GUM Flashcards
What causes Donovanosis
gram -ve klebsiella granulomatosis
intracellular
Characteristics of Donovanosis
BEEFY PAINLESS
1) painless ulcers and lymphadenopathy
2) Beefy red, vascular pseudobubae
3) biopsy/dark ground
4) India, South Africa and South America
Treatment of Donovanosis
azithromycin po OW 500mg 3/52 and until lesions healed
rx if SI <60/7 before symptoms
What causes chancroid
gram -ve haemophilus ducreyi
gram -ve rods, culture/NAAT
biopsy+ giemsa stain- rod shaped inclusion bodies
chancroid= ducreyi /giemsa
Characteristics of Chancroid
SHAGGY PAINFUL
painful ulcers and lymphadenopathy- can last 1-3/12
deep, shaggy, purulent and cotnact bleeding
50% bubae (1-2/52 post ulcer)
africa, south asia, Caribbean and latin america
Chancroid treatment
azithromycin 1g PO STAT
or can give cipro/cef/erythro
PN 10/7 prior to symptoms
HSV in pregnancy- transmission
neonatal 85%
postnatal 10%
utero 5%
Neonatal HSV presentation
1/3- 8 days, skin/eye/mouth (best prognosis)
1/3 - 14 days, CNS disease
1/3- 6 days, disseminated (organs, 1 in 4 mortality)
Management of HSV in pregnancy
Primary:
aciclovir 400mg TDS 5/7
valaciclovir 500mg BD 5/7
32/40- as above
risk of preterm- 22/40 aciclovir BD or valaciclovir OD
- then switch at 32/40
1st/2nd Trimester presentation of HSV
serology
avoid SI 3rd trimester
vaginal delivery if >6/52 (time of asymp shedding)
shedding higher if PLWH
3rd trimester presentation of HSV
(28/40 to 4/52 postpartum)
Serology
CS (IV intrapartum if declines)
pp may have shed during delivery
Ulcers in pregnancy
Do NAAT to confirm matches serology
Presentation in labour- HSV
Primary- CS
Recurrence- NVD (0-3% risk)
HSV and BF
recommend
Discordant couple
serology
avoid SI
Atripla
CONTAINS Efavirenz
enzyme inducer
Penicillins
bactericidal. Inhibit cell wall synthesis. gram +ve/-ve
bind to penicillin binding proteins, inhibit peptide crosslinking= autolytic enzymes
B lactamase-> resistance
benpen is inactivated po
Cephalosporins
bactericidal
more resistant to b lactamase than penicillins
-have dihydrothiazine ring on B lactam)
broad spectrum, disturb colonic flora= diarrhoea
tetracyclines
bacteriostatic
uptake into bacteria by active transport system= irreversibly bind to ribosomes
gram +ve/-ve
less uptake= resistance
tertrA
stAtic
macrolides
eg azithro
static/cidal
reversibly bind to ribosomes, prevents translocation along mRNA
ribosome mutation= resistance
bOth
macrO
Metronidazole pharmacology
bactericidal
inhibit DNA synthesis
anti protozoal/anaerobes
resistance is rare
400mg BD for 5-7 days
Nitrofurantoin pharmacology
uncertain MoA, ?DNA metabolic changes
gram +ve/ e.coli
Aciclovir
MoA
selective phosphorylation into infected cells by viral thymidine kinase
inhibit DNA polymerase
triazole
eg fluconazole
resistance is rare
broad spectrum
inhibit fungal lipid synthesis in cell membranes-ergosterol
changes oxidative enzymes- reduced growth
imidazole
eg clotrimazole
broad spectrum
inhibit fungal lipid synthesis in cell membranes-ergosterol
changes oxidative enzymes- reduced growth
Chlamydia microbiology
obligate intracellular bacterium
trachoma biovar- epithelial cells of mucuous membranes
LGV biovar- can invade lymphatic tissues (L1-3)
A-C ocular
D-K genital/ocular
Populations with high risks of chlamydia
75% cases in <25yo
-1.5-4.3% population
3-10% rectal MSM
0.5-2.3% pharyngeal
Chlamydia concordance
up to 75%
Chlamydia spontaneous clearance
50% at 12 months
Chlamydia- proportion asymptomatic
50% M and 70% F
Complications of chlamydia
SARA <1%
PID 1-30% (16% untreated)
Tubal infertility 1-20%
Vertical transmission of chlamydia
5-12 days- ophthalmia neonatorum
