Section 1. The Clinical Approach of STDs

Section 1 Objectives

1.1.0.0 Taking a Sexual History

1.1.0.1 Guidelines for Language Choice

1.1.0.2 Attitude

1.1.1 Patient History: Reason for the Visit

1.1.2.0 Sexual History

1.1.2.1 Indications of STD Risk

1.1.3 General Clinical Management

1.1.4 Patient Education

1.2.0.0 Physical Examination of the Female

1.2.0.1 Before you Proceed with the Examination

1.2.1 Examination-While Patient is on Table

1.2.1.1 Prepare the Patient for the Examination

1.2.1.2 Bimanual Examination

1.2.1.3 Rectovaginal Examination

1.3.0 Physical Examination of the Male

1.3.1.0 Examination-While Patient is on Table

1.3.1.1 Pelvic Examination

1.4.0 Female Figure

1.4.1 Male Figure

1.5.0 CME Credit Questions

1.5.1 References

1.5.2 Appendix A

1.5.3 Appendix B

2.1.0 Biology

2.1.1 Pathogenesis

2.1.2.0 Epidemiology-Incident Trends in the USA

2.1.2.1 Transmission and Incubation

2.1.3.0 Clinical Manifestations

2.1.3.1 Primary Syphilis

2.1.3.2 Secondary Syphilis

2.1.3.3 Latent Syphilis

2.1.3.4 Tertiary Syphilis

2.1.3.5 Syphilis & Concomitant HIV Infection

2.1.3.6 Tertiary Syphilis

2.1.4.0 Laboratory Diagnosis-Darkfield (DF) Microscopy

2.1.4.1 Direct Fluorescent Antibody- T.pallidum

2.1.4.2 Serological Testing

2.1.4.3 New Diagnostic Techniques

2.1.5 Indications for CSF Evaluation

2.1.6.0 Primary, Secondary & Early latent Syphilis

2.1.6.1 Late Latent Syphilis or Syphilis of unknown Duration

2.1.6.2 Neurosyphilis & Ocular Infection

2.1.6.3 Syphilis during Pregnancy

2.1.6.4 Congenital Syphilis

2.1.6.5 Syphilis in HIV Infected Persons

2.1.7.0 Follow-up

2.1.7.1 Primary and Secondary Syphilis

2.1.7.2 Latent Syphilis

2.1.7.3 Neurosyphilis

2.1.7.4 Pregnancy

2.1.8.0 Partner(s) Requiring Evaluation

2.1.8.1 Partner Management

2.1.9 Reporting

2.1.10 Patient Counseling

2.1.11 Prevention

2.1.12 Interactive web-based case

2.2.0 Review Questions

2.2.1 CME Credit Questions

2.2.2 Figures

2.2.3 References

3.1.0 Biology

3.1.1 Pathogenesis

3.1.2 Transmission and Incubation

3.1.3 Epidemiology-Incidence in the USA

3.1.4.0 Clinical Manifestations-Uncomplicated Infections

3.1.4.1 Complicated Infections

3.1.4.2 Infections in Children

3.1.5.0 Laboratory Diagnosis

3.1.5.1 Gram Stain Smear

3.1.5.2 Culture

3.1.5.3 Antigen Detection Tests

3.1.5.4 Nucleic Acid Tests

3.1.6.0 Treatment

3.1.6.1 Uncomplicated Gonococcal Infections

3.1.6.2 Gonococcal Infections of the Pharynx

3.1.6.3 Gonococcal Conjunctivitis

3.1.6.4 Epididymitis

3.1.6.5 PID

3.1.6.6 DGI

3.1.7 Management in Pregnancy

3.1.8 Follow-up and Partner Management

3.1.9 Screening and Prevention

3.1.10 Reporting

3.2.0 Review Questions

3.2.1 CME Credit Questions

3.2.2 Figures

3.2.3 References

4.1.0 Chlamydial Infections: Biology

4.1.1 Pathogenesis

4.1.2.0 Epidemiology-Incidence in the USA

4.1.2.1 Prevalence in the USA

4.1.2.2 Transmission and Incubation

4.1.3.0 Clinical Manifestations

4.1.3.1 Genital Infections in Men

4.1.3.2 Genital Infections in Women

4.1.3.3 Syndromes seen in Men and Women

4.1.3.4 Syndromes seen in Infants and Children

4.1.4.0 Laboratory Diagnosis

4.1.4.1 Gram Stain

4.1.4.2 Culture

4.1.4.3 Antigen Detection Method

4.1.4.4 Nucleic Acid Technology

4.1.4.5 Serology

4.1.4.6 Rapid Tests

4.1.4.7 Summary Performance Characteristics

4.1.5.0 Treatment

4.1.5.1 Uncomplicated Chlamydial infections in non-pregnant adults

4.1.5.2 Pregnant Women

4.1.5.3 Children

4.1.5.4 Neonatal Infections

4.1.5.5 LGV

4.1.6 Chlamydia and HIV

4.1.7 Follow-up and Partner Management

4.1.8.0 Screening and Prevention-Women

4.1.8.1 Men

