Lecture 9 Flashcards
STDS, AIDS, HIV
1
Q
Pharmacist Role in Prevention/Control of STDs
A
- Resource for STD prevention
- Advise and inform on STDs & HIV/AIDS education
- Refer clients to health clinics for diagnosis and treatment
- Counseling clients on appropriate treatment regimens
- Encourage condom use and communication between partners
2
Q
Genital Ulcer Disease
A
- “Sores”
- Painless - syphilis
- Painful - genital herpes (HSV 1 & 2)
3
Q
Vaginal + Urethral Discharge Disease
A
- “Drips”
- Cervicitis and urethritis
- Gonorrhea, chlamydia, trichomoniasis, bacterial vaginosis
4
Q
HPV
A
1 cause of cervical cancer. Can also cause genital warts
5
Q
Syphilis Organism
A
- Treponema pallidum (T pal)
- Anaerobic spirochete
- Enters skin through abrasions or mucous membranes
6
Q
Syphilis Tranmission
A
- Person to person contact with chancre
- Occurs during vaginal, anal, or oral sex
- Pregnant woman can transmit to fetus, IN UTREO
- 4 Stages: Primary, Secondary, Latent, and Tertiary
7
Q
Primary Stage of Syphilis
A
- Incubates 10-90 days (average 21 days)
- Clinical manifestation - appearance of chancre marks
8
Q
Chancre
A
- HIGHLY infectious
- Clean cased, painless, indurated ulcerative lesion with smooth firm borders at portal of entry
- Unnoticed in 15-30% of patients (especially women)
- Resolves itself in 3-6 weeks
9
Q
Secondary Stage of Syphilis
A
-Develops 4-10 weeks after chancre resolution
Clinical Manifestations
- Mucous membrane lesions in mouth, vagina, and anus
- Maculopapular skin rash (palms, soles of feet, and trunk)
- Condylomata lata - HIGHLY infectious
- Resolves in 2-10 weeks
10
Q
Secondary Stage Symptoms
A
- Low grade fever
- Malaise
- Sore throat
- Headache
- Lymphadenopathy
- Myalgins
- Arthralgias
- Patch hair loss
11
Q
Stages of Latent Syphilis
A
- Early latent
2. Late latent
12
Q
Early Latent Syphilis
A
- Infection acquired within preceding 12 months
- Only sexual contact, document seroconversion, Hx of Sn/Sx and sexual exposure
- Asymptomatic and serologic evidence of T pal infection
- Nontreponemal and treponemal tests
13
Q
Late Latent Syphillis
A
- No evidence of acquired infection within preceding 12 months
- Asymptomatic and serologic evidence of T pal infection
- Nontreponemal and treponemal tests
14
Q
Tertiary Stage of Syphilis
A
- Can occur 1-30 years after acquisition
- Occur in ~15% of untreated patients
15
Q
Tertiary Stage Clinical Manifestations
A
- Central nervous system - neurosyphilis
- Cardiovascular - aortitis
- Gummatous - granulomatous, nodular skin, and bone lesions
16
Q
Neurosyphilis
A
- T pal invades CSF, identified in 25% of untreated patients, can occur during any stage of infection
- May result in meningitis, ocular syphilis, ostosyphilis, meningovascular syphilis & general paresis (dementia paralytica)
17
Q
Congenital Syphilis
A
- T pal passes placenta and is passed to fetus
- Increased risk of passing to fetus as gestation advances
- 70-100% passed to infants of untreated mothers, 40% of which lead to infant death
- Poor pregnancy outcomes - miscarriages, premature births, stillbirths
- All pregnant women should be screened at first prenatal visit
18
Q
Diagnosis of Syphilis
A
- Identified by direct visualization or by serology
- Direct visualization - dark field microscope and direct fluorescent antibody (definitive diagnosis) of scrapings of chancre
- Serology - Nontreponemal for screening (VDRL & RPR) and Treponemal for confirmation (TP-PA & FTA-ABS)
19
Q
Genital Herpes Simplex Clinical Manifestations
A
- Primary episode - small painful grouped vesicles in genital/perianal areas. 2-3 weeks and tend to ulcerate and then crust
- Recurrent episodes - preceded by prodromal tingling or pain, less severe, last 4-6 days
20
Q
Genital Herpes Simplex Diagnosis
A
- Culture - gold standard, sensitive sensitive only during vescular stage
- Direct fluorescent antibody - scraped lesion or unrooted vesicle, less sensitive than culture
- Serology (EIA) - HSV antibodies (IgM)
- Polymerase Chain Reaction (PCR) - qualitative test, more sensitive and preferred
21
Q
Gonorrhea Organism
A
- Neisseria gonorrhoeae
- Intracellular, gram negative, diplococcus with widespread resistance
22
Q
Gonorrhea Pathogenesis
A
- Gonococci attaches to mucosal cell surface
- Local penetration
- Local proliferation
- Local inflammatory response or systemic dissemination
23
Q
Gonorrhea Clinical Manifestations - Women
A
- 50% are asymptomatic
- Vaginal discharge, dysuria, abnormal vaginal bleeded may occur 7-10 days post-acquisition
- Possible inflammation of ovaries and fallopian tubes could lead to infertility
- Diagnosis - NAAT, Vaginal/endocervical swabs, urine specimen
24
Q