1-3/12- pneumonia
direct contact with genital tract
oral erythro 50mg/kg/d QDS 14/7
Chlamydia incubation
1-3/52
Chlamydia testing
VVS 96-98%
POCT 82-84%
TOC: (after 5 weeks)
Pregnant
Incorrect treatment
reinfection
PLWH
-test for LGV
-TOC
-rx for 3/52 if not or TOC 3 weeks
LGV population
8.2x more likely in PLWH
Endemic:
South/West Africa
Madagascar
SE asia
India
Caribbean
LGV Incubation
3-30/7
LGV symptoms
Primary:
papule/ulcer
often in the coronal sulcus
haemorrhagic proctitis
Secondary:
lymphadenitis/bubo
groove sign 15-20%
Tertiary:
Genito-anorectal syndrome
-most recover before this
chronic inflammatory tissue destruction (more common F)
LGV rx
Doxycycline 100mg BD 3/52
- erythromycin 500mg QDS 3/52
-azithromycin 1g OW 3/52
nil TOC
Gonorrhoea transmission
50-90% M to F
20% F to M (60-80% after 4x SI)
C4 coinfection 19% (25% M 40% F 7% MSM)
Gonorrhea incubation
3-5/7 urethral
Gonorrhea sensitivities
smear M
90-95% symp 50-75% asymp
Smear F 20-50%
NAAT >95% (unlicensed if extragenital)
When to do pharyngeal swab for GC
Diagnosed genital +
-cef resistant
-asia pacific contacts
Testing in those with genital reconstruction
neovagina/urine
Gonorrhoea symptoms
M >90% 2-5/7
Discharge 80% > dysuria 50%
<10% asymp (pharyngeal/rectal usually)
F >50% asymptomatic
40% discharge
1 in 4 pain
12% dysuria
Gonorrhoea complications
5-10% F <1% M
14% PID
disseminate (F 3x more likely)
haematogenous spread, rash, tenosynovitis, arthralgia, endocarditis, meningitis, osteomyelitis
= 7/7 ceftriaxone (po switch if improving 24-48hr)
Gonorrhoea treatment
36.4% resistant to cipro
caution:
>60, steroid, kidney, organ transplant
anaphylaxis to penicillin
-gent 240mg IM
-2g azithro po
TOC 7/7 RNA 14/7 DNA
resistant? report to PHE
Primary Syphilis
incubation 9-90 (average 21/7)
-depends on infectious dose
Chancre- resolved 3-8/52
1 in 4>secondary 4-10/52 later
Secondary Syphilis
50-70% maculopapular rash
pals/soles/scalp
mucous patches
condylomata lata
hepatitis/glomeurolnephritis/splenomegaly
1-2% neurological
resolves 3-12/52
25% get recurrence of secondary disease
Tertiary Syphilis
2-7 years:
Meningovascular
10-20 years:
parenchymous
10-30 years:
Cardiovascular
1-46 years (average 15):
Gummatous
Congenital Syphilis
Normally associated with RPR >1 in 8
2/3 asymptomatic at birth, signs by 5 weeks
Early <2 years:
rash, rhinitis, lypmhadenopathy, skeletal
Late:
chronic/persistent inflammation causes gummatous lesions
- saddle nose
-hutchinson’s incisors
-mulberry molars
Syphilis testing
1)
EIA/CLIA/TPPA
Treponemal, test for anti-treponemal IgM
2 to confirm
2) Non-trepenemal
TPHA/RPR
>16 suggestive of active disease
Prozone phenomenon
Secondary/early latent
assay overwhelmed to unable to cross link to form blue colour
repeat 6-12/52 or 2 weeks after chancre
15% of those with chancre have negative serology
Syphilis treatment- key points
Abstain:
lesion healed
2 weeks after completed
Follow up:
3, 6, 12 months until -ve/serofast
>4 fold increase= failure
longer in later as treponemes divide more slowly
steroids in neuro/cv
Syphilis treatment
benzathine penicillin 2.4MU
>14/7 late= restart course
JH reaction
Keep on site 15 minutes after first dose
acute febrile/headache/myalgia
-resolves in 24hrs, supportive rx only
-common in early
Steroids in Syphilis
40-60mg OD 3/7
start 24hr prior to rx
Presentation of Syphilis in pregnancy
usually late infection
-polyhydramnios
-miscarriage
-PTB
-Stillbirth
-hydrops fetalis
Management of syphilis in pregnancy
> 26/40- refer to fetal medicine
2 doses in 3rd trimester
May have contractions with JH (?CTG)
pen allergy- desensitisation, if macrolides fetus needs penicillin at birth
