STD EXAM

STD EXAM
Laurel Sockrider
Grand Canyon University NUR 667
July 30, 2016

STD EXAM

1. A young woman and her boyfriend visit the clinic today because she
has pain and itching with an open sore on her labia. They are
concerned because he has what he thinks is a cold sore on his mouth
and she is afraid he gave it to her. She read that the cold sores you get
on your mouth are not the same infection you get on your genitals.
What education would you provide them?
a) His HSV1 infection causes oral lesions and is only spread oraloral, so her infection cannot be HSV1
b) HSV2 is the primary cause of oral lesions and is not contagious
c) His HSV1 is primarily an oral infection, however it can be spread
to the genitals and cause the lesions
d) HSV1 is not a contagious infection so she will need to be
assessed for other causes of her lesions
HSV1 and HSV2 are highly contagious and both subtypes can be found
above and below the waist (CDC, 2016).
2. After assessing, educating and counseling the couple from question 1,
you decide on a treatment plan. The best prescription for her is:
a) Acyclovir 800mg BID PO x5 days
b) Topical Valtrex OTC
c) IV acyclovir 5 to 10 mg/kg IBW IV every 8 hours for 5 to 7 days
d) This patient does not need antiviral treatment because it is a
bacterial infection
Acyclovir is the preferred treatment protocol for this patient as topical
Valtrex is not indicated, nor is IV treatment for this relatively mild viral
infection (CDC, 2016).
3. A patient with a recurrence of HSV1 scratches an open lesion and
touches another part of her body immediately. She has just given
herself an HSV1 infection on that secondary site.
a) TRUE
b) FALSE
Self-inoculation in a healthy individual with Herpes Simplex virus is
extremely unlikely, and only possible during the first outbreak, before
the body has a chance to develop antibodies to the virus (Herpes,
n.d.).
4. After having been treated 2 months ago for trichomoniasis, a young
woman returns to the clinic with complaints of recurrent symptoms.
She is certain it is the same infection she had last time. The provider
educates her:

STD EXAM

a) She is wrong. It cannot be Trichomoniasis again, she cant

become infected again within 1 year
b) She is likely correct. There is a 1 in 5 chance to become infected
with Trichomoniasis again within 3 months of infection
c) She is wrong. You develop lifelong immunity once you have it
d) Trichomoniasis and herpes have the same symptoms, so she
probably has herpes this time.
The CDC, (2016) clarifies that a patient does not develop any sort
of immunity, whether temporary or lifelong to trichomoniasis and in
fact, reinfection is fairly common within 3 months. Trichomoniasis
and herpes present differently, mainly as trichomoniasis does not
create lesions (CDC, 2016).
5. The patient you have just diagnosed with genital warts is ready to
leave the appointment after youve completed her exam, diagnosis
and treatment planning, but is surprised to learn that she will have to
return for a PAP smear in 6 months. Your best answer regarding why
she must return so soon for a PAP when she is not due for another year
is:
a) Warts need to be monitored for resolution at a period of every 6
months until resolved
b) She likely has risky sexual behavior and will need a PAP and STI
exam every 6 months because of this
c) She is at risk for precancerous changes of the cervix because
warts are caused by a type of virus that is associated with these
changes
d) She is at risk for infertility and more frequent PAP smears will
ensure she can have children someday
Nall & Cherney, (2016) recommends that the timing for PAPs after a
diagnosis of genital warts caused by HPV is repeated in 6 months to
screen for cervical changes due to the virus.
6. Your patient states she would like the prescription for the antibiotics for
her recurrent infection, the same one as last time because it worked so
quickly. Her complaints include greenish/yellow vaginal discharge,
burning, itching and painful urination and pelvic pain after unprotected
sex with a new boyfriend. You are already anticipating to write her the
prescriptions because she most likely has:
a) Gonorrhea
b) Herpes
c) Syphilis
d) Genital warts

STD EXAM

While many women do not develop any symptoms, gonorrhea

symptoms are generally associated with dysuria and pain with fever
while Herpes, syphilis and genital warts do not have the associated
discharge and likely not dysuria (Kiefer, & Sarachik, 2016).

