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Chapter 26: Sexually Transmitted Infections

1. What unique factor causes adolescent girls to have a high risk for sexually transmitted

infections (STIs)?
a. They are in an experimental phase with sexual intercourse and believe they are

resistant to developing STIs.

b. The adolescent cervix is immature and lacks immunity.
c. The length of the vaginal canal is short in adolescents, allowing a greater
concentration of microorganisms within the internal genitalia.
d. In adolescent girls, the anus to the vaginal introitus are in close proximity.

Partly, perhaps, because of risk-taking behavior (unprotected intercourse or selection of highrisk partners), many adolescents have an increased risk for STI exposure and infection. The
unique factor for adolescent women is that they have a physiologically increased susceptibility
to infection because of increased cervical immaturity and lack of immunity. The remaining
options are not considered legitimate risk factors for STIs.
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REF: Pages 918-919

2. How is gonorrhea transmitted from a pregnant woman to her fetus?

a. Unbound in the blood via the placenta
b. Attached to immunoglobulin G (IgG) via the placenta
c. Across amniotic membranes by the direct inoculation with the fetal scalp electrodes

during labor monitoring

d. Predominately through infected cervical and secretions during the birth process

A pregnant woman can transmit gonorrhea to her fetus during the birth process. The infection
passes from mother to child predominately through infected cervical and vaginal secretions.
The transmission is not associated with the other options.
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REF: Page 920

3. Which statement is false about the factors that facilitate the ascent of gonococci into the uterus

and fallopian tubes?

a. Ascent of gonococci is facilitated because the cervical plug disintegrates during

b. Ascent of gonococci is facilitated because the vaginal pH decreases to 2 or 3.
c. Ascent of gonococci is facilitated because the uterine contractions may cause

retrograde menstruation into the fallopian tubes.

d. Ascent of gonococci is facilitated because the bacteria may adhere to sperm and be

transported to the fallopian tubes.


Several factors can facilitate the ascent of gonococci into the uterus and the fallopian tubes,
where they cause pelvic inflammatory disease (PID). Among these factors are (1)
disintegration of the cervical mucous plug and (2) a rise in vaginal pH greater than 4.5 during
menstruation. The other options are accurate statements.
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REF: Page 921

4. In women, what is the usual site of original gonococcal infection?

a. Endocervical canal
c. Fallopian tube
b. Vagina
d. Labia majora

In women, the endocervical canal (inner portion of the cervix) is the usual site of original
gonococcal infection, although urethral colonization and infection of Skene or Bartholin
glands also are common. The other options are not usually associated with gonococcal
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REF: Page 921

5. What is the primary site for uncomplicated local gonococci infections in men?
a. Epididymis
c. Urethra
b. Lymph nodes
d. Prostate

Uncomplicated local infections are observed primarily as urethral infections in men.

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REF: Page 921

6. What local complication of a gonococcal infection is diagnosed in approximately 10% of

affected women?
a. Acute salpingitis
b. Cystitis

c. Vaginitis
d. Cervicitis


Acute salpingitis, or pelvic inflammatory disease (PID), is the most common local
complication in women. Approximately 10% of women with untreated cervical gonorrhea
develop PID.
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REF: Page 921

7. Which laboratory test is considered adequate for an accurate and reliable diagnosis of

gonococcal urethritis in a symptomatic man?

a. Ligase chain reaction (LCR)
b. Gram-stain technique

c. Polymerase chain reaction (PCR)

d. DNA testing


Microscopic evaluation of Gram-stained slides of clinical specimens is deemed positive for

Neisseria gonorrhoeae if gram-negative diplococci with the typical kidney bean
morphologic appearance are found inside polymorphonuclear leukocytes. Such a finding is
considered adequate for the diagnosis of gonococcal urethritis in a symptomatic man. The
other options are not relevant to the diagnosis of this condition.

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REF: Page 922

8. How does an established gonococcal infection usually express itself in newborns?

a. Generalized skin rash 4 to 6 days after birth
b. Systemic infection with fever
c. Bilateral corneal ulceration
d. Yellow vaginal or penile discharge approximately 10 days after birth

Established infection causes bilateral corneal ulceration. The other options are not usual sites
for such an infection.
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REF: Page 922

9. What is the major concern regarding the treatment of gonococci infections?

a. Development of antibiotic resistance c. Changes in pathogenicity
b. Changes in virulence
d. Mutations into different strains

Several types of drug-resistant strains have been identified; they are penicillinase-producing
Neisseria gonorrhoeae (PPNG), which is resistant to penicillin; tetracycline-resistant N.
gonorrhoeae (TRNG), which is resistant to tetracycline; chromosomal control of mechanisms
of resistance of N. gonorrhoeae (CMRNG), which is resistant to penicillin and tetracycline;
and increasingly a fluoroquinolone-resistant N. gonorrhoeae (QRNG). The other options are
not major concerns.
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REF: Page 922

