STD's Flashcards
List the sexually transmitted diseases
Chlamydia Ghonnorhea Trichinomas vaginalis PID Genital herpes Genital warts HIV Syphillis
What causes genital herpes
Herpes simplex virus.
transmitted via skin-to-skin contact -vaginal, anal or oral sex
virus can lie dormant until it recurs later in life causing recurrent outbreaks.
Pathophysiology behind genital herpes
Two types of HSV
HSV1: Genital & Oral herpes
HSV2: Genital herpes
HSV enters the body through small cracks in the skin or through the mucous membranes of mouth, vagina, rectum, urethra or under the foreskin.
After infecting the surface, the virus travels up the nearest nerve to the ganglion and remains there.
Remains dormant for long, as here it cannot be reached by the immune system.
During the reactivation of the virus, it travels back down the nerve onto the surface of the genitals once again to cause a symptomatic outbreak.
How does HSV spread even when people are unaware of infection
Asymptomatic shedding
When the virus multiplies and becomes transmissible without stimulating an immune response from the host and thus no symptoms are present
HSV is notorious for this and up to 1/3 of all transmissions occur this way
Risk Factors for genital herpes
multiple sexual partners
oral sex with a partner suffering from cold sores
Barrier contraception reduces risk but transmission is still possible especially by areas not covered by condoms e.g. THIGHS
Sx of genital herpes
Primary infection symptoms
Secondary (recurrent) infection symptoms
Cold sores
Primary infection symptoms of herpes
1)Small red blisters around the genitals that are very painful and can form open sores
HEAL AFTER 20 DAYS
-F: vulva, clitoris, buttocks and anus
-M: penis n same
2) Vaginal or penile discharge
3) Flu-like symptoms, fever, muscle aches
4) Itchy genitals
Secondary (recurrent) infection symptoms of herpes
recurrent outbreaks are shorter and less severe and over time outbreaks usually reduce in severity and length.
due to antibody production increasing recognition of the virus and increasing the effectiveness of response.
1) Burning and itching around the genitals
2) Painful red blisters around the genitals
Cold sores
They are mainly caused by HSV-1 and can be occasionally caused by HSV-2.
painful lesions around the mouth and nose that last between [[7-10 days]].
usually dormant with outbreaks occurring up to a few times a year.
If someone suffering from cold sores gives oral sex to a partner, the partner is at risk of contracting genital herpes as a result.
The dormant aspect of the infection means people may contract herpes from a partner without knowing. As a result this can make a diagnosis of genital herpes quite shocking and very difficult for a patient.
Dx of genital herpes
Genital ulcer sx
1) aphthous ulcers
2) varicella-zoster virus
3) trauma
[[more than 5 outbreaks]] of genital herpes in one year
indicate a weakened immune system and therefore an underlying diagnosis of HIV.
Dg of herpes
History
– sexual partners,
- history of cold sores
- history of any other STIs.
Swab from the open sore –
- This swab will be tested for the presence of HSV and - -PCR can differentiate between type 1 and 2.
- Even if this swab is negative, the diagnosis of herpes can still be made later on if flare-ups persist.
Other Sti
- screen for other possible std’s especially if history is suggestive
Management of genital herpes
Primary infection
1) Aciclovir:: reducing the number and size of the lesions caused by HSV
2) sexual health advice
- no sex during outbreaks
- disclose it to recent/ current partners
Recurrent outbreaks
1) [[Episodic rx]] w/ aciclovir whenever outbreaks occur
2) Over the counter painkillers, petroleum jelly and ice packs
Over 5 outbreaks a year // Severe outbreaks
-Suppressive rx : daily doses of aciclovir to prevent new outbreaks.
What happens to a woman with Genital herpes who gets pregnant
The mother should maintain rx w/ Aciclovir but the baby should be protected from acquiring the infection due to the antibodies she will pass to the foetus through the placenta.
c/S can be offered as the risk of the baby acquiring HSV transvaginally is 0-3%
What happens if a mother contracts Herpes herself in the last trimester of pregnancy
more dangerous for the baby as the mother has not produced antibodies to pass onto the growing foetus.
baby is a lot more likely to contract herpes during vaginal birth (2/5 chance) and so a caesarean section is recommended in this circumstance.
3 Forms of neonatal herpes
1) SEM:=skin, eyes and mouth herpes
2) DIS= disseminated herpes affecting the internal organs!
3) CNS herpes = affecting the nervous system and the brain and can lead to !!encephalitis!!