7. Your patient is diagnosed with syphilis and has flu-like symptoms with a
maculo/popular rash on his palms.You teach him that it is imperative
that he abstain from sexual intercourse and is highly contagious until
he is treated appropriately because he has which stage of syphilis:
a) Late-stage
b) Latent
c) Primary
d) Secondary
Syphilis is most contagious in the secondary phase, which is
characterized by symptoms of flu-like symptoms and a
maculo/popular rash, notably on the palms of the hands (CDC,
2016). Late stage will manifest with neurological and mental
decline and primary syphilis there may be painless chancres on
the genitals or oral mucosa (CDC, 2016).
8. Untreated Syphilis can cause all of the following: Select all that apply
a) Confusion
b) Aortic Aneurysm
c) Deafness
d) Cardiovascular disease
e) Cataracts
Late-stage syphilis effects multiple organs, including the brain,
heart, neurological system and can cause deafness and
blindness, (CDC, 2016).
9. You are counseling a young woman who is not sure she wants to get
the HPV vaccine. She asks you if the vaccine can protect her from
getting STIs. Your best response is:
a) No, because there is no vaccine against any STI, which is why
she needs to wear condoms every sexual encounter
b) Yes. The cause of genital warts for instance is a strain of HPV, but
she is still at risk for multiple other STIs
c) No, the only thing she can do to avoid an STI is douche regularly
d) Yes, the HPV vaccine will protect her from a variety of different
infections including Herpes and Syphilis

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The HPV vaccine prevents infection of multiple strains of the
virus, some of which are the cause of genital warts, however
other STIs are bacterial or caused by other viruses for which the
vaccination will not offer any protection, (CDC, 2016).

10.
A new patient to your clinic would like a full STI screening as she
just started a new relationship and wants to be sure she is healthy for
sexual activity with her new partner. She is confused about the HIV
testing, having heard that there is a 1-month window for the test. You
explain to her that:
a) The window refers to the time after infection before the testing
can detect antibodies to HIV in the blood, which usually takes 28
days
b) The window is the time after infection that it will take for HIV to
become AIDS
c) The window is the time she can be treated after exposer to cure
the disease
d) The window is the time between the exposure to the onset of
symptoms
When one becomes infected with the HIV virus, the body mounts
an immune response to the virus. This takes approximately 28days, although some literature supports re-testing at 3 or 6
months post-exposure. The CDC, (2016) recommendation is
minimum 28-days with retesting following each potential
exposure.
11.
You are seeing a healthy 22 year-old woman who is in for her
first gynecological exam. She has never had a PAP smear and is
sexually active for the first time with a male partner who is not a virgin.
You tell her that her exam will include an endocervical swab for STIs.
You tell her that the screening will include Chlamydia because:
a) Chlamydia is the most deadly STI so she cant risk not getting
tested
b) Chlamydia is the most frequent STI of women <24 years old and
is part of the routine screening to prevent complications
c) Chlamydia has no symptoms so she probably has it and doesnt
know it
d) Advise her that the CDC recommends routine screening for both
females and males at yearly exams
While chlamydia is a serious infection, it is not a deadly bacteria
for a healthy patient, chlamydia typically presents with
symptoms of dysuria, pelvic pain and yellow/green discharge,
and the CDC does not support the routine screening of chlamydia

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in men (CDC, 2016). It is the most common STI for her age
group, so if she requests testing, it is appropriate (CDC, 2016).

12.
The 22-year old you saw last week returned to the office because
you did indeed find that she has chlamydia. Your best treatment for her
diagnosis is:
a) Azithromycin 1g in a single dose
b) Ketoconazole 500mg orally once daily for 5 days
c) Levofloxacin 500mg orally every 12 hours for 3 days
d) Doxycycline 100mg orally TID for 7 days
The CDC, (2016) treatment guideline for chlamydia is
azithromycin 1 g in a single dose.

