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STD part 2 Viral Infection Flashcards

1
Q

Transjitted thru direct contact, trauma, skin to skin contact

A

HUMAN PAPILLOMA VIRUS (HPV)

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2
Q

Strongest risk factor for HPV-associated cancer:

A

persistent oncogenic HPV infection

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3
Q

Rapid growth noted during pregnancy. Painful, pruritic, friable, foul odor (secondary infection) Acetowhite epithelium

A

CONDYLOMA ACUMINATA

Genital warts

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4
Q
  • HPV6 &11
  • Affects infants and children of mothers with warts
  • Can lead to respiratory distress due to obstruction
  • Transmission: vertical, transplacental, direct contact
A

RESPIRATORY/ LARYNGEAL PAPILLOMATOSIS

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5
Q

Marker of HPV infection

A

KOILOCYTES (basal cell hyperplasia, papillomatosis, parakeratosis)

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6
Q

PRIMARY goal for MGT for HUMAN PAPILLOMA VIRUS (HPV)

A

elimination of disease and prevention of cervical, vulvar, and vaginal cancer

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7
Q

Management or treatment for External genital warts:

A
  • Self: Podofilox 0.5% solution, Imiquimod 5% cream, Sinecathecins 15% ointment
  • Provider: cryotherapy, TCA, surgical removal: electrosurgery
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8
Q

Management or treatment for Cervical warts

A

HSIL (high grade squamous intraepithelial lesion) must be excluded before start of Tx

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9
Q

Management or treatment for Vaginal warts

A

surgery/TCA(Trichloroacetic acid) (weekly if necessary)

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10
Q

Management or treatment for Urethral meatus

A

cryotherapy, podophyllin10-20%

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11
Q

Management or treatment for Anal warts

A

cryotherapy, TCA, surgery

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12
Q

Management of sexual partner in HPV

A

Counseling and examination to assess presence of warts and other STIs.

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13
Q

DIAGNOSIS of HPV for confirmatio n

A

Biopsy–confirmation of diagnosis indication:
• Dx uncertain
• No response to tx
• Worsening of disease during tx
• Immunocompromised pt
• Pigmented, indurated, fixed, bleeding, ulcerated warts

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14
Q

Management for pregnancy having HPV

A

CS delivery–transmission not prevented, indicated only if outlet is obstructed or if vaginal delivery would result in excessive bleeding.

Contraindicated: Imiquimod, podophyllin, podofilox and sine catechins

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15
Q

Prevention of HPV

A
  • Abstinence
  • Monogamous relationship
  • Limit number of sexual partners
  • Limit contact with men who have been abstinent
  • Circumcised partner
  • Condom use–not fully protect
  • HPV vaccine (Nanovalent)– do not affect course of existing HPV infection
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16
Q

Caused by POX virus which is transmitted thru skin to skin contact with sexual intercourse as mc mode of transmission

A

MOLLUSCUM CONTAGIOSUM

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17
Q

Pathognomonic lesion of MOLLUSCUM CONTAGIOSUM

A
  • shiny,
  • dome shaped,
  • white papules (3-5mm),
  • central umbilication containing caseous material
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18
Q

Diagnostic confirmation of MOLLUSCUM CONTAGIOSUM

A
  • Electron mx reveals the pox virus

* Henderson-Patterson bodies–25um ovoid and homogenous contents of the lesion in Wright’s, Giemsa or Gram’s stain.

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19
Q

Treatment for MOLLUSCUM CONTAGIOSUM

A

• Benign and self-limiting(6mos-3years)

- Excisional curettage+ electrodessication of base
- Cryotherapy, podophyllin, TCA, freezing nitrogen
  • Sexual partner: treated to prevent recurrence
  • Pregnancy: same for nonpregnant except podophyllin
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20
Q

Caused by Treponema pallidum which s transmitted thru sexual contact and could be thru transplacental (as early as 6 wks AOG- age of gestation)

A

SYPHILIS

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21
Q

Dx for SYPHILIS

A

darkfield microscopy revealing spirochetes

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22
Q

Stage of SYPHILIS where there is rash accompanied by hepatitis, meningitis, or glomerulonephritis

A

Secondary SYPHILIS

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23
Q

Stage of SYPHILIS where there is gumma of skin that may occurs in deep organs along with CNS degredation and ascending aortic aneurysm

A

Tertiary Syphilis

24
Q

Stage of SYPHILIS where Chancre can be seen at the site of inoculation (penis, labia, or vagina)