Rx >4/52 before delivery:
monitor neonate
<4/52:
treat neonate
MGen background
No cell wall- no gram stain
Too slow to culture
FCU 98-100%
VVS 100%
1-2% prevalence in population
15-25% NGU
10-13% PID
MGen in pregnancy
a/w PTB/miscarriage
if possible avoid rx until after pregnancy
if not possible, 3/7 aizthro (uncertain effectiveness, cannot use moxifloxacin/doxycycline)
MGen treatment- principles of
abstain 14/7 from starting and until asymptomatic
TOC all
macrolide resistance ~40%
doxy improves effectiveness of azithro by reducing load and resistance mutations
Asia-pacific- emerging resistance to moxifloxacin
MGen PID/EO treatment
14/7 moxifloxacin 400mg OD
MGen treatment
MRAM+
Moxifloxacin 400mg PO OD 10/7
Risk:
tendon rupture
hepatotoxicity
c dif
MRAM-
Doxycycline 100mg PO BD 7/7, then azithromycin 3/7
NSU rx
doxycycline 7/7
azithro 3/7 if allergy
MGen and pregnancy/breastfeeding
azithromycin only
TV key points
flagellated protozoan- read slide within 10 mins
associated with preterm birth/low birthweight
TV symptoms
10-50% asymptomatic (M+F)
-frothy yellow discharge 10-30%
-strawberry cervix 2%
TV Testing
microscopy from posterior fornix 40-60% sensitive
-read within ten minutes
NAAT 88-100%
TV treatment
20-25% spontaneous cure rate
10% disulfuram reaction
allergy?- desensitisation
treatment failure:
-repeat course (40% respond)
-increase dose
-increase dose with gel/cream
TOC if still symptomatic 4 weeks after treatment
1) Metronidazole 400-500mg PO BD 7/7
2) 2g OD (STAT, 5-7/7 for failure)
HSV frequency
<1/2 symptomatic at acquisition (1/3 HSV2)
4/year HSV2 1 in 18/12 HSV1
Common cause of proctitis but only 1/3 will have ulcers
DSDNA
Suppression is >6 year
HSV episodic Treatment
If within five days of symptoms/new lesions forming
- reduces severity and duration (1-2/7)
first episode= 5 days
Aciclovir 400mg TDS 5/7
valaciclovir 500mg BD 5/7
famciclovir 250mg TDS 5/7
5% lidocaine ointment
HSV suppression
aciclovir 400mg BD (TDS from 32 weeks in pregnancy)
>6 per year
High risk preterm- BD from 22 weeks then step up
stop and r/v at 1 year- give two rescue packs- two episodes gives clue on frequency of future recurrences
reduce transmission by 80-90%
HSV retention
pain
autonomic neuropathy
HSV and condoms
reduce transmission by 50%
disclosure reduces transmission by 50%
Gardasil
90% AGW are 6 and 11
most Ca are 16 and 18
gardasil 9= 6, 11, 16, 18, 31, 33, 45, 52 and 58
Genital Warts natural history
incubation 3/52 to 8/12
condoms reduce risk by 30-60%
Genital Warts in pregnancy- risk to neonate
recurrent respiratory papillomatosis 4 in 100,000
Genital Warts treatment
30% clearance at 6 months
soft, non-keratinised- podyphyllotoxin/imiquimod
Contact tracing- Chancroid
10 days prior to symptom onsent
Contact tracing- chlamydia
M- 4 weeks prior to symptoms
F/asymp- six months
Contact Tracing- EO
as per C4/GC if tested positive
if nil +ve- six months
Contact Tracing- GC
M- 2/52 prior to symptoms
F/asymp- 3/12
GC 2 and 3
C4 4 and 6
Contact Tracing- HAV
2/52 prior of jaundice
or estimate time of acquisition
Contacting Tracing- HBV
2/52 prior to jaundice
children/household
Contact tracing- LGV
4/52 prior to symptoms
Contact Tracing- NGU
4/52 prior to symptoms
Contact Tracing- PID
6/12
or as per infection if any identified
Contact tracing- scabies
2/12 prior
household
Contact tracing- lice
3/12
lice=thrice
Contact tracing- syphilis
primary- 3/12 before symptoms
secondary- 2 years
late- everyone
Contacting tracing- TV
4/52
Pathophysiology of HIV
Single stranded RNA retrovirus
HIV attached to CD4 and enters cell
proteins and enzymes released
revers transcriptase- DSDNA
