Below are the answers to the quiz with brief rationales for the correct answer. Please refer to the rest of the blog to clear up any remaining confusion, more information can be found using the resources listed at the end of the module.
You are a nurse practitioner for a Women’s health clinic, you come in and tell the patient that she has tested positive for a Chlamydia infection. She tells you that her friend had chlamydia and told her that it causes a weird vaginal discharge. She questions the result saying she didn’t have any weird discharge. What would be the best response?
A.) The lab must have switched the results, let me run the test again
B.) The majority of patients with chlamydia are asymptomatic
C.) Vaginal discharge is not actually a symptom of chlamydia
D.) Vaginal discharge only occurs when chlamydia progresses to pelvic inflammatory disease
Correct Answer: B
Rationale: The majority of patients with chlamydia are asymptomatic, but if female patients do have symptoms they will likely have mucopurulent discharge as a result of cervicitis (inflammation of the cervix). A is not a likely scenario. Chlamydia can progress to pelvic inflammatory disease (PID) and PID does cause vaginal discharge. However, vaginal discharge can occur before the complication of PID, it can occur in females with inflammation of the cervix.
Based on patient interview and physical exam, you suspect your patient has a sexually transmitted infection. As the NP, how would you best differentiate between chlamydia, gonorrhea, and trichomoniasis to give your patient an accurate diagnosis?
B.) Vaginal bleeding
C.) Nucleic Acid Amplification Testing
D.) Vaginal discharge
Correct Answer: C
Rationale: Chlamydia, gonorrhea, and trichomoniasis can all cause dysuria and vaginal discharge. Trichomoniasis tends to cause a green, frothy discharge that’s slightly different from the mucopurulent discharge caused by gonorrhea and chlamydia. Gonorrhea and chlamydia are known to cause either intermittent bleeding or heavier menstrual flow. However, vaginal discharge and bleeding do not provide enough information for diagnosis. The best way to differentiate the disease is by performing nucleic acid amplification testing on vaginal, penile, or urine samples to identify the specific infecting bacterial organism.
True or False: Condom use is an ineffective method for preventing the spread of chlamydia?
Correct Answer: B
Rationale: As discussed in the patient education sections, barrier methods like condoms can prevent the spread of Chlamydia trachomatis bacteria. If engaging in sexual intercourse with a known Chlamydia infection, the best method is abstinence.
Which of the following is a risk associated with prolonged or untreated chlamydia disease?
A.) Ectopic pregnancy
B.) Increased risk for contracting HIV
C.) Development of pelvic inflammatory disease
D.) All of the above
Correct Answer: D
Rationale: The pathophysiology section lists all of the answers as complications of a Chlamydia infection. Pelvic inflammatory disease might occur if a patient is left untreated.
Think back to the pathophysiology of a Chlamydia infection. How does Chlamydia trachomatis infect the cells of the urogenital tract?
A.) Elementary bodies of the bacteria are taken up by urogenital cells through endocytosis, where they convert to their metabolically active form and replicate
B.) The Chlamydia virus attaches to the host cell and injects its viral RNA into the cell to be replicated
C.) The bacteria do not invade the cell, it instead releases an exotoxin that damages cell membranes, initiating an inflammatory response
D.) Reticulate bodies of the bacteria are taken up by urogenital cells through endocytosis, where they convert to their metabolically active form and replicate
Correct Answer: A
Rationale: Elementary bodies are the form of the bacteria that can be endocytosed by the host cells. Once in the cells, the elementary bodies convert to reticulate bodies and can replicate. Chlamydia is caused by the Chlamydia trachomatis bacteria, not a virus. The bacteria do not release an exotoxin capable of damaging host cells, the bacteria need to be inside a host cell to be able to survive.
Image taken from http://www.baronerocks.com/myprofile/511-mrey30