Genital Lesions

Question 1

what is another term for genital warts

Answer 1

condyloma acuminata

Question 2

what is condylomata acuminata caused by

Answer 2

HPV-DNA virus that multiplies within the nuclei of infected epithelial cells

most common STI

Question 3

where else can condylomata acuminata present?

Answer 3

intra-oral lesions

peri-anal lesion

Question 4

prevention of condylomata acuminata

Answer 4

9-valent HPV vaccine (Gardasil 9) protects against cancers

6, 11 prevents genital warts

16, 18 prevents cervical cancer

Question 5

Tx of genital warts

Answer 5

topicals (don’t memorize) -imiquimod, podofilox , sinecatechins

cryotherapy

surgical options (laser, electrosurgical coagulation, excision)

trichloracetic acid solution

Question 6

if a genital ulcer is painful, it is likely that it is

Answer 6

HSV, chancroid

Question 7

what is genital herpes caused by

Answer 7

HSV-2 and HSV-1

chronic viral infection

direct contact transmission

2x risk of HIV infection

Question 8

What is this a presentation of?

Answer 8

genital herpes

Question 9

what are clinical features of genital herpes

Answer 9

common, 14% of Canadians aged 14-59 have HSV-2

chronic recurrent infection

cluster of vesicles on reddened background

subsequent episodes are shorter

prodrome

Question 10

Dx of genital herpes

Answer 10

nucleic acid amplification tests (NAAT) - highly sensitive and rapid

serology can be done but not specific

viral cultures

biopsy

Question 11

Tx for HSV

Answer 11

prevention

severe: IV acyclovir

non-severe: PO acyclovir, famiciclovir, calciclovir

Question 12

what bug is this

Answer 12

Treponema pallidum subspecies pallidum

causes syphillis

Question 13

is syphyllis a reportable STI?

Answer 13

yes

Question 14

what stages of syphilis is it transmissable?

Answer 14

primary, secondary and early latent infection

Question 15

describe the primary stage of syphilis

Answer 15

painless chancre, regional lymphadenopathy

heals spontaenously (lasts 3-6 weeks)

Question 16

describe clinical presentation of secondary syphilis

Answer 16

systemic features (rash, fever, lymphadenopathy, mucus lesions, condyloma lata, alopecia, meningitis, headaches)

can occur at 2-12 weeks following infection

generalized rash

condyloma lata (wart-like lesions)

Question 17

describe the latent stage of syphilis

Answer 17

asymptomatic

early is less than 1 yr

late if more than 1 yr

Question 18

what systems do tertiary syphilis target

Answer 18

cardiovascular

gumma (can grow anywhere, soft, non-cancerous growth)

neurosyphilis

skin lesions - nodular, gummata

Question 19

Dx of syphilis

Answer 19

universal screening in pregnancy

syphilis PCR (molecular detection of T. pallidum from fluid/tissue)

serology (can take up to 12 wk to become positive)

EIA (IgM and IgG)

Question 20

Tx for syphilis

Answer 20

primary, secondary, early latent: penicillin single dose

late latent, tertiary: penicillin 3 doses

neurophyphilis: 10-14 days penicillin

sexual contacts (90days): penicillin single dose

congenital: crystalline peniccilin G <1mo age, benzathine otherwise