Integrase- HIV DNA joins cell DNA, making new HIV genetic material
Protease- cuts and assembles new HIV
each cell produces new virions
Natural History of HIV
Enters and infects cells
infected cells travel to lymph nodes (hours)
HIV multiplies in lymph nodes ad they explode, releasing HIV enter blood (days- weeks)
HIV antibodies formed
80% seroconversion illness
Stages of HIV
Primary <6/12
Secondary >6/12
Late- CD4 <350 or 200 (WHO definition)
HIV Testing
WP= 45 days
4th generation- IgG/M of p24 antibody
POCT- antibody
HIV time to progression to late disease
25% 1-2 years
50% 2-10 years
25% 10-15 years
<1%= slow
Action of ARVs
NRTI/NNRTI- stop HIV RNA to dsDNA conversion
II- stop HIV integration into cell DNA
PI- block new HIV being assembled into virions
When to treat ARV
within 2 weeks of diagnosis
if active TB, treat that first and then wait 2 weeks, then treat
If meningitis, delay treatment 4-6 weeks
Criteria for U=U
VL undetectable
taking ARVs daily for 6 months
1st line ARVs
TDF, emtricitabine, dolutegravir
or
TDF, emtricitabine, bictegravir (Biktarvy)
Monitoring after starting ARVs
VL every 1-2 months until undetectable
CD4 aim >500 (25-65%)
high risk CVD/metabolic changes due to persistent inflammation
resistance- new diagnosis/blips
Ison Hay
1= high levels of lactobacilli
2= mixed flora, some lactobacilli but also mobiluncus
3= predominantly gardnerella, mobiluncus, few lactobacilli
Amsel’s
3 of 4:
thin white homogenous
clue cells
ph >4.5
fishy smell on addition of alkali (gold standard)
What is BV?
imbalance of vaginal flora, increased number of commensals, reduced number of lactobacilli
-gardnerella, clostridia, leptotrioma
discharge + pH>4.5
Treatment of BV
metronidazole 400mg BD PO 5-7/7
or metronidazole 0.75% gel OD for 5 days/clindamycin/tinidazole
metronidazole can increase warfarin levels
relapse- 30% at 1/12, 60% 6/12
if symptomatic in pregnancy/RF for PTB/miscarriage
treat before gynae procedures including abortion
Recurrent candida- diagnostic criteria
4 per year, 2 confirmed on microscopy
Candida treatment failure
no better in 7-14/7, 10-20%
Candida- most common species
80-89% albicans, then glabrata/krusei
Candida on microscopy
blastosphores and neutrophils
pseudohyphae- albicans only
Hep B characteristics
Hepadna DNA virus
incubation 4-160/7 (average 60-90)
acute- <6 months
chronic- >6 months
18% of partners
HbEAg= acute phase, very infectious
IgM= MAN that’s acute
HbeSAg->IgM->symptoms->IgG
Hep B symptoms
often asymptomatic in children (up to 50% adults)
Prodrome:
1-3/52 (malaise/anorexia/nausea/taste changes)
Icteric:
2-24/52 (rash->2/52->jaundice)
bruising, myalgia, fever, headache, RUQ pain
raised ALT/bili/INR in liver failure
Fulminant hepatitis
1% hep a/b
1 in 2 die if no transplant
encephalopathy
Outcomes of Hep B
90% resolve after acute phase
1% go to fulminant
HbSAG >6/12
<5% adults
90% neonates, 5% by 5yo
resolution
or
asymptomatic carrier
or
chronic
-extrahepatic (PAN/glomerulonepritis)
-cirrhosis (50%, then 20% of these go to failure)
-carcinoma 25%
Chronic hepatitis B
HbSAg >6 months
may have similar symptoms to acute:
cirrhosis, carcinoma, cryoglobulinemia, glomerulonephritis, failure
M>F
Bloods for HBV- infection
HBSAg +
HBV Core Ab +
HBV antigen +/-
Bloods for HBV- cleared
HBSAg -
Core Ab +
Surface Ab +
Bloods for HBV- immunised
surface antibody + only
HBV Seroconversion
developing antibodies against surface antigen
Who to vaccinate for HBV
MSM
IVDU
CSW
PEPSE
HCV/HIV
partner <6/52
babies to infected mothers
Immunoglobulin- <7/7
HBV vaccine schedules
Ultrarapid- 0, 7/7, 21/7, 12/12
Response- 4-12/52 in 80%
12/12 in 95%
Normal:
0, 1, 3, 12/12
up to 6 weeks after exposure
