Genital ulcers and genital lesions

Question 1

Syphilis pathology: Name; evasiom; CMI??; disease due to?

Answer 1

Treponema pallidum: spirochaete (spiral shape)
Evades immune system: is in immunologically privileged sites, intracellular, surface is inert
-CMI is critical and to the control of proliferation of bacterium
-Disease is the immune response: vasculitis, destruction and fibrosis

Question 2

Syphilis early manifestations

Answer 2

onset: 9-90 days

Anogenital ulcers; rash; ocular lesions; CN 3,6,7 and 8 signs

Question 3

eary confirmation of Syphillis diagnosis

Answer 3

Dark field microscopy: non specific

Direct fluorescent antibody test

Question 4

Primary and secondary syphilis

Answer 4

Primary: 14-21 days after inoculation. papular rash that ulcerates.
Secondary: 4-10 weeks after primary lesion, haemtogenous spread. A rash that can vary and mucus membrane lesions

Question 5

Tests for syphilis

___ test: overall pretty good, although might have to wit some timeas for primary syphilis not perfect
____: detects an AB against _____ Ag. Positive 3-5 weeks post exposure
_____: confirmatory, in early and late disease.

Answer 5

EIA test: overall pretty good, although might have to wit some timeas for primary syphilis not perfect
RPR: detects and AB against lipoidal Ag. Positive 3-5 weeks post exposure
TPPA: confirmatory, in early and late disease.

Question 6

Early syphilis treatment

Answer 6

• Infected <2 years, benzathine penicillin IM
• Contacts are treated
• Allergy: doxycycline
• Pregnant: benzatine penicillin

Question 7

Herpes infection

Answer 7

Transmission: mucosa more vulnerable
Replicates in epidermis
Travels via unmyelinated sensory neurons, where it can enter a latent phase
HSV1 and HSV2

Question 8

Herpes treatment (Aciclovir facts)

Aciclovir- 15-20% _____

• Activation involves viral _______ ____
• host cell metabolises to ACV triphosphate
• This competitively inhibits ____ ____, incorporates into ___ chain and terminates chain
• HSV resistance uncommon
• L-valine ester makes _____, more bioavailable

Answer 8

Aciclovir- 15-20% bioavailability

• Activation involves viral thymidine kinase
• host cell metabolises to ACV triphosphate
• This competitively inhibits DNA polymerase, incorporates into DNA chain and terminates chain
• HSV resistance uncommon
• L-valine ester makes valaciclovir, more bioavailable

Question 9

Chlamydia trachomatis and serovars L1,L2 and L3 (most common here is L2)

Answer 9

Presentation depends on site, and gender: transient anogenital ulcer, cervicitis , proctitis
Causes lymphogranuloma vereneum

Question 10

HPV features

Answer 10

• DNA virus
• needs differentiating epithelial tissue to grow
• Anogenital warts it can cause, with some association with anogenital neoplasia
• E6 and E7 gene target TS genes and drive replication

Question 11

HPV complications

Answer 11

Intraepithelial neoplasia
Most are benign, small number can cause anogenital cancer.
Smoking and immune status important co-factors
cervical cancer well described
oro-pharyngeal cancer and anal cancer becoming important theme