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SEXUAL HEALTH AND HIV > GENITAL INFESTATIONS > Flashcards

GENITAL INFESTATIONS Flashcards

1
Q

What is the most common viral sexually acquired infection?

A

Genital warts as a result of HPV

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2
Q

What does HPV stand for?

A

Human papilloma virus

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3
Q

How many HPV types have been discovered and how many infect the genital epithelium?

A

Over 100 types

40 of which infect genital epithelium

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4
Q

What are the two most common types of HPV virus to infect the genital epithelium and cause benign genital warts?

A

HPV 6

HPV 11

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5
Q

How are genital warts spread? What does this mean for sexual contact?

A

Direct skin to skin contact

This means that wearing a condom will not necessarily protect as condoms do not cover all the genital skin. It also means penetrative sex is not required for transmission.

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6
Q

What is the median incubation period for warts?

A

3 months (range of 2 weeks to 9 months or even longer)

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7
Q

What percentage of people with HPV genital infection will develop warts? Are they still infectious?

A

Many people (one estimate suggests 99%). However, they are still infectious, although those with genital warts are more likely to transmit HPV.

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8
Q

What are the clinical features of genital warts?

A

Lumps in the genital area (may be singular or multiple)

Usually asymptomatic

Can be itchy

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9
Q

Where do genital warts tend to occur?

A

In locations which undergo small trauma during sexual intercourse, but may be seen anywhere on genital skin:

Penile

Intrameatal

Peri-anal

Intra-anal

Vulva

Intra-vaginal

Cervical

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10
Q

What are the different types of genital wart based on appearance?

A

Condylomata acuminata

Smooth papules

Flat papules

Keratotic warts

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11
Q

What do condylomata acuminata genital warts look like?

A

Cauliflower-like appearance

Skin coloured, pink or sometimes hyperpigmented

If on mucosal surfaces then generally non-keratinised

If on skin then may be keratinised

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12
Q

What do smooth papular genital warts look like?

A

Smooth

Dome-shaped

Skin-coloured

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13
Q

What do flat papular genital warts look like?

A

Macular to slightly raised

Flesh coloured with smooth surface

More commonly found on internal structures (eg cervix), but do also occur on external genitalia

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14
Q

What do keratotic genital warts look like?

A

Thick horny layer

Resemble common warts or seborrheic keratosis

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15
Q

How is diagnosis of genital warts usually made?

A

Clinical diagnosis based on examination under bright light

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16
Q

What should prompt biopsy of a genital growth?

A

Unclear diagnosis

Pigmented lesions

Indurated lesions

Fixed lesions

Do not respond or worsen with treatment

Persistent ulceration or bleeding

Immunocompromised patients (where more vigilance is required to recognise pre-malignant lesions)

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17
Q

What is the differential diagnosis for genital growths?

A

Infections:
Molluscum contagiosum
Condylomata lata of syphilis

Acquired dermatological conditions:
Seborrheic keratosis
Lichen planus
Fibro-epithelial polyp, adenoma
Melanocytic naevus
Neoplastic lesion
Normal variants:
Pearly penile papules/coronal papillae
Fordyce spots
Vestibular papillae (micropapillomatosis labialis)
Skin tags
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18
Q

What investigations should be done in someone with genital warts?

A

STI screen to exclude concurrent STIs

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19
Q

In someone diagnosed with genital warts, how do we go about contact tracing?

A

We don’t. However, current partners may benefit from assessment to exclude undetected STI.

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20
Q

How does a diagnosis of genital warts affect a woman’s cervical smear screening schedule?

A

It doesn’t

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21
Q

What percentage of genital warts will disappear without treatment by 3 months?

A

5-30%

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22
Q

What percentage of genital warts will stay the same by 3 months?

A

20%

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23
Q

What percentage of genital warts will get bigger by 3 months?

A

50%

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24
Q

Which group of patients are more likely to see spontaneous resolution of genital warts?

A

Children

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25
Q

What are the first line treatment options for non-keratinised larger vulval, perineal, penile or perianal warts?

A

Podophyllotoxin 0.5%

OR

Imiquimod

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26
Q

What are the first line treatment options for keratinised, small number or low volume vulval, perineal penile or penile warts

A

Cryotherapy

OR

Imiquimod

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27
Q

What class of medication is imiquimod?

A

Alpha-interferon stimulant

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28
Q

What are the second line treatments for more persistent warts?

A

Excision

Electrosurgery

Laser treatment

29
Q

Within what time period are warts likely to respond to topical treatment?

A

2-3 months

30
Q

How do we treat intra-vaginal warts?

A

Treatment often not necessary.

Cryotherapy

Electrosurgery

Trichloroacetic acid (TCA)

31
Q

How do we treat cervical warts?

A

Treatment often not necessary

Cryotherapy

Electrosurgery

Laser ablation

Excision

Trichloroacetic acid (TCA)

Consider colposcopy if uncertain about diagnosis

32
Q

How do we treat urethral meatal warts?

A

If base of lesion is seen:

Cryotherapy

Electrosurgery

Laser ablation

Podophyllotoxin 0.5% or imiquimod

If lesion is deeper is urethra:

Often no requirement needed

Surgical ablation under direct vision

33
Q

How do we treat intra-anal warts?

A

Treatment often not necessary

Cryotherapy

Electrosurgery

Laser ablation

Trichloroacetic acid (TCA) - with care

Podophyllotoxin

Imiquimod

34
Q

What percentage of patients will experience a recurrence of genital warts within 3 months of treatment?