Treatment of HBV
> 30 years old, DNA >2000 IU/ml with deranged ALT x 2 3 months apart
<30 and fibrosis
cirrhosis
if about to have immunosuppression, treat before starting and continue for 6 months
1) Peginterferon alpha 2a
2) TDF/entacavir
HBV and the neonate
Can BF if baby immunised
HBSag+ but EAg-ve = vaccine
SAG+ and EAg +ve- vaccine and HBIG
can vaccinate mum in pregnancy
CHC and acute hepatitis
I= 3
c= 2
HAV characteristics
picorna RNA virus
incubation 15-40/7 (average 28 days)
contaminated food/water/travel to areas
no chronic state but may have a relapse
suPportive, Picorna
HAV clinical features
3-6 week incubation
<6 years old likely asymptomatic
severity increases with age
HAV symptoms
Prodrome
flu-like + RUQ pain
3-10/7
Icteric
Jaundice, anorexia, fatigue, nausea (1-3 weeks)
Severe
Liver failure (more likely if also chronic HBV/HCV)
less than 0.1% mortality
almost all recover with lifelong immunity but small risk relapse
IgM +ve 45-60/7
HAV treatment
Supportive (avoid paracetamol)
follow up weekly until LFTs normalise
notifiable disease
1% fulminant
give vaccine up to 14 days from exposure
HAV vaccination
0 and 6-12 months
give as PEP if less than 14 days since exposure
PrEP dose
TDF 245mg + emtricitabine 200mg
ok if pregnant/BF
86-97% efficacy
PrEP dosing
Same biological efficacy:
-2 tablets 24-48hr before sex and then daily until 48hrs after last sex
-daily OD (7 day lead in, 7 days after)
only option for RVI
PrEP side effects
nausea and vomiting/GI
dizziness
headache
non-progressive and reversible damage to proximal convoluted tubule (TAF if eGFR <60)
BMD- small risk, only of concern if other risk factors
PrEP- high risk <4/52
add VL to bloods
HBV immunity- bloods
HbSAb
>100 immune
10-100 ?booster
<10 resume (first test for infection)
10-15% non responders
only test for response if CKD or occupational exposure
GFR and PrEP
> 90 and age >40= annual
60-90 and >40 or RF= 6 months
PrEP missed pill rules
frontal sex- <6 doses in 7 days
anal sex- <4 doses in 7 days
PEP dose
TDF 245mg + emtricitabine 200mg + raltegravir 400mg BD
When to initiate PEP
72 hours
Risk source is PLWH and +ve VL x risk exposure
> 1 in 1000= give
1 in 10000 = consider
otherwise not recommended
High risk PEP
concomitant STI
trauma/bleeding
group sex
transgender
Type of sex/PEP
Known HIV + and unknown VL or high risk group:
RAI offer
IAI consider
Known HIV + and unknown VL
RVI offer
IVI consider
(not if high risk group)
OI and PEP
Not recommended
Needlestick and PEP
PLWH + unknown VL
offer
Unknown HIV status
not recommended
Risks of PEP
TDF- tubular nephropathy
mild ALT increase (reversible)
nausea, vomiting, GI, dizziness
-take at night
-anti-emetics
BASHH Recommends-
LFT at initiation and 4 weeks
U+Es at 2 and 4 weeks
HIV at 4-6 weeks
PEP missed pills
1= continue
2= efficacy lost, consider stopping
Factors affecting raltegravir absorption
Mg
Fe
Ca
Gaviscon
BV new study
150 couples
recurrence lower in partner treatment group (35% v 63%)
oral metronidazole and topical clindamycin 50% men had s/e
-2.6 AR difference
Most common cause of discharge in F
BV
BV treatment
metronidazole 400mg PO BD 5-7 days
metronidazole 2g STAT
PV gel 0.5% OD 5/7
clindamycin cream (2%) once daily for 7 days
Candidiasis treatment
1st line= fluconazole 150mg PO STAT (avoid if risk of pregnancy)
2nd line= clotrimazole 500mg PV STAT
80% cure rate, no difference in outcomes, fluconazole 7-30x cheaper
consider asymptomatic colonisation (30-40%)
can trial cetirizine 10mg OD for itch
Resistant candida
azole resistance=100,000 nystatin pessaries for 14 nights
Nystatin resistance= 600mg boric acid PV 14 nights
acute VVC in pregnancy
