HIV, Syphilis and STDs Flashcards
What is HIV itself?
Retrovirus that uses reverse transcriptase for reverse transcription (turning RNA into DNA) to integrate material into host cell DNA and new virus is produced
What is responsible for AIDS?
HIV-1
What does HIV target?
T cells (particularly CD4 T cells the helpers) Also infects B lymphocytes and macrophages
What are lymphocytes?
WBCs that defend against protozoa, fungi, some bacteria and viruses
Routes of HIV transmission
Sexual transmission (infected body fluids)
Injection drug use
Occupational injury (needlestick)
Blood products
HIV mom to infant
(not just casual contact)
*receptive anal intercourse has highest risk of transmission
What is another name for primary HIV infection?
Acute HIV/ acute retroviral syndrome
What is acute HIV?
2-6 wks after exposure
Mono like or flu like illness (about 2 wks and resolves spontaneously)
Why is acute HIV missed?
Routine HIV Ab test is negative so miss it
Lab for acute HIV
HIV RNA (viral load( is measurable and usually extremely high >100,000
Common sxs of acute HIV
Fever, adenopathy, sore throat, rash and mucocutaneous ulcers, myalgia, arthralgia, HA, diarrhea, n/v
What does the rash look like in acute HIV?
Half of pts
Upper trunk, neck and face
Lab abnormalities in acute HIV
Elevated transaminases (LFTs)
Leukopenia
Anemia
Thrombocytopenia
When does clinical latency occur?
When immune system response to infection (acute illness resolves) and pt seroconverts!!! and becomes antibody positive
Viral load decreases to a set point
CD4 t cell count slowly declines
When do you see full symptomatic infection of HIV?
When immune system deteriorates:
- Lymphnodes and tissue damaged from burnt out
- Virus may mutate and become more pathogenic
- Body fails to keep up replacement of CD4
- viral load increases
All general sxs of HIV
Fever, night sweats, LAD, fatigue, arthralgias, weight loss, oral hairy leukoplakia or thrush, prolonged diarrhes, cervical dysplasia, skin disorders, Kaposis, ITP
Normal CD4 t cell count
500-1400 cell/mcL
What is the definition when HIV progresses to AIDS?
CD4 T cell count <200 cells/mcL
OR
HIV and 1 of 27 AIDS defining conditions (regardless of T cell count)
Types of AIDS defining conditions
PCP Toxoplasmosis MAC CMV Candidiasis Kaposis sarcoma Cervical cancer
What is pneumocystic jiroveci pneumonia?
Common opportunistic infection associated with AIDS
Caused by airborne fungus pneumocystis jiroveci
Reactivated dormant infection
Presentation of pneumocystic jiroveci pneumonia
Nonspecific: fever, cough, SOB
May have severe hypoxemia (usually younger 20-30)
CXR shows diffuse or perihilar infiltrates
How to diagnose pneumocystic jiroveci pneumonia
Sputum sample: see elevated LDH in most
Tx for pneumocystic jiroveci pneumonia
Bactrim and supportive
What does toxoplasmosis cause?
Encephalitis (most common intracranial lesion in HIV pts)
What causes toxoplasmosis?
Single celled parasite toxoplasma gondii
How to get toxoplasmosis
Ingestion of cat feces, contaminated rw food or utensils
Immuncompetent doesn’t usually have pts
Presentation of toxoplasmosis in HIV pt
HA, focal neurological deficits, seizures, AMS
Maybe retinits or pneumonitis
Imaging for toxoplasmosis
Multiple contrast enhancing lesions on brain CT or MRI
Also seropositive for toxoplasmosis
Mycobacterium avium complex
May cause pulm infection when immunocompetent
Found in soil or dust inhaled
Presentation of MAC
Systemic disease in HIV
Night sweats, weight loss, abd pain, diarrhea, anemia
How to diagnose MAC
Sputum acid fast bacillus stain positive
Positive sputum and blood cultures
Most common retinal infection in AIDs
CMV retinitis
What is CMV?