A

Primary SYPHILIS

25
Stage of SYPHILIS where there are no symptoms found
Latent SYPHILIS
26
Screening, indices of treatment response: becomes negative post treatment. To confirm the infection
NONTREPONEMAL TEST. VDRL and RPR
27
Confirm infection, remain positive even after tx, many false positive results
TREPONEMAL TEST (MHS-TP and FTA-ABS)
28
Treatment for Primary, Secondary and Early Latent
Benzathine PCNG 2.4M units IMSD
29
Treatment for Late Latent and Tertiary Syphilis
Benzathine PCN G 7.2M admin as 3 doses of 2.4M units IM 1week interval
30
Treatment for Neurosyphilis
Aqueous crystalline PCN G 18-24M units/day admin as 3-4M units IV q4 hor continuous infusion for 10-14 days
31
Treatment for syphilis if allergic to penicillin
• oral desensitization should be done. • During treatment people may develop fever, headache, and muscle pains –Jarisch- Herxheimer Reaction
32
Recurrent STI that is caused by HSV
GENITAL HERPES
33
Ssx: * flu-like: fatigue, malaise, myalgia, fever, nausea * vulvar burning and pruritus precede multiple vesicles -> painful, shallow ulcers
Primary infection of GENITAL HERPES
34
Diagnosis of GENITAL HERPES
* Tzanck smear: multinucleated giant cells | * PCR–test of choice (dx involving CNS)
35
Treatment for GENITAL HERPES in 1st episode
- Acyclovir 400mg TIDx7-10days - Acyclovir 200mg 5xadayx 7-10days - Valacyclovir 1gBID x7-10days
36
Treatment for GENITAL HERPES in recurrent episode
- Acyclovir 400mgTIDx5days | - Acyclovir 800mgBIDx5days
37
Treatment in pregnancy
* TX: same but daily suppression from 36weeks to delivery: Acyclovir 400mg TID * Neonatal HSV infection – deliver by CS for recurrent HSV infection but vaginal delivery is acceptable if no visible lesions noted at the onset of labor
38
Progressive ulcerative disease caused by Klebsiella granulomatis and a co-factor for HIV transmission
GRANULOMA INGUINALE (DONOVANOSIS)
39
MOT of GRANULOMA INGUINALE (DONOVANOSIS)
* sexual contact but not highly contagious | * vertical (time of delivery)
40
Pathogensis of GRANULOMA INGUINALE (DONOVANOSIS)
* Lesion: begins as a painless vesicle or indurated papule erosion ulcer with beefy granular base with rolled edges SQ extension to the inguinal region (pseudo bubo)  secondary bacterial infection pain and tenderness * More aggressive during pregnancy
41
Dx of GRANULOMA INGUINALE (DONOVANOSIS)
Donovan bodies in stained smears
42
Treatment for GRANULOMA INGUINALE (DONOVANOSIS)
• Azithromycin 1gPO once per week at least 3 weeks until all lesions are healed. +Gentamycin1gmg/kgIVq8hifnoimprovement • Sexual partner: treat if within 60days
43
Treatment of GRANULOMA INGUINALE (DONOVANOSIS) during Pregnancy
Erythromycin base 500mg PO QID for at least 3 weeks until all lesions are healed + Gentamycin
44
Soft chancre” that painful ulceration and inguinal adenopathy (bubo formation). Caused by Hemophilus ducreyi and highly infectious, associated with syphilis, HSV and HIV
CHANCROID
45
Lesions of Chancroid
painful vesicular papules -> ulcer with bright red areaol and shelving margins within 2-3 days. Base is covered with necrotic exudates. Painful enlargement of inguinal nodes (bubo) at 7-14days after the infection that may rupture and form fistulous tracts
46
Dx of chancroid
gram stain–school of fish (gram neg rods) + clinical
47
Treatment of Chancroid
* Azithromycin1gPOSD * Ceftriaxone250mgIMSD * Cirpofloxacin500mgBIDx3days * Erythromycinbase500mgTIDx7days * Sexual partner: treatment is given 10days preceding onset of symptoms * Pregnancy: Azithromycin and ceftriaxone
48
There is an enlargement, necrosis and abscess formation that coalesce and rupture fistula and sinus tract. Fibrosis cause obstruction of lymphatic vessels chronic edema and enlargement of affected area which overall damages the lymphatic system and caused by C. trachomatis.
LYMPHOGRANULOMA VENEREUM(LGV)
49
Clinical features of LGV
Groove sign. Painful inflammation and enlargement of inguinal LN above and below the inguinal ligament
50
Dx of LGV
C. trachomatis using culture, direct immunofluorescence and genotyping. Serology(titer>1:64)
51
Treatment for LGV
* Doxycycline100mgPOBIDx21days * Aspiration of fluctuant LN to prevent sinus tract formation * Sexual partner: test for chlamydial infection and treat for Azithromycin 1g PO SD or Doxycycline 100mg PO BID x7days
52
Treatment for LGV during pregnancy
Erythromycin base 500mg PO QID for 21days
53
Diseases in Vaginitis
Bacterial Vaginosis Vulvovaginal Candidiasis Trichomoniasis
54
Disease caused by Viral Infection
Condyloma acuminata | Molluscum contagiosum
55
Diseases caused by Genital Ulcer
``` Syphilis Genital herpes Granuloma inguinale Chancroid LGV ```
56
Disease caused by MUCUPURULENT CERVICITIS
Gonococcal infection | Chlamydial infection

Micro (17 decks)

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