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Y4 Lecture Day I > Molluscum and Herpes > Flashcards

Molluscum and Herpes Flashcards

1
Q

What’s molluscum contagiosum?

A
  • common skin infection caused by molluscum contagiosum (Pox family)
  • epidermal eruption of the skin is caused
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2
Q

How is Molluscum Contagiosum Virus (MCV) transmitted?

A
  • direct: by close personal contact (including sexual transmission), swimming pools etc
  • indirect: via contaminated surfaces (e.g. towels)
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3
Q

What is the most common group of patients with Molluscum Contagiosum?

A
  • majority of cases occur in children (often in children with atopic eczema)
  • the maximum incidence in preschool children aged 1-4 years
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4
Q

What’s the location of molluscum contagiosum lesions in children?

A
  • trunks
  • flexures
  • occasionally anogenital lesions
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5
Q

What’s the location of molluscum contagiosum in adults?

A

As often spread by sexual contact:

  • genitalia
  • pubis
  • thighs
  • lower abdomen

*rarely on oral mucosa or on the eyelids

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6
Q

What is self-care advice in molluscum contagiosum infection?

A

Reassure people that molluscum contagiosum is a self-limiting condition.

  • spontaneous resolution usually occurs within 18 months
  • the lesions are contagious → it’s sensible to avoid sharing towels, clothing, and baths with uninfected people (e.g. siblings)
  • encourage people not to scratch the lesions
  • exclusion from school, gym, or swimming is not necessary
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7
Q

How to diagnose molluscum contagiosum ?

A

By clinical appearance

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8
Q

Treatment of molluscum contagiosum

*Treatment is not usually recommended

A
  • Treatment may be required if:
  • → Itching is problematic -> prescribe an emollient and a mild topical corticosteroid (e.g. hydrocortisone 1%)
  • → The skin looks infected (e.g. oedema, crusting); prescribe a topical antibiotic (e.g. fusidic acid 2%)
  • cryotherapy

Other treatments that may be used: podophyllotoxin, imiquimod

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9
Q

In what cases do we need to refer people with molluscum contagiosum infection?

A
  • people who are HIV-positive + extensive lesions → urgent referral to HIV specialist
  • if eye-lid margin or ocular lesion or red-eye → urgent referral to an ophthalmologist
  • adult with anogenital lesion → GUM referral (to screen for other STIs)
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10
Q

What’s that?

A

Molluscum Contagiosum

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11
Q

What’s that?

A

Genital Herpes

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12
Q

What organism caused Genital Herpes?

A

Herpes Simplex Virus (HSV)

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13
Q

What types of HSV cause genital herpes? (2)

A
  • HSV-1 → genital herpes, mouth, nose (cold sores)
  • HSV-2 → genital and anal areas
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14
Q

How is Herpes Simplex Virus transmitted?

A
  • via small cracks in the skin
  • through mucous membranes (mouth, vagina, rectum, urethra, under the foreskin)
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15
Q

What happens after HSV enters the skin?

A

Skin infection → virus travels to the ganglion of the nearest nerve and remains there

(therefore virus can be dormant in the nerve -> then travels back to the skin surface when reactivated)

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16
Q

Risk factors for Herpes infection

A
  • sexual transmission (een when condom is used if the virus is present on the areas that are not covered up e.g. thighs)
  • multiple sexual partners
  • oral sex with a partner suffering from cold sores
17
Q

When do the symptoms of Herpes appear?

A
  • symptoms may not appear for months or even years after infection
  • some people will develop symptoms straight away
18
Q

What is the presentation of the primary HSV genital infection?

A

Primary = when HSV infection develops for the first time

  • small red, painful blisters around the genitals
  • open sores may be formed
  • vaginal or penile discharge
  • flu-like symptoms (fever, maliase, muslce ache)
  • itchy genitals

In aroudn 20 days the lesions will crust and heal

19
Q

Features of secondary HSV infection

A

Secondary = recurrent (when dormant virus reactivates)

  • burning and itching around genitals
  • painful red blisters around the genitals

*secondary infections tend to be less severe and shorter as immune system develops antibodies that will enable for more effective immune reesponse

20
Q

Investigations for genital herpes

A
  • history -> sexual history, other STIs, Hx of cold sores
  • swab from the open sore -> PCR testing
21
Q

Management of primary Herpes infection

A
  • Aciclovir -> anti-viral medication

(to reduce size and number of the lesions)

  • a full sexual screen and advice on transmission -> once a primary infection has cleared up
  • rest, time off work if unwell
22
Q

What advice about sexual transmission to give to people with Herpes infection?

A
  • advice about preventing transmission of the infection to sexual partners – avoid all sexual contact during an outbreak, as the open sores are the most infective form of HSV
  • disclose the infection to their recent and current sexual partners
23
Q

Management of recurrent (secondary) Herpes infection

A

To reduce pain and discomfort:

  • OTC painkillers
  • petrolleum jelly
  • ice packs
24
Q

What if a woman infected with genital herpes becomes pregnant?

A
  • baby should be protected from acquiring the infection due to the antibodies she will pass to the foetus through the placenta
  • may be required to still take Aciclovir
  • Vaginal delivery is offered to women with recurrent lesions at time of delivery although they may want to have a caesarean section

(The risk of transmission is estimated at 0-3% transmission with vaginal birth)

25
Q

When is a regular treatment with aciclovir recommended in case of Herpes?

A
  • very frequent outbreaks (more than 6 times in a year) or are particularly severe → daily doses of aciclovir to prevent new outbreaks
26
Q

What if a mother contracts Herpes in the third trimester of pregnancy?

A
  • it’s dangerous to a baby → because no time to develop antibodies that will pass to the developing foetus
  • CS is recommended as there is 2/5 chance of a baby contracting the infection during vaginal delivery
27
Q

What are 3 forms of neonatal herpes?

A
  • skin, eyes and mouth (SEM) herpes,
  • disseminated (DIS) herpes affecting the internal organs
  • CNS herpes affecting the nervous system and the brain and can lead to encephalitis

*Aciclovir is sufficient for SEM

* higher rates of mortality for CNS and DIS

Y4 Lecture Day I (13 decks)

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