clotrimazole 500mg PV ON for up to 7 nights
four day course cures 40%
7 day course cures >90%
BF- avoid fluclox, ok if one singular dose but avoid if repeated
Gonorrhoea treatment
Ceftriaxone 1g IM STAT
ciprofloxacin 500mg PO (if susceptibility known prior to treatment)
-resistance around 36%
Ideally only treat those who test positive, within 14 days of exposure may be able to offer epidemiological treatment
Primary v Non Primary HSV
Primary: First infection HSV-1 or 2 with no antibodies to either
Non-Primary- infection of one type with only antibodies to the other type
30% tender inguinal lymphadenitis
CS for HSV
If primary or non primary in 3rd trimester (>28 weeks)
-delivery within 6 weeks of acquisition
If lesions present at birth can offer NVD if confident lesions are that of reccurence
0-3% risk
aciclovir-safety in pregnancy
not licensed
no reports of abnormalities
small amount in breast milk
overall considered safe
HSV 4 weeks postpartum
Likely shedding at time of delivery
consider baby as very high risk
Management of clinically discordant couples
avoid SI in 2nd trimester and 2 weeks prior
recommend abstinence of all sexual activity, if decline:
condoms
suppressive rx to partner
HAV in pregnancy
supportive rx only
increased risk PTB/miscarriage
HBV in pregnancy
vaccinating newborn reduces transmission by 90%
increased risk PTB/miscarriage
consider TDF from 3rd trimester
HCV treatment in pregnancy
Ribavirin is teratogenic, avoid treatment in pregnancy
phthirus pubis in pregnancy
1% permethrin, keep on for ten minutes and then rinse
Phthirus pubis management
incubation 5 days to 7 weeks
- Malathion 0.5%. Apply to dry hair and wash out after at least 2 butpreferably, 12 hours ie overnight
- Permethrin 1% cream rinse. Apply to damp hair and wash out after 10 minutes (can be use on lashes)
retreat 5-7 days, re-examine at 1 week
examine sexual partners
avoid close contact in this time
Scabies management
incubation 3-6 weeks
permethrin 5% cream8-12 hours,
malathion aqueous 0.5% liquid 24 hours
Bedding, clothing, and towels used by infested persons or their close contacts during the four days before treatment - wash over 60 degrees or seal in a bag 72 hours
repeat treatment at 1 week
current partners and household contacts need rx
itch worse at night, may persist up to 2 weeks, beyond this consider reinfection
FCU
> 1 hour
first 20ml
VVS
2-3 inches
10-30s
Chlamydia treatment
Doxycycline 100mg BD PO 7/7
abstain until finished course
azithroymycin 1g PO STAT then 500mg PO OD 2/7
abstain until 7 days after rx
Quinolones pharmacology
inhibit DNA gyrase
bactericidal
Recurrent BV- first line
0.75% gel twice weekly for 4–6 months
hep e
test everyone with unexplained hepatitis
25% mortality 3rd trimester
HBIG
Given within 48hrs of exposure, with vaccine
if at high risk of complications (ie non responder, old, unwell)
if previous vaccine just give a booster dose
HBV advice
avoid alcohol
avoid SI until HBsAG -ve/partner vaccinated
avoid donation
PN
infectious 2 weeks before jaundice until 1 week after
HCV
RNA flaviviridae
PLWH/PWID
incubation 4-20 weeks
>60% asymp
up to 9 months for serology to be +ve
> 90% cure at 8-12 weeks
HCV sequelae
up to 45% clear
50-85% untreated= chronic hep c
-very few resolve
10-20% cirrhosis (20-30 years)
-Ca 1-% decomp 3-6%
HCV treatment
DAA
cure if HCV RNA -ve 12 weeks after rx
PN to time of infection
vacc against other
alcohol- avoid
notifiable
Sjorgren’s, GN, athritis
HSV in PLWH
HSV activated HIV replications (increased chance of acquisition)
recurrence more common, as is rx failure
continue rx until lesions re-epithelialized
double dose in advanced HIV
