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Micro test 6 > Sexual Trans Inf - Viral (HSV & HPV) > Flashcards

Sexual Trans Inf - Viral (HSV & HPV) Flashcards

1
Q

HSV - Initial Genital Infection and Primary Infection

A
  • Lesion progression from macules, papules, vesicles, pustules, to ulcers.
  • Often fever, inguinal adenopathy, malaise
  • Lesion duration is ~3 weeks.
  • Symptoms more severe in women.
  • Common Lesion sites: vulva, cervix, peritoneum, penis, thighs, buttocks.
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2
Q

HSV - recrurent lesions

A
  • 3-5 discreet lesions
  • Vulvar irritation
  • Prodrome
  • Tingling
  • Pain
  • Heal within 7-10 days
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3
Q

Neonatal Herpes Infection

A

-1/2000 to 1/5000 cases per year in the United States.
-Highest risk is infants born to mothers experiencing primary infection.-Rarely asymptomatic-Often Lethal
-Disease localized to Skin, Eyes, and Mouth
Not Lethal
-Present at 10-11 days following birth
Recurrences in first 6 months
~30% untreated have more serious consequences: Blindness; Microcephaly; Spastic Quadriplegia

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4
Q

Encephalitis+/-Skin lesions

A

-Neonatal herpres inf –> basically a herpes infection that goes to the brain - 2nd worst
-1/3 of neonate infections
-Symptoms: Seizures; Lethargy; Irritability; Tremors; Poor Feeding; Temp. Instability; Bulging fontanel
~50% mortality rate in untreated infants
Survivors often neurological impairment

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5
Q

Diesseminated infection HSV

A

-Neonatal HSV
-Lesions in visceral organs and skin: Liver, CNS, Lungs, Eyes, Adrenals…
-Symptoms: Irritability, seizures, respiratory distress, jaundice, bleeding diathesis, shock
~80% mortality rate in untreated infants
-Complications: HSV pneumonitis; Disseminated Intravascular Coagulation
-Proper antiviral treatment reduces mortality rate to ~23%.

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6
Q

Prevention/treatment - Neonatal HSV

A

-Prevention: Physical Examination for Lesions; Caesarian Sections; Health care provider precautions in neonatal wards.(Herpetic whitlow
Orolabial lesions)
-Treatment : IV administration of antivirals for all neonate herpes cases.

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7
Q

HSV - virology

A
  • Herpesvirus family
  • Enveloped
  • dsDNA genome
  • Encodes many of its own enzymes for genome replication.
  • One of which (HSV polymerase) is a target for antivirals.
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8
Q

IMportant note abut herpes viruses?

A

all have latent and lytic

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9
Q

HSV - infection process:

A
  • HSV comes in contact with the epithelium (genital/oral)
  • gets into sensory neurons
  • immune system can clear from epithelial cells but NOT THE NEURONS (LATENT IN THE NEURONS - Trigeminal for oral or sacral for genital)
  • trigger moment = virus moves back into the epithelial tissue
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10
Q

HSV - transmission

A

Direct contact with lesions
Saliva
Sexual transmission of genital herpes

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11
Q

HSV - diagnosis

A
  • Clinical appearance of lesions: 1-2 mm diameter in groups, vesicles pustules ulcers
  • Virological Tests (can distinguish HSV-1 from HSV-2): PCR to detect genome; Immunocytochemistry to detect antigens
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12
Q

HSV - treatment

A
  • Oral: Usually not treated with antivirals.
  • Genital Herpes: Primary – oral antiviral treatment; Recurrent – long term oral antiviral treatment;
  • Neonatal Herpes: IV antiviral treatment
  • Ocular: topical antiviral treatment
  • Anti-herpetic drugs DO NOT act on the latent stage of infection. - CANNOT CURE
  • Treatment goals : shorten time to lesion healing; increase time between outbreaks
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13
Q

How do HSV antivirals work?

A
  • Acydovir/Famciclovir (oral)/valacyclovir - the drug gets into HSV and a phosphorylase (viral thymidine kinsae) adds phosphate to it (monophosphate form)
  • phosphorylated to triphosphate form
  • acts like a mucleotide analog = BLOCKS VIRAL DNA POL - (gets in the strand and cant add anything to it)
  • FEW SIDE EFFECTS
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14
Q

If HSV patient is not responding to normal HSV antivirals? Give…and mechanism

A

foscarnt -> directly binds to viral DNA pol

  • more toxic and less selective so not used more
  • only IV treatment
  • CANT CURE PATIENT
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15
Q

Genital Warts (condyloma acuminatum)

A
  • Hyperkeratotic, firm, exophilic papules
  • 1 mm – 2 cm diameter
  • Symptoms: Itching, pain, burning
  • 75% asymptomatic
  • Cervical warts: Exophilic, Endophilic, Flat; 3-5% Acetic Acid (put on wart and makes look white)
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16
Q