13.
A 25-year old female is diagnosed with gonorrhea. She is quite
upset at her appointment because she was recently unfaithful to her
fianc and is terrified he will find out. You have just reviewed the CDC
guidelines so you tell her that:
a) She doesnt have to tell him because the likelihood of spreading
it to him is negligible even if they have unprotected sex
b) She has exposed him to the infection and he should be evaluated
and treated if needed to avoid re-infecting herself
c) She must contact all sexual partners from her past and
recommend they be tested as well as she has likely been
spreading it for years
d) She can tell him she likely got it from trying on bathing suits at
Target because it can live on surfaces for 48 hours
The CDC, (2016) reports that proper treatment of gonorrhea
includes partner testing so her fianc and the man she was
sexually active with should both be informed and treated.
14.
A 36 year old female comes in complaining of a foul odor from
her vagina, copious greyish, thin discharge with vulvar and vaginal
itching. She also has dysuria. When you perform her PAP, you would
expect to find:
a) Frothy greenish discharge within her vagina
b) Grape-like clusters lining her vagina
c) Cervical inflammation and bloody discharge
d) Atrophic changes to the vaginal walls
The patient is describing trichomoniasis, which presents with an odor,
copious greyish, thin discharge with bubbles, described as frothy. The

STD EXAM

other findings indicate a normal benign condition, chlamydia and

decreased estrogen effect of aging (CDC, 2016).
15.
Your colleague comes to you for advice about a patient who has
a vaginal pH of 5.6 and a positive Sniff test using KOH preparation. She
wants to know which of the following is the best treatment option for
her non-pregnant, non-lactating patient:
a) Doxycyline 100mg orally every 12 hours for 21 days
b) PCN VK 500mg orally every 8 hours for 5 days
c) Ciprofloxacin 500mg orally for 3 days
d) Metronidazole 2g orally for 1 dose
Treatment guidelines for bacterial vaginosis indicate Metronidazole 2g
orally times 1 is the acceptable first line (CDC, 2016).

16.
Your patient is concerned about a new lesion on her labia. She
has a history of multiple sexual encounters and has an IUD therefore
rarely uses condoms. She noticed the lesion a few days ago, stating
that it doesnt cause her pain, it just doesnt look like the skin around
it. You examine her and find a 1.5cm, solitary, raised, red papule that is
firm on the inner aspect of her labia majora. You have a list of
differentials, but given her exam and history, the most likely cause of
her lesion is:
a) Lymphogranuloma Venereum
b) Condyloma Acuminata
c) Syphilis chancre
d) Chancroid
The initial symptoms, usually 2-14 days post exposure of syphilis
includes a painless open sore, unilaterally on the genitals or in
the oral mucosa (CDC, 2016). The other options do not present
with painless, open sores (CDC, 2016).
17.
Your patient is concerned that she has an STD. She reports
vaginal itching, burning and pain, with increasing discharge of a
greyish color, watery consistency. She Googled her symptoms and is
sure she has caught something from her boyfriend. When you diagnose
her with bacterial vaginosis, she becomes outraged that he gave her
an STD. You counsel her about BV, telling her all of the below are true,
EXCEPT:

STD EXAM

a) BV can cause cervical cancer and endocervical tumors

b) BV is not an STD, although it can be attributed to a new sex
partner or multiple sex partners
c) BV can spread between a males female sexual partners
d) BV can resemble Trichomoniasis, which is an STD, so seeking
treatment for her symptoms is always a good idea
BV is not an STD, but can be passed between female-malefemale exhanges and presents similarly to Trichomoniasis
(Majeroni, 1998).
18.
When discussing genital warts with your patient, you educate her
that the infection is most common for sexually active persons who
meet the following criteria: SELECT ALL THAT APPLY
a) HIV positive
b) Over age 30
c) Smoker
d) History of child abuse
According to the CDC, (2016), genital warts is most common in
those under 30, are HIV positive, smoke and have a history of
child abuse.
19.
Your 25 year old patient on Nexplanon for 2 years thinks she has
an STI and complains of dysuria, pelvic pain, chills and recently noticed
an odor to her vaginal discharge. You suspect PID so you appropriately
include which question in your H & P:
a) When was your last pregnancy?
b) Did you finish your treatment for genital herpes?
c) Can you tell me the age you started your period?
d) Can you me about your sexual history, including the number of
partners youve had?
Asking about pregnancy is important, but is not appropriate if she
has never been pregnant and is on nexplanon, rather asking about
any bleeding or whether shes taken a pregnancy test is more
appropriate. There is no indication she has had herpes and the
onset of menses is not related to this complaint. Multiple sexual
partners places the patient at a higher risk for PID and is the best
answer, (CDC, 2016).
20.
Your patient is diagnosed with PID and wants to know if there is a
medication that can treat this STI. After explaining to her that PID is
not an STI, but rather a disease state that may have been caused by
an untreated STI such as chlamydia or gonorrhea, you screen her for

