Question 1

A female patient has come to the STD clinic and has been diagnosed with a Trichomonas vaginalis infection. What education should be provided to this patient?

Accepted Answer

The most important information the nurse can provide is that male partners should always be treated, even if they are asymptomatic. Gels are not indicated for T. vaginalis; oral medications are. T. vaginalis infection can be easily treated with a single dose of metronidazole or tinidazole. Both medications are given as a single dose.

Question 2

Which infections may be acquired through nonsexual transmission?

Accepted Answer

All of these organisms can be acquired through nonsexual transmission, usually from a mother to an infant either prenatally or during delivery.

Question 3

A newborn infant has been given erythromycin ophthalmic ointment as a routine postpartum medication. The infant's mother learns that she has a C. trachomatis infection and asks the nurse if her baby will need to be treated. Which response by the nurse is correct?

Accepted Answer

Infants born to women with cervical C. trachomatis are at risk for conjunctivitis and pneumonia. Topical erythromycin may help prevent conjunctivitis, but it is not completely effective and does not prevent pneumonia; therefore, this infant will need treatment with oral erythromycin. Blindness will not occur as a result of C. trachomatis conjunctivitis. Doxycycline is contraindicated, because it causes staining of the teeth in children under 8 years of age.

Question 4

An adolescent patient comes to the clinic complaining of a burning sensation upon urination and a pus-like discharge from the penis. The nurse is correct to suspect that the patient has which disorder?

Accepted Answer

This patient has signs and symptoms that are consistent with gonorrhea. Herpes simplex manifests as vesicles on the penis or testes (or both) with a watery discharge. Nongonococcal urethritis results in ulcers on the urethral site. Syphilis is characterized by chancres and skin lesions.

Question 5

A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication?

Accepted Answer

Genital herpes can be treated with acyclovir, famciclovir, or valacyclovir, which are antiviral medications. Azithromycin, metronidazole, and tinidazole are antibiotics and do not have antiviral effects.

Question 6

A patient admitted to the hospital is using metronidazole [Flagyl] 0.75% gel. The nurse understands that this agent is used to treat which condition?

Accepted Answer

Gardnerella vaginalis causes bacterial vaginosis and is treated with metronidazole gel. C. trachomatis is treated with systemic antibiotics. H. ducreyi, which causes chancroid, is treated with systemic antibiotics. T. vaginalis is treated with oral metronidazole.

Question 7

An adolescent patient with mild cervicitis is diagnosed with gonorrhea. The nurse will expect the provider to order which drug(s)?

Accepted Answer

The only options for treating cervical infection with gonorrhea are cefixime and ceftriaxone. Ceftriaxone is recommended over cefixime because of antibiotic resistance to cefixime. Because a high percentage of patients with gonorrhea also have chlamydial infections, they should be treated with either doxycycline or azithromycin until a chlamydial infection has been ruled out. Azithromycin combined with doxycycline would not treat gonorrhea. Ceftriaxone would treat gonorrhea only. Doxycycline would treat chlamydia only.

Question 8

A patient is admitted to the hospital with fever, headache, malaise, joint pain, and enlarged lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis?

Accepted Answer

Secondary syphilis occurs when the organism spreads to the bloodstream, causing systemic symptoms such as fever, headache, reduced appetite, and general malaise, along with enlarged lymph nodes and joint pain. Congenital syphilis occurs when infants are exposed to T. pallidum in utero; early symptoms include sores, rhinitis, and point tenderness over bones. Primary syphilis is characterized by a primary lesion, called a chancre, at the point of entry, along with enlarged lymph nodes. Tertiary syphilis develops 5 to 40 years after the initial infection and can involve the brain, heart, and other sites.

Question 9

During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug?

Accepted Answer

The preferred treatment for C. trachomatis during pregnancy is either azithromycin or amoxicillin. Doxycycline can be used for nonpregnant patients. Erythromycin is used for infants. Sulfisoxazole is not recommended for pregnant woman near term, because it can cause kernicterus in the infant.

Question 10

A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which statement by a student indicates understanding of infections caused by C. trachomatis?

Accepted Answer

Chlamydial infections are frequently asymptomatic in women and may be asymptomatic in men; they can cause sterility in women. C. trachomatis conjunctivitis in newborns does not result in blindness. The Centers for Disease Control and Prevention (CDC) recommends routine screening for sexually active women under age 25 and for those over age 25 with new partners or multiple partners. Treatment should begin when infections are identified, regardless of whether they are symptomatic.

Question 11

A patient is diagnosed with pelvic inflammatory disease (PID). Which treatment regimen is most appropriate for reducing the risk of sterility in this patient?

Accepted Answer

Many experts recommend that all patients with PID receive IV antibiotics in the hospital to minimize the risk of sterility and other complications. Medications used intravenously can be cefoxitin or cefotetan combined with doxycycline; when symptoms resolve, IV therapy may be discontinued but must be followed by PO doxycycline. Outpatient regimens are not recommended. Oral medications are not recommended for initial treatment.

Quiz 95: Drug Therapy of Sexually Transmitted Diseases