Lecture 35 - Genital ulcers and genital lesions Flashcards
Syphilis - how do you get it?
-Not very common, except for men having sex with men
T. pallidum - a spirochaete
-can easily evade the immune response
-a lot of the clinical disease is due to immune response to organism e.g vasculitis, destruction, fibrosis
Common features of syphilis
- rash, lesions, neurological signs
- occurs 14-21 days after inoculation
- can have ulcers on mouth or genital or anal regions
- can get a rubbery lymph node
- with serology can see the spiral shaped organisms, they can move and twist a lot
Secondary syphilis
- can occur later on after primary lesion (4-10 weeks later)
- due to haematgenous spread, and may have systemic symptoms
- rash - macular, papular, papulosquamous
- trunk, extremities, palms, osles
- may have mucous membrane lesions - wart like lesions
- patches on tongue
late disease
- when no longer infectious
- can get aortic disease, cognitive change
Congenital disease
- occurs as early as 9 weeks of pregnancy, and inflammatory response goes on for a while
- more than 50% undergo abortion or perinatal death
Tests
- Quite hard to interpret
- can get false positives
- murex ICE is an EIA test which uses 3 recombinant proteins - representing immunodominant epitopes from T. pallidum
- uses anti igG and anti-human igM
RPR test - non specific test, looking for antigen
-uses charcol particles
TPPA
- high specificity
- but can still get false positives
can see that tests work best in secondary stages of the disease
false positives
e.g technical, biological, acute biological - pregnancy
Treatment
Benzathine penicillin (same type used for rhuematic fever) -If have penicillin allergy, use doxycycline
Genital herpes
Type 1 - oral
Type 2 - genital
risk of getting it is higher for women , due to anatomy and amount of mucosa
replicates in cells of epidermis, cellular destruction and inflammation
Transmission
- normally from a blister, or an ulcer
- people can shed virus asymptomatically
- most peopel get it from an asymptomatic partner
- at the beginning, shed a low amount of virus, but then this amount increases
- short incubation period
Diagnosis
Treatment
Best from a vesicle or ulcer
-herpes simplex PCR is performed
Treatment - aciclovir
-this becomes actiavated, and can the inhibit viral DNA poly,erase and causes viral chain termination
reducing transmission
- Condoms
- antiviral therapy - reduces risk by 75%
Chlamydia trachomatis
L2 - most common in NZ
- infect lympocytes and lymphatic tissue
- presentation depends on gender, site of acquisition and stage of disease
- most of the complications are due to chornic disease that has not been controlled e.g in developign countries
- most relevant in developed nations where they are HIV positive, adn have no condom use ect.
- lots of partners, also havign sex with HIV+ partners
- requires doxycycline for 3 weeks (longer course of treatment)
Anogenital warts
- a common sexually acquired problem due to infection with HPV
- normally treated because patients want them gone
- unusual to have warts associated
HPV
DNA virus
- warts are common
- can also get neoplasia with hpv
- there are species specific and site specific
- wart is of clonal origin, all virus in wart will be similar
- need differentiating epithelium to grow