Respiratory Papillomatosis/Laryngeal Papillomas - what is it/ symptoms/treatment

A
  • Nodules on the ciliated and squamous epithelial junction of the larynx.
  • Symptoms: Altered Cry; Hoarseness; Stridor; Respiratory Distress
  • Treatment – surgical removal
  • Caesarian Section not a proven to reduce prevention.
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17
Q

Human Papillomavirus: Virology

A
  • Papovaviridae family
  • Nonenveloped
  • dsDNA genome
  • Replication is closely tied to the differentiation status of the tissue it infects.
  • many serotypes - some that infect mucsa and some that are cutanous
18
Q

HPV - how it infects:

A
  • gets into basal cells and sets up primary infection
  • as basal cell differentiates the virus is brought up to the surace
  • CELL DIFFERENTIATION IS VITAL
19
Q

mucosal HSV

A
  • laryngeal papillomas or anogenital warts
  • anogen is high risk (warts and cancer) or low risk (mostly just warts)
  • laryngeal=HPV 6 and 11 - low risk
20
Q

Laryngeal papillomas HPV serotypes

A

HPV 6 and HPV 11 LOW RISK

21
Q

anogenital wart HPV serotypes

A

HPV 16** , 18,31, 33 HIGH RISK

22
Q

cutaneous warts HPV

A
  • common warts

- plantars warts

23
Q

common warts HPV serotypes?

A

HPV 2, 3, 10

24
Q

plantars warts HPV serotype

A

HPV 1, 4

25
Q

which HPV serotype is most common with cervical cancer?

A

HPV 16

26
Q

HPV and cancer

A

instead of the virus replicating/developing with basal cell development the HPV genome is integrated into the cell. INC E6 and E7 expression (viral oncogenes

27
Q

Why are E6 and E7 elevated with ____ related cancer?

A
  • HPV related cancer
  • the E2 transcriptional repressor for the E6 and E7 gene promoter. –> in this cancer the E2 is missing so so much E^ and E7 transcription
28
Q

What does E7 do? Which disease?

A
  • HPV cancer
  • E7 normally inhibits Rb
  • Rb prevents cell cycle from moving from G1 into S
29
Q

What does E6 do? Which disease?

A
  • HPV cancer
  • E6 leads to the degredation of p53
  • p53 prevents cell cycle from moving from G1 into S
30
Q

Does HPV cause cancer?

A

it definitely helps the inf cells get a step CLOSER to being cancerous but no direct link

31
Q

Cervical intraepithelial neoplasm 1/LOW GRADE LEISION

A
  • HPV and virus infection = basically get warts

- very mild dysplasia

32
Q

Cervical intraepithelial neoplasm 2/HIGH GRADE LESION

A

severe dysplasia (more weird cells)

33
Q

Cervical intraepithelial neoplasm 3/HIGH GRADE LESION

A

in situ carcinoma- so many weird cells - all cells are dysplasic

34
Q

When does HPV turn into an invasive cervical carcinoma?

A

when the high grade lesion/in situ carcinoma pierces through the basement membrane

35
Q

HPV transmission

A
  • Genital warts are sexually transmitted.
  • Cuts and abrasions (sometimes inapparent) provide a route of entry for the virus.
  • Incubation period is approximately 3-4 months.
36
Q

HPV diagnosis

A
  • Clinical appearance usually sufficient for diagnosis.
  • Hyperkeratosis and koilocytes are histological markers.
  • HPV types can be identified using PCR.
37
Q

What does an abnormal pap smear look like?

A

Koilocytes are enlarged keratinocytes that contain irregular hyperchromatic nuclei surrounded by a characteristic halo.

38
Q

HPV treatments:

A

1) Genital Warts:
- Cryotherapy
- CO2 Laser
2) Pre-Malignant and Malignant Cervical Neoplasms
- Low Grade Lesions: Cauterization; Cryotherapy; CO2 laser therapy; Loop excision
- High Grade Lesions/Cancer treatment may include: Hysterectomy; Radiation; Chemotherapy

39
Q

HPV prevention

A
  • Papanicolaou stained cervical smears
  • Reduce high risk behavior
  • HPV vaccines: Made in yeast; Prepared from viral capsid proteins (L1); Three doses;
  • Gardasil (Quadrivalent)-Protects against HPV 6, 11, 16, and 18
  • Cervarix (Bivalent)-Protects against HPV 16 and 18
40
Q

Cervarix (Bivalent)-Protects against

A

HPV 16 and 18

41
Q

Gardasil (Quadrivalent)-Protects against

A

HPV 6, 11, 16, and 18

42
Q

recommended age for HPV vaccination?

A

both sexes = 11-12 yrs

Micro test 6 (4 decks)

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