4.1.9 Patient Counseling and Education

4.1.10 Reporting

4.2.0 Review Questions

4.2.1 CME Credit Questions

4.2.2 Figures

4.2.3 References

5.1.0 Biology

5.1.1 Pathogenesis-Mechanism of Infection

5.1.1.1 Natural History of Infection

5.1.1.2 Oncogenic Potential

5.1.2.0 Prevalence in the USA

5.1.2.1 Transmission and Incubation

5.1.3.0 Clinical Manifestations

5.1.3.1 Women

5.1.3.2 Men

5.1.4.0 Physical Examination

5.1.4.1 DNA Detection

5.1.4.2 Cytology

5.1.4.3 Pap Smear

5.1.4.4 Liquid-Based Cervical Cytology

5.1.4.5 Colposcopy

5.1.4.6 Histology

5.1.5 Differential Diagnosis

5.1.6.0 Treatment

5.1.6.1 External Condyloma of the Genital Tract

5.1.6.2 Vaginal Condyloma

5.1.6.3 Urethral Meatal Warts

5.1.6.4 Anal Warts

5.1.6.5 Oral Warts

5.1.6.6 Cervical Lesions

5.1.6.7 Genital Warts in Pregnancy

5.1.6.8 Abnormal Pap Smears

5.1.6.9 Recommended follow-up of abnormal smears

5.1.6.10 Pre-Invasive and Invasive Lesions

5.1.7 Follow-up

5.1.8 HPV and HIV Infection

5.1.9 Management of Sexual Partners and Prevention

5.1.10 Patient Counseling and Education

5.1.11 Prevention

5.1.12 Interactive web-based case

5.2.0 Review Questions

5.2.1 CME Credit Questions

5.2.1 References

6.1.0 Biology of Genital Herpes

6.1.1.0 Pathogenesis of Disease

6.1.1.1 Primary Infection

6.1.1.2 Recurrence

6.1.2.0 Epidemiology of Genital Herpes Infections-Global significance

6.1.2.1 HSV Seroprevalence in U.S.

6.1.2.2 Incidence of Clinical Disease in U.S.

6.1.2.3 Transmission and Incubation Period

6.1.3.0 Clinical Manifestations of Genital Herpes-Definition of Terms

6.1.3.1 Clinical Manifestations

6.1.4.0 Laboratory Diagnosis-Viral Culture

6.1.4.1 Antigen Detection Tests

6.1.4.2 Tzanck Prep or PAP

6.1.4.3 PCR

6.1.4.4 Serologic Tests

6.1.5.0 Treatment, Available Medications

6.1.5.1 Treatment Regimens

6.1.5.2 Initial Clinical Episodes

6.1.5.3 Recurrences

6.1.5.4 Episodic Treatment of Recurrent Infections

6.1.5.5 Suppressive Therapy for Frequent Recurrences

6.1.5.6 Intravenous Treatment

6.1.6.0 HSV in Pregnancy-Risk of Mother to Infant Transmission

6.1.6.1 Complications of Neonatal HSV Infection

6.1.6.2 Complications of HSV in Pregnant Women

6.1.6.3 Management of HSV during Pregnancy

6.1.7.0 Genital Herpes and HIV Infection-Effect of HSV on HIV

6.1.7.1 Effect of HIV Infection on Genital HSV

6.1.7.2 Management of Genital Herpes in HIV Infection

6.1.7.3 Episodic Infection for HIV

6.1.7.4 Daily Suppressive Therapy for HIV

6.1.8 Counseling and Sexual Contacts

6.1.9 Prevention of HSV

6.1.10 Interactive web-based case

6.2.0 Review Questions

6.2.1 CME Credit Questions

6.2.2 References

7.1.0 Pathophysiology and Definition

7.1.1.0 Etiology, infectious causes

7.1.1.1 Other Causes Of Cervical Inflammation/Lesions

7.1.2 Clinical Manifestations

7.1.3 Laboratory Diagnosis and Clinical Evaluation

7.1.4 Treatment

7.1.5 Follow-up and Management of Partners

7.1.6 Complications

7.2.0 Definition

7.2.1 Etiology

7.2.2 Epidemiology

7.2.3 Clinical Manifestations

7.2.4.0 Laboratory Diagnosis

7.2.4.1 Urethral Gram Stain

7.2.4.2 Urine Microscopy/Testing

7.2.4.3 Test For Neisseria Gonorrhoeae & Chlamydia Trachomatis

7.2.4.4 Testing For Chlamydia Trachomati

7.2.4.5 Other Laboratory Assessments

7.2.5 Treatment

7.2.6 Follow-up and Management of Sexual Partner(s)

7.2.6.1 Patient Counseling/Education

7.2.7.0 Recurrent or Persistent Urethritis

7.2.7.1 Guidelines for Management of Recurrent or Persistent Urethritis

7.2.8 Complications

7.2.9 Interactive Web-based Case

7.3.0 Epidemiology

7.3.1 Etiology

7.3.2 Clinical Manifestations

