STDs key points Flashcards
what organism is trichomonas vaginalis?
protozoa
tx of trichomonas
metronidazole
oral effects of trichomonas
oral ulcers
rare
if IC
chlamydia organism
chlamydia trachomatis
bacteria
chlamydia forms
elementary body - metabolically inactive. EC
reticulate body - replicative form. IC
chlamydia tx
azithromycin or doxycycline
chlamydia oral effects
rare - tonsillopharyngitis
cervical and oropharyngeal lymphogranuloma
rarely vesicles/erosive nodules L lip, ulcers frenum tongue
gonorrhoea organism
neisseria gonorrhoeae
bacteria
gonorrhoea oral effects
gonococcal tonsillar infection (rare)
gonorrhoea tx
IM ceftriaxone
syphilis organism
bacteria
treponema pallidum
primary syphilis
painless “chancre” ulcer/papule
regional lymphadenopathy
lasts 6-8wks
secondary syphilis
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
latent syphilis
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
tx of syphilis
IM penicillin x2
congenital syphilis oral effects
approx 6yrs
hutchinson teeth
mulberry molars
hutchinson teeth
centrally notched, widely spaced, peg shaped U1s
mulberry molars
surface has numerous poorly formed cusps surmounting a dome shaped tooth
tertiary syphilis
systemic multiorgan disease process 15% untreated pts progress to this 3 main systemic manifestations: - neurological - CV (aneurysms) - gummatous (MC) lesions
what type of virus is HSV?
dsDNA
HSV1
oral (usually)
HSV2
genital
genital herpes lifelong infection
viral genome maintained within ganglia for life (latency - episomes
reactivation
primary HSV 2 infection outcome
usually resolves approx 3 wks
HSV2 recurrent infections
can get prodrome (travelling along axons)
lesions more likely to be fewer in number, unilateral and generally without systemic symptoms
more mild
HSV non-primary infection
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
HSV and antivirals
reduce symptoms and likelihood of transmission
main risk factor for genital herpes
number of lifetime sex partners
what type of virus is HPV?
dsDNA
non-oncogenic low risk HPV
6 and 11
oncogenic high risk HPV
16 and 18
low-risk HPV oral features
variety - solitary/multiple verruca vulgaris (common wart) condyloma acuminatum (cauliflower like) squamous papilloma - hairy like (pedunculated) lesions
squamous cell papilloma
neoformation epithelial origin
HPV 6 and 11
slow exophytic growth with wide base or pedicle
HPV related - STD screen?
squamous cell papilloma histology
hyperkeratotic surface papillary (finger-like) projections projections have fibrovascular CT cores SSE covers cores no dysplasia
condyloma acuminatum
wart
HPV 6, 11, 16, 18
tongue and palate
acanthotic and sometimes hyperkeratotic epithelium with occasional koilocytosis
focal epithelial hyperplasia (Heck’s)
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
focal epithelial hyperplasia (Heck’s) - onset
mostly in specific groups in certain geographical regions
- often poverty/low SES
usually childhood/adolescence
focal epithelial hyperplasia (Heck’s) - tx
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
oncogenic HPV
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
what type of virus is HIV?
enveloped ssRNA virus
revised WHO HIV/AIDS clinical staging system
4 clinical stages for adults
demonstrate at least one clinical condition in that stage’s criteria
stage 1 acute HIV infection
asymptomatic/persistent generalised lymphadenopathy
may remain for several years
CD4+ cell count >500 cells/uL
stage 2 early/mildly symptomatic HIV
unexplained WL <10% TBW
recurrent resp infections
dermatological conditions
CD4+ cell count 350-499/uL
stage 3 late/moderately symptomatic HIV
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
stage 4 AIDS
develop AIDS-defining conditions or a CD4 cell count of <200 cells/uL in HIV-infected pts
HIV coinfection
TB most prevalent (1 in 4)
chronic HBV
HCV
HPV
oral lesions strongly associated with HIV
candidiasis: erythematous, pseudomembranous hairy leukoplakia Kaposi sarcoma PDD - LGE - NG/P lymphoma
LGE
distinct band of erythema of gingival margin
HIV oral bacterial infections - TB
painful, superficial lingual ulcer, well-circumscribed with crateriform aspect and slightly elevated and indurated borders
HIV oral bacterial infections - syphilis - secondary
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
HIV and oral ulcerations
freq increases with HIV progression
HIV and SGs
bilateral parotid gland enlargement
Kaposi Sarcoma
associated with HHV8 infection red/bluish/purplish macular or nodular lesion can ulcerate and bleed small to extensive HP, gingiva and tongue
NHL
clinically - rapidly enlarging necrotic masses - ulcerated/non-ulcerated masses - palate and gingivae most common sites v poor prognosis
HAART drugs
NRTIs NNRTIs INSTIs protease inhibitor entry inhibitor
HAART recommended initial regimen
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
orofacial adverse effects of HAART
EM ulcers xerostomia taste alteration perioral paraesthesia facial lipodystrophy (hyperpigmentation) (cheilitis)
