STDs key points

Question 1

what organism is trichomonas vaginalis?

Answer 1

protozoa

Question 2

tx of trichomonas

Answer 2

metronidazole

Question 3

oral effects of trichomonas

Answer 3

oral ulcers
rare
if IC

Question 4

chlamydia organism

Answer 4

chlamydia trachomatis

bacteria

Question 5

chlamydia forms

Answer 5

elementary body - metabolically inactive. EC

reticulate body - replicative form. IC

Question 6

chlamydia tx

Answer 6

azithromycin or doxycycline

Question 7

chlamydia oral effects

Answer 7

rare - tonsillopharyngitis
cervical and oropharyngeal lymphogranuloma
rarely vesicles/erosive nodules L lip, ulcers frenum tongue

Question 8

gonorrhoea organism

Answer 8

neisseria gonorrhoeae

bacteria

Question 9

gonorrhoea oral effects

Answer 9

gonococcal tonsillar infection (rare)

Question 10

gonorrhoea tx

Answer 10

IM ceftriaxone

Question 11

syphilis organism

Answer 11

bacteria

treponema pallidum

Question 12

primary syphilis

Answer 12

painless “chancre” ulcer/papule
regional lymphadenopathy
lasts 6-8wks

Question 13

secondary syphilis

Answer 13

typically several weeks after untreated primary. Wide spectrum

• rash - palms and soles
• oral: erosions, polymorphic aspect, bullous, erythematous, L lip, tongue, white border surrounding erythematous areas

Question 14

latent syphilis

Answer 14

early (1st year, infectious) and late (usually non-infectious and doesn’t respond well to tx)
absence of clinical manifestations in the setting of serologic detection of syphilis

Question 15

tx of syphilis

Answer 15

IM penicillin x2

Question 16

congenital syphilis oral effects

Answer 16

approx 6yrs
hutchinson teeth
mulberry molars

Question 17

hutchinson teeth

Answer 17

centrally notched, widely spaced, peg shaped U1s

Question 18

mulberry molars

Answer 18

surface has numerous poorly formed cusps surmounting a dome shaped tooth

Question 19

tertiary syphilis

Answer 19

systemic multiorgan disease process
15% untreated pts progress to this
3 main systemic manifestations:
 - neurological
 - CV (aneurysms)
 - gummatous (MC) lesions

Question 20

what type of virus is HSV?

Answer 20

dsDNA

Question 21

HSV1

Answer 21

oral (usually)

Question 22

HSV2

Answer 22

genital

Question 23

genital herpes lifelong infection

Answer 23

viral genome maintained within ganglia for life (latency - episomes
reactivation

Question 24

primary HSV 2 infection outcome

Answer 24

usually resolves approx 3 wks

Question 25

HSV2 recurrent infections

Answer 25

can get prodrome (travelling along axons) lesions more likely to be fewer in number, unilateral and generally without systemic symptoms more mild

Question 26

HSV non-primary infection

Answer 26

infection with HSV 1 or 2 in an individual with pre-existing ABs to the other virus manifestations tend to be milder than those of primary infection - presumably due to cross-immunity protection from prior infection with the other HSV type

Question 27

HSV and antivirals

Answer 27

reduce symptoms and likelihood of transmission

Question 28

main risk factor for genital herpes

Answer 28

number of lifetime sex partners

Question 29

what type of virus is HPV?

Answer 29

dsDNA

Question 30

non-oncogenic low risk HPV

Answer 30

6 and 11

Question 31

oncogenic high risk HPV

Answer 31

16 and 18

Question 32

low-risk HPV oral features

Answer 32

``` variety - solitary/multiple verruca vulgaris (common wart) condyloma acuminatum (cauliflower like) squamous papilloma - hairy like (pedunculated) lesions ```

Question 33

squamous cell papilloma

Answer 33

neoformation epithelial origin HPV 6 and 11 slow exophytic growth with wide base or pedicle HPV related - STD screen?

Question 34

squamous cell papilloma histology

Answer 34

``` hyperkeratotic surface papillary (finger-like) projections projections have fibrovascular CT cores SSE covers cores no dysplasia ```

