STD Part II Flashcards by Jasmine Watts

How are HPV types divided up?

Into two groups based on their association with cancer
*Low-risk (non-oncogenic)
*associated with genital warts and mild Pap test abnormalities
*High-risk (onogenic)
*associated with moderate to severe Pap test abnormalities, cervical dysplasia and cervical cancer, and other cancers

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How are most genital HPV infections?

Asymptomatic with no clinical consequences

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What is estimated about HPV?

It is estimated that most sexually active men and women acquire genital HPV infection at some point in their lives

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What is the transmission of genital HPV?

Sexual activity
Can be transmitted from mother to newborn during delivery (rare)

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What are the risk factors for women acquiring HPV?

Young age
Sexual behavior
*risk increases with increasing number of sexual partners
Immune status
*HPV more likely to be detected in immune-suppressed women

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What are the risk factors of men acquiring HPV?

Risk increase with multiple sex partners
Being uncircumcised

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What are the low-risk types of HPV?

Most are genital warts (6,11)
Recurrent respiratory papillomatosis associated with 6,11

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What are the high-risk HPV types?

18,16 are 70% of cervical cancers
Most women with high-risk HPV infection have normal Pap test results and never develop cellular changes or cervical cancer

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What are some clinical manifestation of genital HPV?

Anogenital warts (MC)
Cervical cellular abnormalities detected by Pap test (16,18)
Some oropharyngeal cancers (MC)
Recurrent respiratory papillomatosis (babies)

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What are some variations of appearances of genital warts?

Condylomata acuminata
-cauliflower-like appearance
-skin colored
Smooth papule
-dome-shaped and skin-colored
Flat papules
-More commonly found on internal structures
Keratotic warts
-Thick horny layer can resemble common warts or seborrheic keratosis

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Where do genital warts mainly occur near?

Areas of coital friction (external genitalia)
HPV types causing genial warts can occasionally cause lesions on oral, upper respiratory, upper GI, and ocular locations

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What are the symptoms of genital warts?

Usually cause no symptoms but some can be
*Pruritis
*burning discomfort
*bleeding
*obstruction of the birth canal

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What are some differential diagnosis of genital warts?

Condylomata lata (syphilis)
*smoother, moist, more round (T.Pallidum)
Molluscum contagiosum (virus pox)
*papules with central dimple
Seborrheic keratosis
Lichen planus (atrophy)
Melanocytic Nevus

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Wha are some normal anatomical variants of genital warts?

Pink pearly penile papules
vestibular papillae
Skin tags

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How is genital warts diagnosed?

Made by visual inspection
Consider a biopsy when
*patient is immunocompromised
*Warts are fixed, indurated, pigmented

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How to diagnose cervical cellular abnormalities?

Cytology (pap test, screening)
***NOT a diagnosis test
*can detect cervical cell changes
*detects squamous epithelial cell changes

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What do atypical squamous cell of undetermined significance show?

ASC-US
*changes often caused by HPV infection
*changes are usually mild

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What do Atypical squamous cells of High grade show?

ASC-H
*changes are more likely t be associated with precancerous abnormalities than ASC-US

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What are Low-grade squamous intraepithelial lesion?

LSIL
*caused by HPV infection/mild dysplasia

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What are high-grade squamous intraepithelial lesions?

HSIL
*changes due to persistent infection with high-risk HPV type *higher risk for progression to cervical cancer

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What is the HPV DNA test used for?

For women with ASC-US Pap test results 21 and older
-used as an adjunct to Pap test screening for cervical cancer in women 30 years or older

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When should HPV DNA test NOT be used?

Screening for cervical cancer as a stand-alone test
Women <25 years of age as part of routine screening

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When is a colposcopy used?

Used when there is an abnormal PE or Pap test findings

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When is a cervical biopsy used?

When there are visible exophytic lesion on cervix
Pap test with HSIL, ASC-H or other findings

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What is the primary goal for the treatment of genital warts/

To remove the warts *Consider screening persons with newly diagnosed genital warts for other STIs

What are the recommendations for external genital wart treatment? (Patient applied)

Podofilox 0.5% solution or gel *2x day for 3 days *followed y 4 days of no therapy Imiquimod 5% cream (Aldara) *one a day at night, 3x a week for 16 weeks *wash with soap after 6-10 hours after application Sinecatechins 15%ointment *3x a day for 16 weeks *do not wash off

What a the recommendation for external genital warts? (Provider-administered)?

Cryotherapy with liquid nitrogen or cryoprobe *1-2 weeks Trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80-90% Surgical removal

How to manage genital warts during pregnancy?

Podophyllin, podofilox, and imiquimod (DO NOT USE) TCA BCA, and surgical removal can be used

What can cause recurrent respiratory papillomatosis in children?

HPV types 6, 11

What are the screening recommendations for HPV?

Women 21-29 screen every 3 years Women 30-65 screen with pap (3) or hrHPV (5) or both

What are the three HPV vaccines?

Cervarix Gardasil Gardasil-9 *only one available in the US

What are the recommendation of the HPV vaccine?

<15 2 dose >15 3 dose (also immunocompromised) *No recommendation to repeat vaccination of Gardasil-9 if already completed the other vaccines schedule

Is there a cure to herpes?