10. Which sexually transmitted infection frequently coexists with gonorrhea?

a. Syphilis
c. Chlamydia
b. Herpes simplex virus
d. Chancroid

The coexistence of chlamydial infection with gonorrhea frequently occurs. No coexistence

exists with the other options.
PTS: 1

REF: Page 922

11. During which stage of syphilis do bloodborne bacteria spread to all the major organ systems?
a. Primary
c. Latent
b. Secondary
d. Tertiary

Bloodborne bacteria spread to all major organ systems during only stage II, secondary syphilis
(see Box 26-2).
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REF: Page 923

12. In which stage of syphilis would the following clinical manifestations be found: destructive

skin, bone and soft tissue lesions, aneurysms, heart failure, and neurosyphilis?
c. Latent
d. Tertiary

a. Primary
b. Secondary


Stage IV, tertiary syphilis, is the only stage during which significant morbidity and mortality
occur, including destructive skin, bone, and soft-tissue lesions (see Box 26-2).
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REF: Page 924

13. Which organism is responsible for the development of syphilis?

a. Neisseria syphilis
c. Haemophilus ducreyi
b. Treponema pallidum
d. Chlamydia trachomatis

T. pallidum is the only cause of syphilis.

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REF: Page 923

14. Which is a characteristic lesion of secondary syphilis?

a. Condylomata lata
c. Chancroid
b. Gummas
d. Donovan bodies

The only secondary syphilis lesion is the condylomata lata.

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REF: Pages 924-925

15. By which method is the organism that causes syphilis best identified?
a. Acid-fast stain
c. In vitro culture
b. Gram-stained slide
d. Darkfield microscopy

Because Treponema pallidum cannot be cultured in vitro, early definitive diagnosis of primary
or secondary syphilis depends on darkfield microscopy of a specimen taken from a chancre,
regional lymph node, or other lesion. The remaining options are not relevant.
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REF: Page 925

16. When a patient has small, vesicular lesions that last between 10 and 20 days, which sexually

transmitted infection is suspected?

a. Genital herpes
b. Chancroid

c. Syphilis
d. Chlamydia


If symptoms occur, the individual may have small (1 to 2 mm), multiple, vesicular lesions that
are generally located on the labia minora, fourchette, or penis. They may also appear on the
cervix, buttocks, and thighs and are often painful and pruritic. These lesions usually last
approximately 10 to 20 days. The other options do not demonstrate these symptoms.
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REF: Page 933

17. Which statement is false regarding the risk of transmission of the herpes simplex virus (HSV)

from mother to fetus?

a. Neonatal infection of HSV rarely occurs in the intrapartum or postpartum period.
b. The risk is higher in women who have a primary HSV infection.

c. The risk is higher in women who experience ruptured membranes more than 6

hours before delivery.

d. The risk is higher when internal fetal monitoring devices are used.

Neonatal infections can occur in utero or, more commonly, during the intrapartum or
postpartum period. The other options are accurate statements.
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REF: Page 933

18. During the latent period of a herpes virus infection, where in the host cell is the genome of the

virus maintained?
a. Mitochondria
b. Lysosomes

c. Nucleus
d. Cytoplasm


During the latent period, the genome for the virus is maintained in the host cell nucleus
without causing the death of the cell.
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REF: Page 933

19. During reactivation (release from latency), herpes virus genomes are transported through

which nerves to the dermal surface?

a. Somatic
b. Peripheral sensory

c. Autonomic
d. Peripheral motor


Only during reactivation are the viral genomes transported through the peripheral sensory
nerves back to the dermal surface.
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REF: Page 933

20. Which statement provides the most accurate information regarding the transmission of herpes

simplex virus (HSV)?

a. HSV is transmitted only when vesicles are present.
b. HSV is transmitted only while lesions are present.
c. The use of condoms prevents the transmission of HSV.
d. The risk of transmission is present even during latent periods.

Latent infections can become reactivated and cause a recurrent infection with similar
manifestations. The other options are not accurate statements regarding the transmission of
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REF: Pages 933-934

21. Which drug may be prescribed orally for outbreak management of herpes simplex viral (HSV)

a. Acyclovir (Zovirax)
b. 5-Fluorouracil (5-FU)

c. Zidovudine (AZT) (Retrovir)

d. Bichloroacetic acid (BCA)

Although no curative treatment for HSV infection is known, only oral acyclovir, valacyclovir,
penciclovir, and famciclovir are used for primary and periodic outbreaks and to prevent
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REF: Page 934

22. Which of the following causes condylomata acuminata or genital warts?

a. Chlamydia
c. Human papillomavirus (HPV)
b. Adenovirus
d. Herpes simplex virus 1 (HSV-1)

Genital warts are quite contagious and are a result of only HPV.
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REF: Pages 934-935

23. Which treatment is used for trichomoniasis?

a. Topical application of 5-Fluorouracil (5-FU)
b. Topical application of acyclovir
c. Systemic metronidazole
d. Systemic tetracycline

The treatment of choice for trichomoniasis is a single 2-gram dose of metronidazole (Flagyl)
or tinidazole. The other options are not applicable.
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REF: Page 938

24. A woman diagnosed with trichomoniasis asks if her sexual partner should be treated as well.

What is the appropriate response?

a. Sexual partners should be treated only if symptoms are present.
b. Sexual partners should be treated even if they are asymptomatic.
c. Infections in men are self-limiting; therefore a male sexual partner does not require

d. Sexual partners should be treated to prevent infection.