Herpes virus in general pop (blood, sexually transmittesd, perinatally)
Presentation of CMV retinitis
Visual disturbances
Can cause blindness when untreated
How to diagnose CMV retinitis
Perivascular hemorrhages and white fluffy exudates on fundoscopic
Seropositive for CMV
Candida and CD4
More invasive the candida (like into trachea) the lower the associated CD4 t cell count
What CD4 count does kaposis sarcoma occur at?
ANY
When is kaposis seen classically?
Elderly eastern european and mediterranean males
When is aids related kaposis sesn most?
Homosexual men (lesions multifocal and widespread with LAD)
When do you screen for HIV?
Everyone 13-64: voluntary opt out Anyone in whom TB tx is being initiated At each presentation for STD Pts at risk (MSM) Pregnant
Most common screening and diagnostic testing for HIV
Combo HIV antibody (4-12 wks after infection-after seroconversion) and antigen (won’t miss the acute) testing
Who is treated with antiretroviral therapy?
All with HIV, even those in acute infection
When to start post exposure prophylaxis for HIV?
Within 72 hrs
When do people do well usually with CD4
> 350
Medication based on CD4 count <200
Bactrim DS (prophylaxis for PCP)
Medication based on CD4 count <100
Bactrim DS (prophylaxis for toxoplasma encephalitis)
Medication based on CD4 count <50
Azithromycin (for disseminated mycobacterim avium complex)
What causes syphilis?
Treponema pallidum
Stages of syphilis
Primary Secondary Latent Tertiary Neurosyphilis Ocular syphilis
Presentation of primary syphilis
Painless chancre that appears at location where syph entered body (4-6 wks)
Presentation of secondary syphilis
Rash (COMMON): non-pruritis, palms and soles of feet, not contagious
Condyloma lata
Mucous patches: painless flat patches (infectious)
May have malaise LAD
2-6 wks
What is condyloma lata?
Moist, heaped, wart-like papules
Occur in intertriginous areas (gluteal folds, perianal area)
Contagious
Latent phase of syphilis
Asymptomatic
No longer sexually transmittable
Years
Presentation of tertiary syphilis
Most don’t get this (more in untreated)
10-30 yrs after infection
Damage heart, bvs, nervous system
What is neurosyphilis?
Any stage
Paralysis, difficulty with coordination, dementia
What is ocular syphilis?
Any stage
Changes in vision or blindness
Diagnosis of syphilis
Rapid plasma reagin (RPR) or venereal disease lab test (VDRL)–antibody with titer (low may be false positive)
What to do to confirm RPR?
Treponemal antibody test (FTA-ABS)
What to do is suspect neurosyphilis or ocular syphilis?
LP (lumbar puncture) or VDRL on spinal fluid to confirm
What to do after treat pt for syphilis
Confirm success with RPR titer at 3, 6, 12 and 24 mos
4 fold decrease is good response
Congenital syphilis
Untreated syph in pregnancy can lead to stillbirth, neonatal death, deafness, neuro impairment and bone deformities
How to prevent congenital syphilis
Screen pregnant woman at 1st prenatal visit
If high risk, screen and get sex history at 28 wks and delivery
What causes lymphogranuloma venereum?
Chlamydia trachomatic
Presentation of lymphogranuloma venereum
Unilateral inguinal bubo
Self limited gential ulcer or papule at site of innoculation
Anal discharge and rectal bleeding
How to diagnose lymphogranuloma venereum
R/o syph
Contact health dept
Maybe specimen swab
Tx for lymphogranuloma venereum
Erythro or doxy
What causes chancroid
Haemophilus ducreyi
Presentation of chancroid
Painful tender genital ulcer
Lesions with foul-smelling discharge
Inguinal adenitis
Diagnose chancroid
R/o syph and HSV
Contact county health (special culture)
Tx for chancroid
Azithro, ceftriaxone, cipro