Gonorrhea Clinical Manifestations - Men
A
- 90% will develop mucopurulent discharge and dysuria 2-14 days post-acquisition
- Possible epididmyitis and infertility
- Diagnosis - NAAT, urethral swabs, urine sample
25
Q
Chlamydia
A
Organism - Chlamydia Tranchomatis
- Obligate, intracellular bacteria
- Biphasic life cycle - elementary bodies (EB) and reticulate bodies (RB)
Pathogenesis - ER from secretions attach and enter host, RB replicate and start process over
26
Q
Chlamydia Clinical Manifestations - Women
A
- Majority are asymptomatic
- Purulent vaginal discharge and abnormal vaginal bleeding occurs 5-10 days post-acquisition
- Transmission to newborn during delivery possible, can lead to conjunctivitis and pneumonia
- Possible proctitis, conjunctivitis, or infertility
- Diagnosis - NAAT, vaginal/endocervical swabs, urine sample
27
Q
Chlamydia Clinical Manifestations - Men
A
- Majority are asymptomatic
- Mucoid or watery urethral discharge for 7-14 days post-acquisition
- Possible epididymitis, prostatitis, proctitis, conjunctivitis, and infertility
- Diagnosis - NAAT, urethral swabs, and urine sample
28
Q
HPV
A
Organisms - Type 16/18 & 6/11
Type 16 & 18 - onogenic (cancer causing)
Type 6 & 11 - non-onogenic (warts)
-Pathogenesis - expression of viral genes demonstrated in tissues with lesions
29
Q
HPV Prevention
A
- Routine pap smears can give early detection of pre-cancerous lesions
- Vaccines - Cervavix (16 & 18), Gardasil (9 & 11), Gardasil 9 (9-valent
- All vaccines prevent cervical cancer
- Last two prevent genital warts/anal cancers
- Recommended for boys and girls between 11-12 years old, though can be give at later stages of life as well
30
Q
HIV/AIDS -Transmission
A
- Blood, semen, vaginal secretion, uterine, cervix, and breast milk are all modes of transmisison
- Cannot be transmitted via urine, saliva, tears, CSF, amniotic fluid, and feces (Antibodies are present though)
31
Q
Who Should be Tested for HIV/AIDS?
A
- Everyone between 13 and 64
- Risky behaviors increase risk. These include sex without condoms, PrEP, HIV medications, sharing needles, being diagnosed/treated for STD
32
Q
HIV Types
A
- Same routes of transmission and both cause AIDS
- HIV 1 - most common worldwide
- HIV 2 - mainly seen in those with West African origins and characterized by lower viral loads, slower rates of CD4 decline, and slower disease progression. Sensitivity and resistance are more variable in this type to retrovirals
33
Q
HIV
A
- Genome-retrovirus (RNA virus), RNA»_space; DNA via reverse transcriptase
- HIV particle - two strands of RNA, protease, integrase, and reverse transcriptase
34
Q
HIV Bonding & Fusion
A
- Targets CD4 on T-cells
- Envelopes protein gp120 and 41 and specifically envelopes CD4 receptor
- Chemokine co-receptors aid entry into cell - CCR5 & CXCR4
35
Q
HIV Diagnostic Markers
A
HIV Antibodies
- Establish infection
- 1st response by IgM then IgG persists
- Detected withing 3-4 weeks after acquisition
p24 Antigen
- Elevated and detectable antibody response
- Determines early infection
- Reappears at times of profound immunosuppression
36
Q
HIV Progression Markers
A
HIV RNA
- Viral Load
- Number of HIV RNA copies in blood cells (viral burden)
- Critical in determining response to Anti-retroviral therapy (ART)
- Goat of ART: <50 copes/mL by week 16
CD4 T-Cells (CD4 count)
- Major indicator of immune function
- Normal range > 500 cells/mm^3
- Important in determining start and response to ART
- Key factor in determining prophylaxis for opportunistic infections (OI)
37
Q
HIV Clinical Manifestations
A
- Acute stage - flu-like illness (1-6 weeks)
- Prolonged asymptomatic clinical state
- Decline in CD4 counts and increase in AIDS-defining illness
- No cure, death is end result
- Appropriate treatment will make HIV treatments more like to die of CV complications, liver problems, or cancer than the HIV itself
38
Q
AIDS-Defining Illnesses and CD4 Values
A
- Toxoplasmosis: <100 cells/mcL (CNS disorder)
- MAC, CMV: <50 cells/mcL (disseminated disorder)
- Other: Kaposi’s sarcoma, thrush, cryptococcal, meningitis, histoplasmosis
39
Q
When to start ART
A
-Recommended for all with HIV
Factors that Influence Start:
- CD4 count (<350 cells/mm^3)
- Viral load (>100,000 copes/mL)
- Pregnancy
- HIV-related illness
- Co-infection
- AIDS
- Person’s readiness
40
Q
HIV Transfer to Fetus
A
- Mother-to-child: occurs in pregnancy, vaginal delivery, and breast feeding
- 25% chance of transmission if NOT treated
- <1% chance of transmission is treated during pregnancy and delivery. Also safer to have C-section
- Babies born from HIV+ mothers will also have antiretroviral treatments for the first 6 weeks of life
