If the threshold of a screening test is increased.
How it will affect sensitivity and specificity?
Correct Answer B:
In the classic model above. The definitions are as follows:
A real world example will clearly explain that will happen if the threshold is increased. Say we are testing people for diabetes. We are using our current random blood sugar value of 200 and a threshold for a positive test. We test 40 people. See the model, where the black circles represent normal people and the red are those with diabetes. Then we test again using a threshold value of 250 for random blood sugar.
Calculations of the sensitivity and specificity clearly shows that when you increase the threshold the sensitivity will decrease and the specificity will increase.
A man suspects that he may have gonorrhea. Tests confirm it. He tells you that his wife works at the hospital and he wishes to keep this a secret to avoid possible conflicts and embarrassment.
What is the appropriate way to handle this situation at this point?
Correct Answer A: Gonnorhea should be reported to local public health unit. Since gonorrhea is an STD that is communicable, his partner should know about it also. Since patient confidentiality must be respected, it is best to ask him to tell his wife about this.
Contact tracing includes an educational component, in order to ensure that the index case and contacts are informed about the nature and implications of the infection, modes of transmission and prevention, and treatment options. The health care provider should be culturally aware and have basic counselling skills and other personal qualities such as tact, empathy and awareness of the physical, emotional, and social conditions of the client. The provider also needs current and accurate knowledge of treatment and support services and must be familiar with the HPPA and other legal aspects of STI management.
Screening for Chlamydia trachomatis infection should be performed on which one of the following asymptomatic patients who present for routine evaluation?
Correct Answer B: It is estimated that 70%-90% of women and a large percentage of men with Chlamydia trachomatis infection are asymptomatic. The most predictive risk factor for the presence of the disease is sexual activity at a young age. Other risks include being unmarried, black race, a past history of sexually transmitted disease, new or multiple sexual partners, cervical ectopy, and inconsistent use of barrier contraceptives. Asymptomatic Chlamydia infection can cause pelvic inflammatory disease and result in ectopic pregnancy, infertility, and chronic pelvic pain in women.
There are good screening tests available and effective treatments for women with the disease. Unfortunately, there are currently no studies describing the effectiveness of routine screening or early treatment of men. The Preventive Services Task Force strongly recommends (class A) routine screening for Chlamydia infection in all sexually active women 25 years and younger, as well as in other asymptomatic women at increased risk. The Centers for Disease Control and Prevention recommend routine screening of sexually active adolescent women and screening of older women who are at increased risk for the disease.
A 31-year-old female presents with her first outbreak of genital herpes. She has been married for 4 years and says she has not had sexual relations with anyone other than her husband since they started dating.
When counseling this patient, which one of the following would be appropriate advice?
Correct Answer B: The average incubation period after contracting genital herpes is 4 days. However, a significant number of patients do not recognize the initial infection.
Type-specific serologic tests can assist in the classification of infection as primary or recurrent, but there is significant potential for false-negative results. Oral once-daily suppressant therapy can reduce the risk of transmission of herpes simplex to uninfected partners but topical therapy is not effective. Acyclovir, valacyclovir, and famciclovir are all effective for suppressive therapy
A 70-year-old white female presents with a pruritic rash on her sacrum that has occurred intermittently over the last 6 years. She reports that the area is always very tender just before the blister-like lesions erupt. She is otherwise in good health, and takes no medications. Her past medical history is unremarkable. You provide appropriate treatment for the condition.
You should advise the patient to avoid which one of the following during future outbreaks?
Correct Answer B: Genital herpes is the most common sexually transmitted genital ulcer disease. It can occur at any age, and data suggests that it may be the most common sexually transmitted disease in women over the age of 50 years. Extragenital sites are involved in one-fourth of infected women, and the sacrum and buttocks are frequent locations. Sacral nerve innervations from the vaginal area provides a pathway for the virus. Prevention of transmission depends upon cogent patient education advising abstinence from skin-to-skin contact when active lesions are present.
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