin (Levaquin) d. ceftriaxone (Rocephin) e. ciprofloxacin (Cipro) f. Amoxicillin (Ampicillin) g. acyclovir (Zovirax)

13.  Primary stage  When does this occur?

14. ◦ In what stage does this Bilateral symmetric rash on trunk, extremities, and palms appear? ◦ What other symptoms will the patient exhibit?

15.  Occur mostly in late syphilis  Gummas can produce irreparable damage to bone, liver, or skin  Aneurysm may press on structures such as intercostal nerves, causing pain  Scarring of aortic valve  Neurosyphilis  Tabes dorsalis  Sudden attacks of pain  Loss of vision and sense of position

17.  Nonspecific antitreponemal Tests used for screening: ◦ VDRL ◦ RPR  Specific treponemal Tests for confirmation: ◦ Fluorescent treponemal antibody absorption (FTA-Abs) All these tests – tests for antibodies Even Better - presence of spirochetes on dark field microscopy

18.  Mr. L., 61 years old, was admitted to the hospital for pre-operative preparation for surgery. His pre- operative blood work included a VDRL test and it came back positive.  What would be most important for the nurse to ask the patient?  Why?  What would be different in this situation if the patient was 16?

20.  Drug therapy ◦ Benzathine penicillin G (Bicillin) ◦ Aqueous procaine penicillin G ◦ **Be sure they complete full course of therapy  Contact Isolation o Lesions of primary and secondary syphilis are highly infective. o Gloves should be worn in direct contact o Good Handwashing after removal of gloves

21. Which of the following is NOT a symptom of syphilis? a. a hard chancre sore b. a rash on the skin including the palms and soles. c. a thick, yellowish discharge d. large ulcers called gummas.

23.  What causes a patient with genital herpes to seek medical care?

24.  Primary (initial) episode ◦ Burning or tingling at site ◦ Small vesicular lesion appear on penis, scrotum, vulva, perineum, perianal areas, vagina, or cervix ◦ Primary lesions present for 17 to 20 days ◦ New lesions sometimes continue to develop for 6 weeks ◦ Lesions heal spontaneously

25.  When are they most contagious?

26.  Recurrent genital herpes ◦ Occurs in 50% to 80% in following year ◦ Triggers  Stress  Fatigue  Sunburn  Menses ◦ Prodromal symptoms of tingling, burning, itching at lesion site ◦ Symptoms are less severe and lesions heal within 8 to 12 days ◦ With time, lesions will occur less frequently

27.  How is the diagnosis confirmed?

28.  What is the major treatment for genital herpes?

29.  Drug therapy ◦ Inhibit viral replication ◦ Suppress frequent recurrences  Acyclovir (Zovirax)  Valacyclovir (Valtrex)  Famciclovir (Famvir)  Given several times /day for 7-10 days.

30.  Do the antiviral medications eradicate the disease?

31.  Symptomatic care ◦ Genital hygiene ◦ Loose-fitting cotton underwear ◦ Lesions clean and dry ◦ Sitz baths ◦ Barrier methods during sexual activity ◦ Drying agents ◦ Pain  Dilution of urine with water  Local anesthetic

32.  A primary Herpes Simplex virus (HSV) infection differs from recurrent HSV episodes in that: a.Only primary infections are sexually transmitted b.Systemic manifestations such as fever and myalgia are more common c.It is of shorter duration than recurrent episodes d.Transmission of the virus to a fetus is less likely during primary infection.

34.  What causes genital warts?  Who is most likely to get this condition?

36.  How is this condition diagnosed?

37.  What is the Primary goal in the treatment of genital warts?  Treatment includes a course of therapy rather than one treatment. Explain.

38.  With removal of genital warts infectivity is decreased? Explain

39.  Treatments ◦ Chemical  Trichloroacetic acid (TCA)  Bichloroacetic acid (BCA)  Podophyllin resin  For small external genital warts ◦ Patient managed  Podofilox (Condylox/Condoylox gel)  Imiquimod (Aldara)  Immune response modifier

40.  Treatments ◦ If warts do not regress with previously mentioned therapies  Cryotherapy with liquid nitrogen  Electrocautery  Laser therapy  Use of α -interferon  Surgical excision

41.  Recurrences and re-infection possible  Careful long-term follow-up advised  Health Preventive Measures ◦ Vaccine to prevent cervical cancer, precancerous genital lesion, and genital warts due to HPV ◦ Gardisal vaccine Gardisal vaccine

42. The age group that seems particularly susceptible to HPV infections is: a.students of college age b.teenagers c.middle-aged adults d.senior citizens

43. Human papilloma viruses (HPVs) are associated with: a.cancer of the cervix b.skin cancer c.lung cancer d.spontaneous abortions