Sexual Trans Inf - Viral (HSV & HPV) Flashcards
HSV - Initial Genital Infection and Primary Infection
- 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.
HSV - recrurent lesions
- 3-5 discreet lesions
- Vulvar irritation
- Prodrome
- Tingling
- Pain
- Heal within 7-10 days
Neonatal Herpes Infection
-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
Encephalitis+/-Skin lesions
-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
Diesseminated infection HSV
-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%.
Prevention/treatment - Neonatal HSV
-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.
HSV - virology
- Herpesvirus family
- Enveloped
- dsDNA genome
- Encodes many of its own enzymes for genome replication.
- One of which (HSV polymerase) is a target for antivirals.
IMportant note abut herpes viruses?
all have latent and lytic
HSV - infection process:
- 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
HSV - transmission
Direct contact with lesions
Saliva
Sexual transmission of genital herpes
HSV - diagnosis
- 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
HSV - treatment
- 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
How do HSV antivirals work?
- 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
If HSV patient is not responding to normal HSV antivirals? Give…and mechanism
foscarnt -> directly binds to viral DNA pol
- more toxic and less selective so not used more
- only IV treatment
- CANT CURE PATIENT
Genital Warts (condyloma acuminatum)
- 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)
Respiratory Papillomatosis/Laryngeal Papillomas - what is it/ symptoms/treatment
- 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.
Human Papillomavirus: Virology
- 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
HPV - how it infects:
- 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
mucosal HSV
- 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
Laryngeal papillomas HPV serotypes
HPV 6 and HPV 11 LOW RISK
anogenital wart HPV serotypes
HPV 16** , 18,31, 33 HIGH RISK
cutaneous warts HPV
- common warts
- plantars warts
common warts HPV serotypes?
HPV 2, 3, 10
plantars warts HPV serotype
HPV 1, 4