A

30-60%

35
Q

Within what time frame will most HPV infections clear in immunocompetent patients?

A

2 years

36
Q

What percentage of patients are left with subclinical HPV?

A

10%

37
Q

What are the main complications of genital warts?

A

Detriment to quality of life

Low self-esteem

Clinical depression

Increased stress

Negative impact on relationships

38
Q

What is the organisms that causes molluscum contagiosum?

A

Pox virus

39
Q

How is the pox virus transmitted to cause molluscum contagiosum?

A

Skin to skin contact - and therefore can be sexually transmitted but this is not the only way

40
Q

What groups of patients is molluscum contagiosum most commonly found in? What sites are most commonly affected?

A

Children - hands, face, arms and trunk

41
Q

What is the incubation period for molluscum contagiosum?

A

3-12 weeks (but can be up to 6 months)

42
Q

What are the clinical features of genital molluscum contagiosum?

A

Papular lesions

1-3 mm in size

Smooth

Pearly coloured - resemble vesicles but in fact solid

Central umbilication

Affects skin around pubic hair, thighs, buttocks and lower abdomen

Normally spares mucous membranes

43
Q

How do we diagnose molluscum contagiosum?

A

Normally clinically through inspection

If doubt, central punctum can be extracted and poxvirus-like particles viewed under electron microscope. Histology will also reveal enlarged epithelial cells with intracytoplasmic molluscum bodies.

44
Q

What investigations should be done in someone who presents with genital molluscum contagiosum?

A

Full STI screen

45
Q

When do we treat molluscum contagiosum?

A

It is only treated for cosmetic reason. It usually resolves spontaneously in 3 months

46
Q

How do we treat genital molluscum contagiosum?

A

Cryotherapy

Extraction of central core

Piercing with stick that has been dipped in tincture of iodine or phenol

47
Q

What percentage of patients will experience a recurrence of molluscum contagiosum within 8-24 months?

A

35%

48
Q

What is the microorganism responsible for scabies?

A

Parasitic mite Sarcoptes scabiei

49
Q

How is scabies transmitted?

A

Direct prolonged skin to skin contact

50
Q

How long does skin to skin contact need to be maintained for in order to transmit scabies?

A

20 mins

51
Q

What causes the symptoms of scabies?

A

Hypersensitivity reaction to absorbed mite excrement into skin capillaries

52
Q

How long after first infection do symptoms of scabies usually take to come to fruition?

A

May take up to 4-6 weeks

53
Q

How long after re-infection do symptoms of scabies take to come to fruition?

A

24-48 hours because of previous sensitisation.

54
Q

What are the main symptoms of scabies?

A

Intense itching

Especially at night

Polymorphic and symmetrical rash

Burrowed appearance to rash - small raised greyish wavy channel on skin surface extending from an erythematous papule

Reddish-brown pruritic nodules - found especially on scrotum, penis and groin

Excoriations

55
Q

What are the main sites affected by scabies?

A

Interdigital spaces of hands

Flexor surfaces of wrists

Extensor surfaces of elbows

Anterior axillary folds

Buttocks

Genitalia in males

Periumbilical region

56
Q

How is scabies usually diagnosed?

A

Clinical diagnosis based on classic appearance

Confirmation by microscopic presence of mite, eggs or faecal excrement can be performed from skin scrapings, curettage or shave biopsy

57
Q

What investigations would you do for someone with scabies?

A

Full STI screen

58
Q

How do we treat scabies?

A

Avoid close contact until patient and partner have completed treatment

Topical permethrin 5% aqueous lotion

Topical malthion 5% aqueous lotion

Applied to whole body from neck downwards and then washed off 12 hours later (best to apply overnight)

Anti-histamines for itch

Bed linen and clothes should be washed at 50˚

59
Q

What are the complications of scabies?

A

Itch may persist for several weeks following treatment

60
Q

What is the form of scabies that occurs specifically in immunocompromised patients and the elderly?

A

Norwegian scabies

61
Q

What are the clinical features of Norwegian scabies?

A

Widespread

Crusted lesions with thick scales

Only a mild itch

62
Q

How do we treat Norwegian scabies?

A

Ivermectin

63
Q

What are the more commonly used names for pediculosis pubis?

A

Crabs

Pubic lice

64
Q

Which areas are affected by pubic lice?

A

Hairs of the:

Pubic and perianal areas

Thighs

Abdomen

Axillae

Eyebrows

Eyelashes

65
Q

How are pubic lice transmitted?

A

Direct skin to skin contact

66
Q

What is the incubation period of pubic lice?

A

Between 5 days and several weeks

67
Q

What are the clinical features of crabs (or pubic lice)?

A

Itch

Rust coloured spots on underwear - represents louse faecal matter

68
Q

How do we manage pubic lice?

A

Avoid close body contact and treat partner

Topical treatments:

Malthion 0.5% aqueous lotion - apply and leave for 12 hours

Permethin 1% cream - apply and leave for 10 minutes, can be used on eyelashes

Phenothrin 0.2% - apply and leave for 2 hours

Carbaryl 0.5% and 1% - apply and leave for 12 hours

Second application after 3-7 days required.

Fine tooth comb should be used to clear out dead eggs

SEXUAL HEALTH AND HIV (13 decks)

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