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Community And Wellness > STD Part II > Flashcards

STD Part II Flashcards

1
Q

How are HPV types divided up?

A

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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2
Q

How are most genital HPV infections?

A

Asymptomatic with no clinical consequences

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3
Q

What is estimated about HPV?

A

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

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4
Q

What is the transmission of genital HPV?

A

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

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5
Q

What are the risk factors for women acquiring HPV?

A

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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6
Q

What are the risk factors of men acquiring HPV?

A

Risk increase with multiple sex partners
Being uncircumcised

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7
Q

What are the low-risk types of HPV?

A

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

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8
Q

What are the high-risk HPV types?

A

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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9
Q

What are some clinical manifestation of genital HPV?

A

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

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10
Q

What are some variations of appearances of genital warts?

A

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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11
Q

Where do genital warts mainly occur near?

A

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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12
Q

What are the symptoms of genital warts?

A

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

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13
Q

What are some differential diagnosis of genital warts?

A

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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14
Q

Wha are some normal anatomical variants of genital warts?

A

Pink pearly penile papules
vestibular papillae
Skin tags

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15
Q

How is genital warts diagnosed?

A

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

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16
Q

How to diagnose cervical cellular abnormalities?

A

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

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17
Q

What do atypical squamous cell of undetermined significance show?

A

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

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18
Q

What do Atypical squamous cells of High grade show?

A

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

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19
Q

What are Low-grade squamous intraepithelial lesion?

A

LSIL
*caused by HPV infection/mild dysplasia

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20
Q

What are high-grade squamous intraepithelial lesions?

A

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

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21
Q

What is the HPV DNA test used for?

A

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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22
Q

When should HPV DNA test NOT be used?

A

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

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23
Q

When is a colposcopy used?

A

Used when there is an abnormal PE or Pap test findings

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24
Q

When is a cervical biopsy used?

A

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

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25
Q

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

A

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

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26
Q

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

A

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

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27
Q

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

A

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

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28
Q

How to manage genital warts during pregnancy?

A

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

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29
Q

What can cause recurrent respiratory papillomatosis in children?

A

HPV types 6, 11

30
Q

What are the screening recommendations for HPV?

A

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

31
Q

What are the three HPV vaccines?

A

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

32
Q

What are the recommendation of the HPV vaccine?

A

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

33
Q

Is there a cure to herpes?

A

No genital herpes is a chronic, lifelong viral infection

34
Q

What are the two serotypes?

A

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

35
Q

What is the transmission of HSV-2?

A

Sexually
Perinatal

*Efficiency of transmission is greater from men to women

36
Q

What is the incubation period after acquiring HSV?

A

2-12 days

*drying and soap and water readily inactive HSV

37
Q

What does primary infection mean for herpes?

A

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

38
Q

What does non-primary infection mean for HSV?

A

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

39
Q

What does recurrent symptomatic infection mean for HSV?

A

-there were multiple outbreaks
-antibody present when symptoms appear

40
Q

What does asymptomatic infection mean for HSV?

A

Serum antibody is present
No known history of clinical outbreaks

41
Q

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

A

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

42
Q

what is the typical lesion progression for HSV primary infection

A

Papules-vesicles-pustules-ulcers-crusts-healed

43
Q

Describe the symptoms of HSV for a recurrent infection without treatment

A

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

44
Q

When is HSV-2 usually transmitted?

A

During asymptomatic shedding

Rates of asymptomatic shedding
*HSV2>HSV1

45
Q

What are the MC sites of asymptomatic shedding?

A

Women: vulva and perianal
men: penile skin and perianal

46
Q

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

A

Yes
*will reduce the rate of transmission but still infectious

47
Q

What are the virological tests to diagnosis HSV

A

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

48
Q

What can serological tests specifically find for HSV?

A

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

49
Q

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

A

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

50
Q

What are the different type of antiviral medications for HSV?

A

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

51
Q

Is topical antiviral treatment recommend for HSV?

A

NO

52
Q

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

A

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

53
Q

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

A

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

54
Q

What are the medications for episodic treatment of herpes/

A

Same as first clinical episode

55
Q

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

A

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

56
Q

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

A

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

57
Q

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

A

Yes

58
Q

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

A

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

59
Q

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

A

@36 weeks until delivery

60
Q

What is the agent of HIV/AIDS?

A

RNA retrovirus
*targets the helper T cells and monocytes

61
Q

How does the CDC define AIDS?

A

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

62
Q

How many people are living with HIV/AIDS?

A

1.2 mil

63
Q

What is the transmission of HIV?

A
  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
64
Q

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

A

Anal sex
*receptive

65
Q

What are the clinical presentations of HIV/AIDS

A

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

66
Q

What are some diagnostic test of HIV?

A

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

67
Q

What are the brand names from PrEP?

A

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

68
Q

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

A

99% sexually
74% drug users

69
Q

When is PEP used?

A

For a recent high-risk event
*within 72 hours

70
Q

what are the management therapy for HIV?

A

Antiretroviral therapy (ART)

71
Q

What is the screening for HIV?

A

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

Community And Wellness (39 decks)

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