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BDS M5 Human Disease > Infectious disease and liver disease > Flashcards

Infectious disease and liver disease Flashcards

1
Q

How are infections transmitted during “sex”?

A
  • sexual/genital secretions (many)
  • direct inoculation (skin to skin) (e.g. HSV)
  • trauma (e.g. HCV)
  • ingestion (e.g. shigella)
  • fomites (objects i.e. sex toys) (e.g. gonorrhoea)
  • IVDU (injection drug use) (e.g. HIV, HCV)
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2
Q

What trends have been shows by NATSAL surveys?

A
  • increased reporting of first sex before 16 years of age in successive birth cohorts
    • greatest difference in women
  • higher numbers of lifetime partners since NATSAL-1 (1990)
    • greatest difference in women
  • expanding repertoire of heterosexual activities
  • increased reporting of AI and OI in each birth cohort
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3
Q

What are risk factors for STIs?

A
  • <25 years old
  • change sexual partner
  • non condom use
  • MSM
  • past history of STI
  • large urban areas
  • social deprivation
  • black ethnicity
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4
Q

What STIs affect the mouth?

A
  • chlamydia trachomatis
  • neisseria gonorrhoea
  • treponema pallidum (syphilis)
  • herpes simplex virus (HSV)
  • human papilloma virus (HPV)
  • human immunodeficiency virus (HIV)
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5
Q

What is syphilis caused by?

A

treponema pallium - a spirochaete

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6
Q

How long after exposure to syphilis would you expect to get symptomatic primary syphilis?

A

10-90 days (usually 14-21 days)

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7
Q

What is a “chancre” and where is it found?

A
  • sort of ulcer at the site of infection in syphilis
  • 70% painless
  • commonly seen in mouth or other extra-genital sites
  • resolves without treatment 3-6 weeks
  • quite indurated, like a hard disc
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8
Q

What causes a chancre?

A
  • spirochaete invaded intact mucosa or via microabrasions
  • host cellular inflammatory response
    papule —> ulcer
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9
Q

What may be present in association with a chancre?

A

+/- regional lymphadenopathy

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10
Q

What is the differential diagnosis for a chancre?

A
  • trauma
  • herpes simplex
  • lymphogranuloma venereum
  • tropical ulcers
  • cancer
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11
Q

How long after primary syphilis will secondary syphilis develop?

A

usually 3-6 weeks but can be up to 2 years

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12
Q

What does secondary syphilis involve?

A
  • haematogenous and lymphatic dissemination
  • multi-system disease
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13
Q

What are the systemic symptoms of secondary syphilis?

A
  • low-grade fever
  • sore throat
  • headache
  • lymphadenopathy
  • rash
    (flu like/like glandular fever)
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14
Q

How often does secondary syphilis present as lesions in the mouth?

A

30% of cases

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15
Q

How does secondary syphilis present in the mouth?

A

white glistening patches
- greyish membrane
- hyperaemic halo
- coalesce to form “snail track” ulcer

soft palate, hard palate, gums, buccal mucosa

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16
Q

What conditions may secondary syphilis present with?

A
  • meningitis
  • hepatitis
  • iritis
  • uveitis
  • glomerulonephritis
  • periostitis
  • condylomata lata
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17
Q

If secondary syphilis goes untreated and becomes latent, what can it go on to form?

A

30% interacted syphilis will progress to tertiary syphilis

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18
Q

What kind of issues can tertiary syphilis cause?

A
  • neurological
  • cardiovascular
  • gummatous
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19
Q

How is syphilis diagnosed?

A

lesion - swab for treponema pallidum by PCR

venous blood - syphilis antibody and confirmatory tests, diagnosis and screening

20
Q

How is syphilis treated?

A

antibiotics - benzathene penicillin IM or doxycycline (2nd line)

public health - partner notification, comprehensive STI testing, sexual abstinence, risk reduction

21
Q

What is the UK and Tayside prevalence of HIV?

A

0.19% UK, ~ 0.15% Tayside

22
Q

What is the late diagnosis rate for HIV?

A

43%, mortality rate higher

23
Q

What are the modes of transmission of HIV?

A
  • sexual transmission 79%
  • injecting drug use 2.5%
  • unknown 16.5%
  • other 0.8%
24
Q

What are the higher risk groups for HIV?

A
  • MSM
  • high prevalence countries
  • injecting drugs
  • sexual contact with the above
25
Q

What cell count is important in HIV?

A

CD4 T Lymphocyte count

26
Q

How does primary HIV present?

A
  • up to 80% present with symptoms
  • onset average 2-4 weeks after infection

combination of
- fever
- rash (maculopapular)
- myalgia
- pharyngitis
- headache/aseptic meningitis

very high risk of onward transmission

oral lesions

27
Q

What oral lesions may be present in primary HIV?

A
  • aphthous ulcers
  • candidiasis
28
Q

What can late stage HIV present as in the mouth?

A

mucosal candidiasis

gingivitis
- relating to other lifestyle issues including IVDU

Kaposi’s sarcoma

oral hairy leukoplakia

seborrhoeic dermatitis

29
Q

What can present in the mouth/head/neck that may be associated with HIV?

A
  • HPV
  • HSV
  • Varicella Zoster
  • Idiopathic Immune thrombocytopenia
  • Lymphoma
  • Salivary gland disease and xerostomia
  • unexplained lymphadenopathies
30
Q

When should HIV be tested for?

A

when HIV falls within the differential diagnoses an HIV test should be performed regardless of risk factors

31
Q

How is HIV tested for?

A

blood test
- possible false negative result in first 6 weeks of infection
- specific verbal consent to test for HIV
- often from GP or clinic

32
Q

As a dentist how should you approach treating patient’s with HIV?

A
  • ask patients if they are on treatment
  • be aware of drug interactions
  • do not be scared of patients with HIV
33
Q

What does post-exposure prophylaxis for HIV include?

A
  • combination of anti-retro viral drugs
  • 4 week course
  • off license indication - reduce risk of transmission by 80%
34
Q

What are the indications for post-exposure prophylaxis?

A
  • high risk injury + high risk source + high risk fluid
  • sexual
  • occupational
35
Q

What are methods of wider HIV prevention?

A
  • behaviour change interventions
  • address substance use
  • needle exchange/harm reduction
  • STI management
  • prevention of mother-child transmission
  • circumcision
  • condoms
  • treatment as prevention
  • PrEP
36
Q

What types of HSV are orally transmittable?

A

HSV 1 and 2

37
Q

How does a primary HSV infection present in the mouth?

A
  • gingivostomatitis
  • pharyngitis
  • +/- systemic symptoms
38
Q

What type of herpes is usually responsible for recurrent orolabial herpes?

A

type 1

39
Q

What percentage of adults are seropositive for HSV-1?

A

56-85% and declining with time

40
Q

How can HSV present in HIV?

A
  • more frequently recurring
  • extensive lesions
  • hypertrophic lesions
  • may be resistant to aciclovir
41
Q

How is orolobial herpes managed?

A
  • self-limiting 7-10 days
  • usually no treatment
  • symptom control
  • avoid kissing
  • avoid oral sex
  • wash hands are touching
  • reassurance
42
Q

How many strains of HPV are there?

A

more than 100, of which 50 affect oral and genital mucosa

43
Q

What types of HPV cause 95% of genital warts?

A

HPV 6 and 11

44
Q

What types of HPV are high-risk oncogenic types?

A

HPV 16 and 18

45
Q

In addition to genital warts, what can low risk strains of HPV cause?

A

orolabial warts - oral sex common route of infection

BDS M5 Human Disease (13 decks)

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