7.3.3 Laboratory Diagnosis

7.3.3.1 Syphilis

7.3.3.2 Chancroid

7.3.2.3 Herpes

7.3.3.4 Lymphogranuloma Venereum

7.3.3.5 Granuloma Inguinale (Donovanosis)

7.3.3.6 Other Laboratory Methods

7.3.4 Diagnostic Approach

7.3.5 Treatment

7.3.6 Follow-up and Management of Partners

7.3.7 Complications

7.3.8 Interactive Web-Based Case

7.4.0 Definition

7.4.1.0 Epidemiology

7.4.1.1 Incidence and Prevalence

7.4.1.2 Demographic and Behavioral Factors

7.4.2.0 Pathogenesis and Etiology

7.4.2.1 Etiology

7.4.2.2 Factors Influencing the Development of PID

7.4.3 Clinical Manifestations

7.4.4.0 Diagnosis

7.4.4.1 CDC Diagnostic Criteria

7.4.4.2 Diagnostic Workup

4.5.0 Treatment

4.5.1 CDC recommended Outpatient Oral Regimens

4.5.2 CDC recommended Parenteral Regimens

7.4.6 Follow-up and Partner Management

7.4.7 Sequelae of PID

7.4.8 Prevention

7.4.9 Interactive Web-Based Case

7.5.0 Etiology and Epidemiology

7.5.0.1 Normal Vaginal Environment

7.5.0.2 Most Frequent Etiologies of Abnormal Vaginal Discharge

7.5.0.3 Noninfectious causes

7.5.1.0 Pathogenesis

7.5.1.1 Bacterial Vaginosis

7.5.1.2 Vulvovaginal Candidiasis

7.5.1.3 Trichomonas Vaginalis

7.5.2.0 Clinical Manifestations

7.5.2.1 Bacterial Vaginosis

7.5.2.2 Vulvovaginal Candidiasis (VVC)

7.5.2.3 Trichomonas Vaginalis

7.5.3.0 Diagnosis

7.5.3.1 Bacterial Vaginosis

7.5.3.2 Vulvovaginal Candidiasis (VVC)

7.5.3.3 Trichomonas Vaginalis

7.5.4.0 Laboratory Diagnosis

7.5.4.1 Saline and KOH Preps

7.5.4.2 Gram Stains

7.5.4.3 Cultures

7.5.4.4 PAP Smears

7.5.4.5 DNA Probes and other Technologies

7.5.5.0 Treatment

7.5.5.1 Bacterial Vaginosis

7.5.5.2 Vulvovaginal Candidiasis (VVC)

7.5.5.3 Trichomonas Vaginalis

7.5.6 Partner Management

7.5.7 Follow-Up

7.5.8 Interactive Web-Based Case

7.6.0 Review Questions

7.6.1 CME Credit Questions

7.6.2 References

8.1.0 Comparison of Viral Hepatitides

8.1.1 Brief Overview by Viral Agent

8.1.2 Transmission and Clinical Manifestations of Viral Hepatitis

8.2.0.0 Epidemiology-Global Incidence

8.2.0.1 US Incidence

8.2.0.2 Modes of Transmission, Incubation Period and Infectivity

8.2.1.0 Clinical Manifestations of Acute Disease

8.2.1.1 Natural History and Complications

8.2.2 Laboratory Diagnosis and Clinical Evaluation

8.2.3 Treatment

8.2.4 Counseling

8.2.5 Partner Management

8.2.6.0 Prevention and Pre-Vaccination Screening

8.2.6.1 Give Vaccine in the following

8.2.6.2 Vaccine Dosing and Administration

8.3.0.0 Epidemiology-Global Incidence/Prevalence

8.3.0.1 US Prevalence

8.3.0.2 Modes of Transmission, Incubation Period and Infectivity

8.3.1.0 Clinical Manifestations

8.3.1.1 Natural History and Complications

8.3.2.0 Laboratory Diagnosis-HBV Viral Markers

8.3.2.1 Interpretation of Hepatitis B Serologic Markers

8.3.2.2 Interpretation of the Hepatitis B Panel

8.3.3 Treatment

8.3.4 Patient Counseling

8.3.5.0 Prevention-Pre-Exposure Prophylaxis

8.3.5.1 Post-Exposure Prophylaxis

8.3.5.2 Hepatitis B Immunization

8.4.0 Epidemiology

8.4.1 Modes of Transmission and Incubation Period

8.4.2 Clinical Manifestations

8.4.3.0 Laboratory Diagnosis

8.4.3.1 Interpretation of Diagnostic Testing for HCV

8.4.4 Treatment

8.4.5.0 Screening

8.4.5.1 Counseling Persons who test Positive for HCV

8.5.0 Epidemiology

8.5.1 Pathogenesis

8.5.2 Clinical Manifestations

8.5.3 Diagnosis

8.5.4 Treatment

8.5.5 Prevention

8.6.0 Epidemiology

8.6.1 Pathogenesis

8.6.2 Clinical Manifestations

8.6.3 Diagnosis

8.5.4 Treatment

8.6.5 Prevention

8.7.0 CME Credit Questions

8.7.1 Figure 1

8.7.2 References

	Previous page: Registration	Next page: CME Test Overview