ID- viral infections + STIs Flashcards
Name the HHVs
HHV1- HSV1 HHV2- HSV2 HHV3- VZV HHV4- EBV HHV5- CMV HHV8- Kaposi's sarcoma related
Describe the infections caused by HSV 1+2
Oral/ labial herpes: more commonly 1 Genital herpes : 1/2 Ramsay-Hunt syndrome: 1 Encephalitis: 1 Disseminated infection
Describe the presentation of oral + genital herpes
Prodrome- tingling, pain, burning sensation
-> vesicles -> ulceration
Genitals: typically several small, very tender ulcers + lymphadenopathy
Describe the diagnostic investigation for HSV infection
Diagnostic: swab for viral PCR
Genital- do other STI screen
Recurrent- consider HIV testing
Describe the management of HSV infections
Topical/PO/IV aciclovir depending on type/severity
eg. labial - topical, genital - PO, encephalitis - IV
Describe the type of infections caused by VZV
1st infection: Chickenpox
Subsequently -> shingles
Describe the presentation of VZV infections
Chickenpox: viral illness -> itchy vesicles -> burst -> scab (5-7 days)
Shingles: viral illness -> painful vesicular rash in dermatomal distribution -> ulceration + scabbing
-Pain may remain for weeks-months (postherpetic neuralgia)
Describe the management of VZV infections
Chickenpox: children not treated, adults PO aciclovir
Shingles:
-Aciclovir PO or IV if disseminated/immunocompromise
-Pain: NSAIDs/paracetamol, opioids, gabapentin, TCA
Describe the type of infections caused by CMV
Immunocompetent: flu-like illness, mono Immunocompromise: -BM suppression -Colitis -Pneumonitis -Hepatitis -Retinitis
Describe the management of CMV infection
Immunocompetent: no antivirals Compromised: -PO valganciclovir/ IV ganciclovir -Cidofovir -Foscarnet
Describe the course of HIV infection
Infection -> seroconversion with flu-like/viral illness
- > primary infection: 6 months, high viral load
- > slowly declining CD4 count, asymptomatic
- > AIDS after 10-15 years
Describe the AIDS-defining illnesses
AIDS usually occurs at CD4 <200 CMV retinitis Cryptococcal infections eg. meningitis Disseminated infections eg Candidiasis, HSV HIV-related encephalopathy PCP Toxoplasmosis
Kaposi’s sarcoma
Cervical cancer
Describe the investigations for HIV
Diagnosis:
- HIV antibody/antigen test or ELISA
- > confirm with Western blot
Further Ix:
- Urine NAAT/genital swabs for other STIs
- Bloods: FBC, U+Es, LFTs, lipids, glucose, CD4 count, PCR for viral load, viral hepatitis serology, syphilis serology
- CXR
- Tuberculin skin test
Describe the management of HIV
All positive patients should be started on ART
MDT with HIV/GUM, specialist nurse, psych, dietician etc
-Higher risk of CVD. RF Mx eg. statins
Specific management around pregnancy
-ART, C-section/SVB, no breastfeeding etc
Describe the presentation, investigations and management of PCP
Presentation:
- Dry cough, SOB worse on exertion, weight loss
- Desat on walking
Investigations:
- Sputum sample if possible/BAL: silver stain
- Bloods
- CXR: bilateral perihilar interstitial shadowing
Mx:
- Co-trimoxazole
- Given as prophylaxis when CD4 <200
What causes a ring-shaped contrast enhancing lesion?
Toxoplasmosis
What is the classic investigation findings in cryptococcal meningitis?
CSF:
- Very high opening pressure
- India Ink stain +
What are some causes of headache in a patient with HIV?
- Cerebral toxoplasmosis
- Meningitis eg. TB, cryptococcal
- Cerebral abscess
- Malignancy eg lymphoma
Describe the presentation of syphilis
Primary: occurs week after infection
-Chancre: painless, single, shallow ulcer
Secondary: weeks-months later
- Palmo-plantar rash, lymphadenopathy, fever
- Condylomata lata
Tertiary: years later
- Neurosyphilis
- Vascular: aortic aneurysms/dissection
- Gummatous lesions
Describe the investigations and management of syphilis
Investigations:
- Non-treponemal: VDRL, RPR
- Test for other STIs: swab, serology
Management:
- IM benzathine benzylpenicillin
- Can monitor RPR/VDRL
Describe the presentation of gonorrhoea and chlamydia
Often asymptomatic or mild symptoms
- Dysuria, dyspareunia
- Itching, abnormal discharge
- PID: pelvic pain, fever, cervical motion tenderness
Describe the investigations and management of gonorrhoea and chlamydia
Ix:
- Swabs/urine for NAAT
- Test for other STIs
Mx:
- Gonorrhoea: IM cef
- Chlamydia: 7 days doxycycline
- PID: IM cef, metronidazole + doxycycline
Describe the presentation of Candidiasis
In immunocompetent: usually vulval/sometimes oral
Oral + systemic occurs typically in immunosuppressed eg. HIV, DM
-Vulval: itching, redness, pain, dysuria, dyspareunia, thick white discharge
-Oral: white plaques, pain, dysphagia
-Systemic: many manifestations eg. oesophageal, blood
Describe the management of Candidiases
Vulval:
- Topical antifungals eg. Clotrimazole cream/pessary
- PO fluconazole once only
Oral:
-Nystatin wash/ PO antifungal eg. fluconazole
Systemic:
-PO caspofungin, fluconazole, amphotericin B