Question 35

condyloma acuminatum

Answer 35

wart HPV 6, 11, 16, 18 tongue and palate acanthotic and sometimes hyperkeratotic epithelium with occasional koilocytosis

Question 36

focal epithelial hyperplasia (Heck's)

Answer 36

asymptomatic benign mucosal disease multiple, painless, soft, sessile papules/plaques/nodules, can coalesce to give larger lesions HPV 13 and 32 associated etc usually need histopathology to confirm exact diagnosis

Question 37

focal epithelial hyperplasia (Heck's) - onset

Answer 37

mostly in specific groups in certain geographical regions - often poverty/low SES usually childhood/adolescence

Question 38

focal epithelial hyperplasia (Heck's) - tx

Answer 38

sometimes resolves spontaneously but tx often indicated - aesthetics/any interference with occlusion no specific tx - SR, laser excision or possibly topical antiviral agents may be of benefit no evidence that it is potentially malignant

Question 39

oncogenic HPV

Answer 39

if infection fails to clear and persists for long time, viral E2 protein fct gets abrogated, leading to overexpression of main viral oncoproteins E6 and E7

Question 40

what type of virus is HIV?

Answer 40

enveloped ssRNA virus

Question 41

revised WHO HIV/AIDS clinical staging system

Answer 41

4 clinical stages for adults | demonstrate at least one clinical condition in that stage's criteria

Question 42

stage 1 acute HIV infection

Answer 42

asymptomatic/persistent generalised lymphadenopathy may remain for several years CD4+ cell count >500 cells/uL

Question 43

stage 2 early/mildly symptomatic HIV

Answer 43

unexplained WL <10% TBW recurrent resp infections dermatological conditions CD4+ cell count 350-499/uL

Question 44

stage 3 late/moderately symptomatic HIV

Answer 44

``` WL >10% TBW, prolonged unexplained diarrhoea pulmonary TB severe systemic bacterial infections MC conditions - ROC, oral hairy leukoplakia, NG/P/S CD4+ cell count 200-349/uL ```

Question 45

stage 4 AIDS

Answer 45

develop AIDS-defining conditions or a CD4 cell count of <200 cells/uL in HIV-infected pts

Question 46

HIV coinfection

Answer 46

TB most prevalent (1 in 4) chronic HBV HCV HPV

Question 47

oral lesions strongly associated with HIV

Answer 47

``` candidiasis: erythematous, pseudomembranous hairy leukoplakia Kaposi sarcoma PDD - LGE - NG/P lymphoma ```

Question 48

LGE

Answer 48

distinct band of erythema of gingival margin

Question 49

HIV oral bacterial infections - TB

Answer 49

painful, superficial lingual ulcer, well-circumscribed with crateriform aspect and slightly elevated and indurated borders

Question 50

HIV oral bacterial infections - syphilis - secondary

Answer 50

mucous patches appeared as white slightly raised plaques on an erythematous base with a serpentine and white/reddish well-defined outline shallow ulcers macular lesions

Question 51

HIV and oral ulcerations

Answer 51

freq increases with HIV progression

Question 52

HIV and SGs

Answer 52

bilateral parotid gland enlargement

Question 53

Kaposi Sarcoma

Answer 53

``` associated with HHV8 infection red/bluish/purplish macular or nodular lesion can ulcerate and bleed small to extensive HP, gingiva and tongue ```

Question 54

NHL

Answer 54

``` clinically - rapidly enlarging necrotic masses - ulcerated/non-ulcerated masses - palate and gingivae most common sites v poor prognosis ```

Question 55

HAART drugs

Answer 55

``` NRTIs NNRTIs INSTIs protease inhibitor entry inhibitor ```

Question 56

HAART recommended initial regimen

Answer 56

2NRTIs plus one from INSTI/NNRTI/PI and a pharmacokinetic (PK) enhancer (also known as a booster) e.g. cobicistat and ritonavir lots of oral HC drug interactions - check

Question 57

orofacial adverse effects of HAART

Answer 57

``` EM ulcers xerostomia taste alteration perioral paraesthesia facial lipodystrophy (hyperpigmentation) (cheilitis) ```