Aciclovir is sufficient for SEM herpes but mortality is estimated to be much higher for DIS and CNS herpes, especially if undiagnosed for some time.
What are genital warts
benign epithelial or mucosal outgrowths caused by DNA human papilloma virus (HPV).
How many types of HPV are there
over 100 types of the human papilloma virus, responsible for different types of warts.
More than 40 types of HPV have been associated with anogenital warts (condyloma acuminatum)
however HPV6 and HPV11 are responsible for roughly 90% of cases.
Pathophysiology of genital warts
spread through skin-to-skin contact during vaginal and anal sexual intercourse,
however penetrative sex is not necessary for transmission!!
——In rare cases it can be passed on from the hand to genitals, during oral sex and to the neonate during delivery.
It is important to note that condoms do not fully protect against HPV as not all skin is covered e.g. the inner thighs just like herpes
virus penetrates the epithelial barrier and !!infects basal keratinocytes!!!.
Within the keratinocyte the virus replicates resulting in multiplication of the keratinocyte and this rapid growth manifests as lesions.
Risk Factors for genital warts
Sim to other std’s and cervical cancer
Early age at first sexual intercourse Multiple partners Immunosuppression Smoking Diabetes associated with persistence of warts
Clinical Features of genital warts
Onset of weeks to years
painless, fleshy growths that can be soft or hard and can be singular or multiple.
Can also cause extragenital lesions in oral cavity, larynx, conjunctivae and the nasal cavity.
Most are assyx and spontaneously resolve
Dx of genital warts
Vestibular papillomatosis:
-projections of the vestibular epithelium or labia minora
Dx sx: non-viral and not sexually transmitted
Dx dg: Application of acetic acid does not change their colour – HPV lesions turn whitish.
Molluscum contagiosum: viral infection causing small firm raised papules on the skin.
What is vestibular papilomatosis
https://www.healthline.com/health/vestibular-papillomatosis
Dg work up of genital warts
Colposcopy and biopsy IF neoplasms suggested
Vaginal speculum
Proctoscopy - Anal lesions
Rx of genital warts
Lesion usually resolve especially postpartum
2 types: Topical rx & Physical ablation
Topical rx
Podophyllotoxin:
twice daily for 3 days followed by 4 days rest (4-5 cycles)
Clusters of small warts, better for non-keratinised lesions
Imiquimod:
3 times weekly and wash off after 6-10 hours (up to 16 wks)
Larger warts, particularly keratinised warts
C.I on topical rx of warts
Topical treatments may weaken latex condoms.
They are also contraindicated in pregnancy and breastfeeding, and may cause local inflammation.
Physical ablation for rx of warts
Excision: Pedunculated/large warts or small hard warts
-surgical removal under local anaesthetic
Cryotherapy: Multiple small warts
-freezing using liquid nitrogen usually repeated weekly (consider alternative treatment if no response after 4 weeks)
Electrosurgery: Large warts that have failed to respond to topical treatment
-excision removes the majority of the wart and then an electric current is passed through a metal loop pressed against the wart to remove any remaining part
Laser surgery: Difficult to access warts e.g. inside the anus
-a laser is used to burn the warts under local or general anaesthetic.
Vaccination against HPV
HPV vaccine is offered to all girls aged 12-13. This was introduced in 2008 and the vaccine originally protected against the high risk HPV types 16 and 18, however since 2012 the vaccine Gardasil® additionally protects against the most common types HPV 6 and 11.
The vaccine is most beneficial if administered before first sexual contact.
It is argued that only immunising females will not necessarily protect males and herd immunity will not apply to men who have sex with men.
In some countries, Gardasil is administered to both males and females.
How does HPV affect pregnancy
HPV is not associated with miscarriage, premature birth or other pregnancy complications.
due to the hormonal changes associated with pregnancy, genital warts may multiply or enlarge.
Treatment is to reduce the burden of lesions so that during childbirth the neonate’s exposure is reduced.
physical ablation methods are preferred during pregnancy .
Can HPV be transmitted to the baby
The risk of transmission to the neonate during birth is extremely low
If transmission does occur then the immune system will usually clear the virus
in rare cases the baby may develop
respiratory papillomatosis!!!
where genital warts develop in the throat.
What is HIV
human immunodeficiency virus (HIV).
a single stranded RNA retrovirus that infects and replicates within the human immune system using
host [[CD4]] cells.
Without treatment, destruction of the immune system can lead to acquired immune deficiency syndrome (AIDS).