Sexual partners, even if asymptomatic, are also treated and examined for coexisting sexually
transmitted infections.
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REF: Page 938

25. Which microorganism is sexually transmitted, primarily by homosexual men, through infected

a. Shigellosis
b. Cytomegalovirus (CMV)

c. Giardia lamblia
d. Entamoeba histolytica


Only the Shigella infection, termed shigellosis, is transmitted by contact with infected feces
particularly among homosexual men.
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REF: Page 940 | Table 26-3

26. Which hepatitis virus is known to be sexually transmitted?

a. A
c. C
b. B
d. D

Only hepatitis B virus (HBV) is known to be sexually transmitted.

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REF: Page 940

27. Which sexually transmitted disease occasionally causes clinical manifestations of scant

intermittent penile discharge, slight pruritus, and mild dysuria?

c. Cytomegalovirus enteritis
d. Trichomoniasis

a. Campylobacter enteritis
b. Shigellosis

Most men with trichomoniasis are asymptomatic but may have scant intermittent discharge,
slight pruritus, and mild dysuria. The other options do not demonstration these symptoms.
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REF: Page 937

28. Which statements are true regarding the hepatitis B infection? (Select all that apply.)
a. Hepatitis B poses a significant risk for chronic liver disease.
b. Hepatocellular cancer is a common comorbid condition.
c. Universal vaccination of infants and children is recommended.
d. The preventive method of choice is immunization.
e. Universal vaccination of sexually active adults is recommended.
ANS: A, B, C, D

Hepatitis B infection poses significant health risks including chronic liver disease and
hepatocellular cancer. Immunization against hepatitis B is the most effective means of
preventing transmission. Universal vaccination of infants and children is recommended, as
well as vaccination of high-risk adults.
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REF: Page 941

29. What are the common modes of transmission for the hepatitis B virus (HBV)? (Select all that

Needle punctures
Blood transfusions
Contact with infected body fluids
Skin cuts
Ingestion of infected substances


ANS: A, B, C, D

Transmission of HBV can occur through needle puncture, blood transfusion, cuts in the skin,
and contact with infected body fluids. Ingestion is not a recognized transmission mode.
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REF: Page 941

30. Which statements are true regarding the parasitic infection referred to as scabies? (Select all

that apply.)
Scabies is spread through skin-to-skin contact.
The crab lice, Phthirus pubis, cause scabies.
Severe pruritus is its major clinical manifestation.
Symptoms worsen at night.
Treatment is provided through oral medication therapy.


ANS: A, C, D

Scabies is a common parasitic infection that can be spread by skin-to-skin contact and sexual
contact. The scabies mite burrows through the skin, depositing two or three large eggs per day.
Intense pruritus, especially at night, is the most pronounced clinical manifestation. Treatment
consists of topical application of a pediculicide. Pediculosis pubis (crabs) is commonly
transmitted sexually and is caused by the crab louse, P. pubis.
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REF: Pages 938-939

31. Which statements are true concerning the sexually transmitted infection (STI)

lymphogranuloma venereum? (Select all that apply.)

Lymphogranuloma venereum is an STI commonly diagnosed in the United States.
It begins as a skin infection.
Lymphogranuloma venereum spreads to lymph tissues.
Primary and secondary lesions are apparent with this STI.
A 60-day course of oral erythromycin is the recommended treatment.


ANS: B, C, D

Lymphogranuloma venereum is a chronic STI uncommon in the United States. The lesion
begins as a skin infection and spreads to the lymph tissue, causing inflammation, necrosis,
buboes, and abscesses of the inguinal lymph nodes. Primary lesions appear on the penis and
scrotum in men and on the cervix, vaginal wall, and labia in women. Secondary lesions
involve inflammation and swelling of the lymph nodes with the formation of large blue
buboes that rupture and form draining ulcerative lesions. A 21-day or longer course of oral
doxycycline or erythromycin is needed for treatment. Treatment of sexual partners is
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REF: Pages 931-932


Match the disease with the corresponding causative organism.

______A. Trichomoniasis
______B. Granuloma inguinale
______C. Amebiasis
______D. Syphilis
______E. Chancroid

Treponema pallidum
Haemophilus ducreyi
Calymmatobacterium granulomatis
Entamoeba histolytica

36. Trichomonas vaginalis

32. ANS: D
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REF: Page 923
MSC: T. pallidum is the cause of syphilis.
33. ANS: E
PTS: 1
REF: Page 925
MSC: H. ducreyi, a gram-negative bacillus, causes chancroid.
34. ANS: B
PTS: 1
REF: Page 929
MSC: Granuloma inguinale (donovanosis) is a chronic, progressively destructive bacterial infection
caused by Calymmatobacterium granulomatis.
35. ANS: C
PTS: 1
REF: Page 919 | Table 26-1
MSC: E. histolytica is the cause of amebiasis.
36. ANS: A
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REF: Page 937
MSC: Trichomoniasis is a result of infection caused by T. vaginalis.