8 Year-end Questions on STI, HCV, PWID, and Flu

Sexually transmitted disease spread, the threat of emerging organisms, antimicrobial resistance, and poor patient awareness were just some of the infectious disease topics Patient Care highlighted in 2019 for primary care clinicians. 

The questions in this short year-end quiz are based on the most popular infectious disease stories, slide shows, and quizzes we brought you this year. Find out how much you remember! For more information, use the link after each answer to see the original article.

Question 1: A recent surge in HIV/AIDS, hepatitis, heart infections, skin and soft tissue infections, and other infectious diseases was cited as a byproduct of what ongoing epidemic?

A. Vaping

B. Obesity

C. Opioids

D. Sleep deprivation

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(image ©denissismagilov/stock.adobe.com)

Answer: C. Opioids. The authors of a Journal of Infectious Diseases commentary called for a comprehensive strategy that tailors prevention and treatment approaches to infectious disease in persons who abuse or are addicted to opioids and that focuses on opioid use disorder, the underlying predisposing factor.-Updates in Infectious Disease: Spreading the Word

Question 2: Current challenges in treatment of sexually transmitted infections (STIs) include which of the following?

A. Increasing co-infections

B. High cost of nucleic acid amplification tests

C. No new antibiotic-resistant gonorrhea treatments for >30 years

D. All of the above

E. A and B but not C

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Answer:Answer: D. All of the above. Other STI treatment challenges include a global shortage of benzathine penicillin G and a potential shortage of off-patent first-line antibiotics for chlamydia, gonorrhea, and trichomonias. Discussion of key issues in the HIV and STI syndemics appeared in a special issue of the Journal of the International AIDS Society.-How to Address the HIV-STI Syndemics

Question 3: In studies of patients with hepatitis C virus (HCV) infection, how did primary care physicians (PCPs) and specialists compare in effectiveness of treatment with direct-acting antivirals (DAAs)?

A. Specialists somewhat more effective

B. Specialists significantly more effective

C. PCPs somewhat more effective

D. PCPs significantly more effective

E. PCPs and specialists equally effective.

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Answer: E. PCPs and specialists equally effective. In a retrospective analysis, >90% of patients achieved sustained virologic response (SVR) with no difference between groups. The authors concluded that uncomplicated patients can be treated with DAAs for HCV infection by their PCPs with outcomes similar to those in specialty clinics. In a study of HCV-infected people who inject drugs (PWID), DAA initiation was 2.5 times more likely with PCPs than with local hospital standard of care. PWID were 63% more likely to reach SVR12 with PCPs.-Primary Care vs Specialist for HCV Treatment

Question 4: Early exposure to germs reduces the immune system’s ability to resist infections in later years. 

A. True

B. False

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Answer: B. False. According to the hygiene hypothesis, susceptibility to allergic and autoimmune diseases increases with the absence of childhood infections. In a New York Times article, Pulitzer Prize-winning reporter Matt Richtel summed up current thought: “Leading physicians and immunologists are reconsidering the antiseptic, at times hysterical, ways in which we interact with our environment.”-Hygiene and Health: Are We Too Clean?

Question 5: What percentage of adults hospitalized for flu had at least 1 reported underlying medical condition that placed them at high risk for flu-related complications?

A. 27%

B. 51%

C. 68%

D. 92%

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Answer: D. 92%. The most frequently reported underlying conditions were cardiovascular disease (46%), metabolic disorders (43%), obesity (37%), and chronic lung disease (30%). Vulnerabilities of specific populations were highlighted in a National Foundation for Infectious Diseases report, “Call to Action: The Dangers of Influenza and Benefits of Vaccination in Adults With Chronic Health Conditions.”-Flu in Adults with Chronic Health Conditions

Question 6: What kind of testing for early active Lyme disease is likely to become available in the near future?

A. Direct testing

B. Enzyme-linked immunosorbent assay

C. 2-tiered antibody testing

D. 3-tiered antibody testing

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Answer: A. Direct testing. According to a recent review, reliance on serologic testing that provides indirect evidence of Borrelia burgdorferi infection has been suboptimal because serologic testing cannot differentiate active infection, past infection, or reinfection. Direct tests for early active Lyme disease are ready for practical assessment and future tests are probable, the authors noted.-6 Essential Updates in Lyme Disease Research

Question 7: In a systematic review of HCV treatment outcomes achieved with DAAs, how did cure and reinfection rates in PWID compare with non‐PWID?

A. Significantly lower cure rates and higher reinfection rates

B. Significantly higher cure rates and lower reinfection rates

C. Significantly lower cure rates and reinfection rates

D. Similar treatment outcomes

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Answer: D. Similar treatment outcomes. Pooled SVR for recent PWID and opioid substitution therapy (OST) recipients was 88% and 91%, respectively. Relative risk of achieving SVR for recent PWID compared with non‐recent PWID was 0.99, and pooled treatment discontinuation was 2% for both. Pooled incidence of reinfection among recent PWID and OST recipients was 1.94 and 0.55 per 100 person years, respectively. The authors concluded that recent PWID and OST recipients should not be excluded from HCV treatment.-When Epidemics Overlap: Opioids, HIV, HCV

Question 8: In a survey of sexually active Americans, how many said they thought they could get a sexually transmitted disease (STD) from a public toilet seat?

A. 12%

B. 34%

C. 53%

D. 78%

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Answer: B. 34%. Other common misconceptions included: STDs can be transmitted by sharing a drinking glass with an infected person and protection from STDs can be doubled by wearing 2 condoms. Although 81% of survey respondents said they think they are knowledgeable about sexual health, the survey identified a variety of factors that help explain a general lack of sexual health awareness among Americans.-Sexual Health Fables, Fallacies, and Risk Mitigation: 6 Studies.

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