STI's Flashcards
Types of HSV Infection
Primary: infection in a patient without antibodies to HSV-1 or HSV-2
Nonprimary: due to acquiring genital HSV-1 w/ preexisting antibodies to HSV-2 or vice versa
Recurrent: reactivation of genital herpes in which the HSV type recovered in the lesion is the same type as the antibodies recovered in the serum
HSV Symptoms
Primary:
variable from very symptomatic to asymptomatic
Symptoms more severe in women then in men
Systemic symptoms, local pain/itching, dysuria, lymphadenopathy
Dysuria
Nonprimary: less symptomatic than first episode
Recurrent: less severe/shorter duration**
Asymptomatic shedding
Treatment of HSV
Acyclovir (Zovirax)
Famcilovir (Famvir)—more bioavailable
Valacyclovir (Valtrex)—more bioavailable/BID
HSV in Pregnancy
Most common mode of transmission is from direct contact of the fetus w/ infected vaginal secretions during delivery
Maternal immunity is important**
Acyclovir can be used to treat a primary infection
Syphilis
Causative agent: Treponema palidum Cannot be cultured Can be seen with darkfield microscopy Serologic tests available: Nontreponema (titers of Ab) Treponemal (confirmative test: reactive or nonreactive)
Primary Syphilis
Incubation period of 2-3 wks from inoculation—a papule forms and soon ulcerates to the chancre
Chancre is usually painless
Usually there is bilateral lymphadenopathy
Chancres heal spontaneously within 3-6 wks even without treatment
Secondary Syphilis
Weeks to a few months later 25% of people w/ untreated infections will develop systemic illness:
Rash: any form BUT vesicular, includes the palms/soles **
Gray/white lesions warm moist areas—condyloma lata**
Systemic symptoms
Musculoskeletal and renal abnormalities
Ocular disease
Tertiary Syphilis
1-25 years after secondary syphilis tertiary:
Early tertiary syphilis (~1 year)
Late tertiary syphilis ( > 1year from initial infection)
Systems involved:
Subcutaneous tissues (gumma)—granulomas
CV: ascending thoracic aorta becomes dilated aortic valve regurgitation occurs
CNS: (most common)
Early: meningitis, meningiovascular disease
Late: general paresis, tabes dorsalis, ocular, otosyphilis
Neurosyphilis
When suspected need to do lumbar puncture (LP) (Nonpretonemal VDRL) CSF findings: Lymphocytic pleocytosis Elevated protein \+ CSF-VDRL and/or + FTA-ABS
Need to follow CSF during treatment to make sure there is a response
Treatment of Early Syphilis
For primary, secondary syphilis & early latent:
2.4 million units of benzathine penicillin G IM
Treatment for Late Syhphilis
Patients w/ gummas or CV involvement need to have an LP to r/o neurosyphilis before treatment
If they have localized disease treatment is:
2.4 million units of benzathine penicillin G IM weekly for 3 weeks
Treatment for Neurosyphilis
IV penicillin G either 3-4 million units q 4 hrs or
Non-penicillin regimens are not recommended for patients w/ documents neurosyphilis
HPV Manifestations
Genital warts (condyloma acuminatum)
Bowenoid papules and Bowen’s disease
Giant condyloma (Buschke-Lowenstein tumors)
Intraepithelial neoplasia and/or carcinoma of the vagina, vulva, cervix, anus or penis
(ONCOGENIC)
Anogenital Warts
Most common viral sexually transmitted disease in the U.S.
67% patient population women
Persistent infection especially w/ other risk factors (such as infection w/ HIV) can result in the development of squamous cell carcinoma
Anogenital Warts Treatment
Spontaneous regression occurs 20-30 % cases
All therapies have a 30-70% recurrence rate
Ablative:
Podophylliin (contraindicated in pregnancy)
Imiguimod (Aldara)–also used for IEN vulva/anus
Trichloroacetic acid (applied by provider)
Cryotherapy
Laser therapy
