Oral Manifestations of STIs

Question 1

What occurs during stage 3 HIV?

Answer 1

Immune system loses the struggle to contain HIV, for 3 reasons:
- Lymph nodes and tissues become damaged
- HIV mutates and becomes more pathogenic, stronger and more varied, leading to more T helper cell destruction
- Body fails to keep up with replacing T helper cells that are lost

Symptomatic stage

Question 2

What is congential syphillis, and what complications may arise from this?

Answer 2

In uterus transmission of Treponema Pallidum to baby after 3 months of pregnancy.

Hutchinson’s teeth (teeth abnormalities) occuring few years after birth.

Question 3

How long after infection does tertiary syphillis occur and what percentage of syphillis patients experience this?

Answer 3

3-30 years later

Around 30%

Question 4

What occurs during stage 2 HIV?

Answer 4

• Lasts for ten years and is free from major symptoms although there may be swollen glands
• HIV in peripheral blood drop but still infectious and detectable
• Lots of T helper cells are infected and die; lots of virus is produced

Clinically asymptomatic stage

Question 5

What occurs during stage 4 HIV?

Answer 5

Immune system becomes more and more damaged, illnesses that present become more severe leading eventually to an AIDS diagnosis

Acquired immune deficiency syndrome

Question 6

What type of infection causes genital herpes?

Answer 6

Viral (HSV2)

Question 7

Describe what you may expect to see in a patient with primary syphilis

Answer 7

• Chancre lesions (very infectious painless ulcer on genitals or around mouth that last for 2-6 weeks then heal)
• Potentially swollen lymph nodes

Question 8

What occurs during stage 1 HIV?

Primary HIV infection

Answer 8

• Short flu like symptoms
• Large amount of HIV in peripheral blood
• Immune system begins to respond by producing HIV antibodies and cytotoxic lymphocytes (seroconversion)

Question 9

Why does HIV found in the saliva not transmit the virus to other people?

Answer 9

Saliva doesn’t transmit HIV due to its antibodies

Question 10

What is the difference between HIV1 and HIV2?

Answer 10

• Still both cause HIV
• HIV1 more common
• HIV2 seen in west Africa which is weaker, less infective and lower death rate

Question 11

What type of infection causes Genital Warts?

Answer 11

Viral (Human Papiloma Virus)

Question 12

What is the treatment of syphillis?

Answer 12

As bacterial use of ABX such as penicillin.

Alternatives such as tetracyclines and erythromycin

Question 13

What type of infection causes Hep B?

Answer 13

Viral

Question 14

What may occur to a patient with a CD4 count of less than 500?

Answer 14

Opportunitic infections arise

Question 15

What type of infection causes Syphilis?

Answer 15

Bacterial

Question 16

What may result of tertiary syphillis?

Answer 16

Life-threatening damage to brain, nerves, eyes, heart, bones, skin

Or life-threatening damage to blood vessels causing stroke, heart disease, dementia, paralysis, blindness or deafness

Question 17

Describe what you may expect to see in a patient with secondary syphilis

Answer 17

• Non-itchy rash which is highly infectious on trunk and extremities
• Sore throat lasting several weeks
• General flu like symptoms

Question 18

What may occur to a patient with a CD4 count of less than 200?

Answer 18

CD4 < 200 + clinical signs = AIDS
[200 is the critical value for CD4]

Question 19

What type of infection causes Gonorrhoea?

Answer 19

Bacterial

Question 20

What are the different periodontal conditions that can arise from HIV?

Answer 20

Linear gingival erythema
Acute necrotising ulcerative gingivitis (ANUG)
Necrotising ulcerative periodontitis (NUP)

Question 21

What are some oral lesions strongly associated with HIV? (5)

Answer 21

• Candiasis
• Oral hairy leukoplakia
• Kaposi sarcoma
• Periodontal disease
• Non-Hodgkins Lymphoma

Question 22

How can the microorganism that causes syphillis enter the body?

Answer 22

Treponema Pallidum penetrates through intact mucosa or abraded skin

• Sexual contact
• Through lesions
• IV drug use

Question 23

What are the most infective stages of syphillis?

Answer 23

Primary and secondary stage

Question 24

What are some signs of Kaposi sarcoma as a result of HIV?

Answer 24

Long-standing singular/multiple neoplasm
That is red/purple
That is flat or nodular
On palate or gingivae.

Affects blood vessels so present in the whole body but only visible in the mouth.

Aetiology HHV8

Question 25

What is a normal CD4 range?

Answer 25

400-800

Question 26

If a patient has stable HIV (low viral load and high CD4) what treatment will they be on?

Answer 26

HAART (Highly Active Anti-retroviral Therapy)

Question 27

What microorganism causes syphilis?

How can this microorganism be seen in a lab?

Answer 27

Treponema Pallidum (causative bacteria)

Visible through UV light using anti-treponema antibodies

Question 28

How does HIV infect T helper cells?

Answer 28

• HIV attaches itself to the CD4 cell-surface receptor molecules on its surface to enter
• Once inside, HIV replicates and the replicas go to infect other cells, which stop working or are destroyed
• The immune system kills HIV and HIV-infected cells

Question 29

What type of infection causes Chlamydia?

Answer 29

Bacterial

Question 30

What bodily fluids transmit HIV?

Answer 30

• Blood
• Semen
• Vaginal secretions
• Breast milk

Question 31

How do you manage a patient with syphilis who has come to your dental practice?

Answer 31

Refer to sexual health clinic
Observe confidentiality
Partners will need to informed/tested