STD EXAM

STIs and treat her appropriately. Your counseling should include which
information:
a) PID is not that serious and can be treated by improving her
hygiene
b) She should wear condoms to reduce the risk of infection from
STIs to prevent the recurrence of PID
c) She should start on birth control because they reduce the risk of
contracting STIs
d) Only herpes and HPV are associated with PID, therefore she does
not need to be screened for Chlamydia/Gonorrhea
PID is a serious infection that is not effected by hygiene, but risk
is increased with multiple sexual partners, birth control is not
effective at reducing STIs and PID can be caused by untreated
infections, including chlamydia and gonorrhea (CDC, 2016).
21.
A couple is seeking counseling in your office. The male has had a
recent exposure to HIV, having been possibly inoculated at his
workplace. The couple wants to know what they should do regarding
intercourse and oral sex until they know for sure if he has the virus. You
offer the patients the following information EXCEPT:
a) HIV can be passed from semen through an open lesion in the
mouth and therefore oral sex remains risky
b) Male condoms can reduce transmission by up to 85% so
intercourse can be relatively safe
c) HIV cannot be transmitted in the early period of infection so no
extra precaution is needed
d) The couple may choose abstinence at this time to provide 100%
protection from transmission
Transmission of HIV, in any stage of the infection is possible when
blood or bodily fluids are exchanged through lesions or breaks in the
skin including oral mucosa and genitalia, therefore precautions need
to be taken to reduce the likelihood of transmission (CDC, 2016).
22.
HPV is a preventable STI that has been linked to causing cancers
of the following: LIST 3 examples: (Cervix, penis, vulva, vagina, anus,
oropharyngeal)
1. ________________
2. ________________
3. ________________
Human Papiloma Virus invades cells and creates cellular dysplasia that
is linked to the development of cancers of the cervix, penis, vulva,
vagina and anus if not treated (Mayo, 2016).

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23.
Your HSV2-positive patient comes in today to ask about whether
or not she can stop taking her antiviral suppressive therapy
Valacyclovir 1gm oral once daily since she has not had an outbreak for
a year. Answer her briefly below to include why she should continue
antiviral therapy:
Antiviral suppressive therapy is shown to reduce recurrence by
70-80%, with many patients having no recurrence and can
prevent transmission to her partner when used with condoms
(CDC, 2016). Improved quality of life has been reported by
patients who are on suppressive therapy, (CDC, 2016).
24.
HPV 16, a high-risk subtype of Human Papilloma Virus known to
cause cancers of the cervix has been found to also cause
oropharyngeal cancers.
a) TRUE
b) FALSE
According to The Cancer Institute, (2016) a patient can become
infected with high-risk HPV in the soft palate, base of the tongue
and tonsils. HPV is the cause of more than half of all oral cancers
in the US (NCI, 2016).
25.
You are considering the differences between trichomoniasis and
bacterial vaginitis after a patient complains of irritation, burning,
dysuria and a foul odor with an increased amount of vaginal discharge.
You decide to take a swab and look under the microscope to be sure.
You find the following, which confirms your suspicion of bacterial
vaginosis:
a) Protozoa
b) Clue cells
c) Spirochetes
d) Reed-Sternberg cells
The presence of clue cells >20% with a fishy odor, burning and dysuria
are symptoms of bacterial vaginosis (Majeroni, 1998).
References
CDC, (2016). STD fact sheet. Retrieved from www.cdc.gov
Nall, R., & Cherney, K., (2016). Genital warts. Retrieved from
http://www.healthline.com/health/std/genital-warts#Overview1

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National Cancer Institute, (2016). HPV and Cancer. Retrieved from

http://www.cancer.gov/about-cancer/causes-prevention/risk/infectiousagents/hpv-fact-sheet
Majeroni, B. (1998). Bacterial vagnosis. American Family Physician. 57(6).
Pp1285-1289