Mindful Continuing Education

1. CDC recommendations for the prevention and control of STDs are based on each of the following major strategies EXCEPT:

2. The "Five P's" approach to obtaining a sexual history is one strategy for eliciting information concerning five key areas of interest, including partners, practices, prevention of pregnancy, prevention of STDs, and:

3. Prevention counseling for STD/HIV should be offered to all sexually active adolescents and to all adults who have received an STD diagnosis, have had an STD in the past year, or have multiple sexual partners, and it should be provided in an empathetic manner appropriate to the patient's culture, language, gender, sexual orientation, age, and developmental level.

4. In observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis, although experts do not recommend diaphragms as a sole source of protection against HIV or other STDs.

5. Definitive data has clearly demonstrated that male circumcision reduces HIV acquisition in heterosexual males as well as in men who have sex with men (MSM).

6. Which of the following is NOT a correct statement about Expedited Partner Therapy (EPT) or patient delivered partner therapy (PDPT)?

7. Syphilis, gonorrhea, chlamydia, chancroid, HIV infection, and AIDS are reportable diseases in every state, but reporting must be provider-based rather than laboratory-based.

8. Recommendations to screen pregnant women for STDs are based on several factors, including disease severity and sequelae, costs, medico-legal considerations, and:

9. All pregnant women in the United States should be screened for HIV infection at the first prenatal visit, as treating those who are infected is vital to the woman, and perinatal transmission of HIV may be reduced through available antiretroviral and obstetrical interventions.

10. Factors contributing to increased STD risk during adolescence include having multiple sexual partners concurrently, having sequential sexual partnerships of limited duration, failing to use barrier protection consistently and correctly, having increased biologic susceptibility to infection, and facing multiple obstacles to accessing health care.

11. Recommendations for primary prevention of STDs among adolescents include each of the following EXCEPT:

12. Comprehensive national guidelines regarding STD care and management have been developed for correctional populations, as growing evidence has demonstrated the utility of expanded STD screening and treatment services in these settings.

13. Although the frequency of unsafe sexual practices and the reported rates of bacterial STDs and incident HIV infection declined substantially in MSM from the 1980s through the mid-1990s, since that time, higher rates of sexual risk behaviors have been documented among MSM in the U.S. as well as increased rates of:

14. Routine cervical cancer screening should be offered to all women, including WSW who are at risk for acquiring HPV from both their female partners and from current or prior male partners, and thus are at risk for cervical cancer.

15. HCV can be transmitted through sex, and likely because of high-risk and traumatic sexual practices, new cases of HCV are emerging among MSM, as well as among:

16. Since HCV has been shown to be transmitted through breast milk, mothers with HCV infection should abstain from breastfeeding.

17. Despite the availability of effective antiretroviral therapy, many cases of HIV infection continue to be diagnosed at advanced stages, and although HIV testing facilitates early diagnosis, rates of testing remain relatively low.

18. Notifying the patient that an HIV test will be performed unless the patient declines, which is known as passive consent, is recommended in health-care settings that serve at-risk populations.

19. Acute retroviral syndrome, which develops in 50%-90% of persons within the first few weeks after they become infected with HIV, is characterized by nonspecific symptoms, including fever, malaise, lymphadenopathy, and skin rash.

20. Providers should expect persons with HIV infection to be distressed when first informed of a positive test result, as they have to face coping with the reactions of others to a stigmatizing illness as well as:

21. At the initial HIV care visit, providers should test all sexually active persons with HIV infection for curable STDs (e.g., syphilis, gonorrhea, and chlamydia) and perform testing at least annually during the course of HIV care.

22. In the United States, most young, sexually active patients who have genital, anal, or perianal ulcers have either genital herpes or syphilis, with the frequency of each condition differing by geographic area and population.

23. Each of the following is an accurate statement about genital HSV infections EXCEPT:

24. In order to significantly reduce the frequency of genital herpes recurrences, by as much as 70%-80% in patients who have frequent recurrences, some patients choose to take daily antiviral therapy, which is known as:

25. Immunocompromised patients can have prolonged or severe episodes of genital, perianal, or oral herpes, and lesions caused by HSV that may be severe, painful, and atypical are common among persons with HIV infection.

26. Women with recurrent genital herpetic lesions at the onset of labor should deliver by cesarean delivery, as cesarean delivery completely eliminates the risk for HSV transmission to the neonate.

27. Syphilis has been divided into stages based on clinical findings, helping to guide treatment and follow-up, and manifestations of primary infection include skin rash and mucocutaneous lesions at the infection site.

28. False-positive nontreponemal test results can be associated with various medical conditions and factors unrelated to syphilis, including other infections such as HIV, autoimmune conditions, immunizations, pregnancy, injection drug-use, and:

29. Penicillin G, administered parenterally, is the preferred drug for treating persons in all stages of syphilis, and nearly all recommendations for this treatment are based not only on clinical trials and observational studies, but also on many decades of clinical experience.

30. Sex partners of persons with syphilis are considered at risk for infection and should be confidentially notified of the exposure and need for evaluation if they are partners who have had sexual contact within:

31. Although data to support use of alternatives to penicillin in the treatment of primary and secondary syphilis are limited, azithromycin is generally recommended as the first-line treatment when the use of penicillin is not feasible.

32. Persons with HIV infection who have early syphilis might be at increased risk for neurologic complications and might have higher rates of serologic treatment failure with recommended regimens.

33. All women should be screened serologically for syphilis early in pregnancy, and for populations in which the prevalence of syphilis is high and for women at high risk for infection, serologic testing should also be performed at 20-24 weeks and at 34-38 weeks' gestation.

34. Which of the following is a correct statement about syphilis treatment and management in pregnancy?

35. Infants and children who require treatment for congenital syphilis but who have a history of penicillin allergy or develop an allergic reaction presumed secondary to penicillin should be desensitized and then treated with penicillin.

36. Persons who report a history of penicillin reaction and who are skin-test negative can receive conventional penicillin therapy to treat syphilis.