No genital herpes is a chronic, lifelong viral infection

What are the two serotypes?

HSV-1 (oral) and HSV-2 (genital) *herpetoviridae

What is the transmission of HSV-2?

Sexually Perinatal *Efficiency of transmission is greater from men to women

What is the incubation period after acquiring HSV?

2-12 days *drying and soap and water readily inactive HSV

What does primary infection mean for herpes?

-first infection ever with either HSV-1 or HSV-2 -no antibody present -disease is more severe

What does non-primary infection mean for HSV?

-Already positive for HSV-1/2 -symptoms are milder -antibody may take weeks to a few months to appear

What does recurrent symptomatic infection mean for HSV?

-there were multiple outbreaks -antibody present when symptoms appear

What does asymptomatic infection mean for HSV?

Serum antibody is present No known history of clinical outbreaks

Describe the first episode of a primary infection of HSV without treatment

-multiple lesion that are more severe, last longer, and have higher titers -illness last around 3 weeks -painful genital lesions

what is the typical lesion progression for HSV primary infection

Papules-vesicles-pustules-ulcers-crusts-healed

Describe the symptoms of HSV for a recurrent infection without treatment

Prodromal symptoms are common *tingling *12-24 hours before lesion *lasts 3-5 days *HSV-2 primary infection more prone to recur than HSV-1

When is HSV-2 usually transmitted?

During asymptomatic shedding Rates of asymptomatic shedding *HSV2>HSV1

What are the MC sites of asymptomatic shedding?

Women: vulva and perianal men: penile skin and perianal

Is someone still infectious with HSV if they are are antiviral suppressive therapy?

Yes *will reduce the rate of transmission but still infectious

What are the virological tests to diagnosis HSV

Viral culture *sensitivity depends on the stage of lesion *positive more in primary infection Polymerase chain reaction (PCR) *more sensitive than viral culture Preferred test for detecting HSV in spinal fluid

What can serological tests specifically find for HSV?

-Presence of HSV-2 antibody indicates anogenital infection -Presence of HSV-1 does not distinguish anogenital from orolabial infection

If someone has an ulcer what should they be evaluated for?

Evaluated with a serologic test for syphilis and a diagnostic eval for genital herpes *If a chancroid is present test for Haemophilus ducreyi

What are the different type of antiviral medications for HSV?

Acyclovir (zovirax) valacyclovir (valtrex) Famciclovir (Famvir)

Is topical antiviral treatment recommend for HSV?

What is the recommendation of treatment for HSV? (First clinical episode)

Acyclovir 400mg orally 3x day for 7-10days Famciclovir 250mg orally 3x day fro 7-10days Valacyclovir 1g orally 2x day for 7-10 days *In order of least expensive to most expensive

What a the different types of treatments for recurrent genital herpes?

Episodic treatment *treatment needs to start within 1 day of lesion onset *self-initiate treatment immediately when symptoms begin Suppressive therapy *will reduces frequency of recurrences

What are the medications for episodic treatment of herpes/

Same as first clinical episode

What are the medications for suppressive therapy of recurrent genital herpes?

-Acyclovir 400 mg orally twice a day, or -Famciclovir 250 mg orally twice a day, or -Valacyclovir 500-1000 mg orally once a day

When is the risk of transmission the highest of HSV in pregnancy?

When women acquire genital herpes near the time of delivery *3rd trimester

Can women without symptoms or signs of genital herpes deliver vaginally?

Yes

When should oral or IV acyclovir be given to pregnant women?

Oral: first episode or severe recurrent herpes IV: for severe infection

When should suppressive acyclovir or valacyclovir be started in pregnant women?

@36 weeks until delivery

What is the agent of HIV/AIDS?

RNA retrovirus *targets the helper T cells and monocytes

How does the CDC define AIDS?

CD4 count <200 cells/mm3 or development of an AIDS defining disease

How many people are living with HIV/AIDS?

1.2 mil

What is the transmission of HIV?

1. Sexual contact *blood, semen, rectal fluids, breast milk *contact with mucous membranes 2. Use of contaminated needles or blood products 3. Perinatal transmission from mother to child

What is the most high-risk sexual behavior for acquiring HIV?

Anal sex *receptive

What are the clinical presentations of HIV/AIDS

Acute *mono-like illness *weeks to months Chronic *months to years AIDS *dementia *kaposi sarcoma

What are some diagnostic test of HIV?

HIV antigen/antibody immunoassay HIV antibody differentiation immunoassay (Confirmatory test) HIV rapid antibody test (MC) HIV-viral loss Absolute CD4 lymphocyte count CD4 lymphocyte percentage *determining the severity

What are the brand names from PrEP?

Truvada *used in combination with other medicines to treat HIV Descoy *Approved for men

When PrEP is taken consistently what are the % of risk reduction?

99% sexually 74% drug users

When is PEP used?

For a recent high-risk event *within 72 hours

what are the management therapy for HIV?

Antiretroviral therapy (ART)

What is the screening for HIV?

Screen 15-65 Screen Younger than 15 and older than 65 if at increased risk Screen pregnant women *3rd trimester