STD Part II Flashcards
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
How are most genital HPV infections?
Asymptomatic with no clinical consequences
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
What is the transmission of genital HPV?
Sexual activity
Can be transmitted from mother to newborn during delivery (rare)
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
What are the risk factors of men acquiring HPV?
Risk increase with multiple sex partners
Being uncircumcised
What are the low-risk types of HPV?
Most are genital warts (6,11)
Recurrent respiratory papillomatosis associated with 6,11
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
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)
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
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
What are the symptoms of genital warts?
Usually cause no symptoms but some can be
*Pruritis
*burning discomfort
*bleeding
*obstruction of the birth canal
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
Wha are some normal anatomical variants of genital warts?
Pink pearly penile papules
vestibular papillae
Skin tags
How is genital warts diagnosed?
Made by visual inspection
Consider a biopsy when
*patient is immunocompromised
*Warts are fixed, indurated, pigmented
How to diagnose cervical cellular abnormalities?
Cytology (pap test, screening)
***NOT a diagnosis test
*can detect cervical cell changes
*detects squamous epithelial cell changes
What do atypical squamous cell of undetermined significance show?
ASC-US
*changes often caused by HPV infection
*changes are usually mild
What do Atypical squamous cells of High grade show?
ASC-H
*changes are more likely t be associated with precancerous abnormalities than ASC-US
What are Low-grade squamous intraepithelial lesion?
LSIL
*caused by HPV infection/mild dysplasia
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
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
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
When is a colposcopy used?
Used when there is an abnormal PE or Pap test findings
When is a cervical biopsy used?
When there are visible exophytic lesion on cervix
Pap test with HSIL, ASC-H or other findings
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?
NO
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?
- Sexual contact
*blood, semen, rectal fluids, breast milk
*contact with mucous membranes - Use of contaminated needles or blood products
- 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
