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RGU 1 > STIs involving genital lesions > Flashcards

STIs involving genital lesions Flashcards

1
Q

What are the STDs of concern?

A

“sores” (ulcers:

  • Syphilis (Treponema Pallidum).
  • genital herpes (HSV-2, HSV-1).
  • Less common in the US: lymphogranuloma venereum, chancroid, granuloma inguinale
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2
Q

What genital ulcers are PAINFUL?

A
  • chancroid (Haemophilus ducreyi)= looks like “school of fish”
  • herpes simplex
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3
Q

What genital ulcers are painLESS?

A
  • syphilis
  • lymphogranuloma venereum (from Chlamydia).
  • granuloma inguinale
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4
Q

** What is important about herpes simplex viruses? (SKETCHY)

A
  • enveloped DNA virus
  • potential for latency and reactivation.
  • reactivation may be asymptomatic, but virus is still shed.
  • HSV-1 (mostly oral) and HSV-2 (mostly genital) are closely related.
  • transmitted sexually or perinatally.
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5
Q

What are the symptoms of genital herpes?

A
  • symptoms= pain, itching, dysuria.
  • lesions= vesicle, wet ulcer (fluid contains virus), crust.
  • tender lymph nodes
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6
Q

What is the primary infection of HSV-1 or 2?

A
  • first infection EVER.
  • no antibody present when symptoms appear.
  • disease is more sever than recurrent disease (progresses form vesicles to ulcers to crusts).
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7
Q

What is a non-primary infection of HSV-1 or 2?

A
  • newly acquired HSV-1 or 2 infection in an individual previously seropositive to the other virus.
  • symptoms usually milder than primary infection
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8
Q

What is recurrent symptomatic infection?

A
  • antibody present when symptoms appear.
  • disease mild and short in duration (localized tingling, irritation before visible lesions (prodrome).
  • person is infectious even if asymptomatic
  • duration (5-10 days) and is shorter than primary infection.
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9
Q

Is serum antibody present in asymptomatic infection?

A

YES

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10
Q

What is a possible complication of genital herpes?

A
  • aseptic meningits (more likely with primary infection than reactivation).
  • self resolves and neurological sequelae are unlikely.
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11
Q

*** Is HSV-1 or HSV-2 more likely to be associated with encephalitis?

A

HSV-1 (#1 cause of sporadic encephalitis)

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12
Q

When is MOST herpes simplex virus transmitted?

A

during asymptomatic shedding

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13
Q

How can we treat the first episode of herpes simplex virus?

A
  • acyclovir, famciclovir or valacyclovir

* you can apply these creams also after primary infection to decrease duration of viral shedding.

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14
Q

Can you eliminate latent herpes infections?

A

NO because the antivirals only inhibit active viral replication.

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15
Q

** How do we diagnose herpes simplex virus (HSV)?

A
  • PCR (NAAT)= gold standard; more sensitive than culture.
  • viral culture of fluid from vesicles
  • Cytology (TZANCK SMEAR).
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16
Q

Can tests identify HSV-1 vs HSV-2?

A

YES via antibody testing

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17
Q

For what should all patients with genital, anal, or perianal ulcers be evaluated?

A
  • a serologic test for SYPHILIS and a diagnostic evaluation for GENITAL HERPES
  • in settings where chancroid is prevalent, test for Haemophilus ducreyi
18
Q

** What are the papillomaviruses (HPV)? (SKETCHY)

A
  • naked, icosahedral DNA viruses (over 100 different types).
  • transmitted via breaks in the skin, sexually, or through the birth canal.
  • infects BASAL epithelial cells, but replication depends on state of differentiation of the cell; productive replication is seen in the most differentiated epithelial cells (seen as a wart).
19
Q

What is a risk factor for developing cervical cancer?

A

PERSISTENT HPV infection that is a high risk subtype (16, 18, 31, 33).

20
Q

Do most HPV-infected individuals become HPV DNA negative within 1 year?

A

YES 70% and 90% within 2 years! :)

21
Q

What happens with latent and transforming infections of basal stem cells, respectively?

A
  • LATENT= viral DNA is present in the nucleus but does not integrate. Treatment will NOT clear latently infected cells.
  • TRANSFORMING= viral DNA is integrated and can either be inactivated due to bad integration :) or it can lead to dysplasia and carcinomas :(
22
Q

** How does HPV 16, 18, 31, or 33 (high risk types) increase the likelihood of a transformation event and subsequent cancer?

A
  • HPV E6 protein binds to host p53 and targets it for degradation.
  • HPV E7 protein binds and inactivates Rb.
23
Q

** What HPV types are associated with laryngeal papillomas and genital warts?

A

6 and 11 (low risk types)

24
Q

What are genital warts caused by HPV also called?

A

CONDYLOMA ACUMINATA= cauliflower-like appearance (skin-colored, pink, or hyperpigmented).

  • usually asymptomatic
  • associated with HPV 6 and 11.
25
Q

How do you diagnose HPV?

A
  • usually made by clinical appearance

- type-specific DNA tests (not recommended).

26
Q

What are some important clinical manifestations of herpes simplex virus (HSV)?

A
  • oral ulcers and targetoid lesions

- erythema multiforme

27
Q

What is Koebner phenomenon?

A

development of skin lesions at sites of trauma/UV light

28
Q

How will herpes manifest?

A
  • grouped vesicles on an erythematous base
29
Q

Are herpes pts stunned with emotion of guilt, fear and denial?

A

YES. Explain to pt that this does not make them “damaged goods.” It is a virus, not a judgment.

30
Q

What is herpetic whitlow?

A 
painful lesion (whitlow) on a finger or thumb caused by the herpes simplex virus. 
*usually dentists who have fingers in mouth.
31
Q

** What will you see on a tzanck smear of a pt with herpes?

A
  • multinucleated giant cells

* KNOW PICTURE

32
Q

** What is important to know about Treponema pallidum (Syphilis)? (SKETCHY)

A
  • thin spirochete (not visualized under light microscopy).
  • transmitted sexually, congenitally, or via blood transfusion.
  • symptoms occur do host immune response.
  • PAINLESS CHANCRE= indurated ulcer with smooth firm borders. HIGHLY INFECTIOUS.
33
Q

*** What are the stages of syphilis?

A
  • primary= chancre
  • secondary= nonpruritic maculopapular RASH on palms and soles of feet (keratoderma blennorrhagica), fever, neuro symptoms.
  • latent= no symptoms
  • tertiary= gumma, ARGYL ROBERTSON PUPIL (dilated pupils), cardiac, and nerve disease.
34
Q

What is the dory flop sign of syphilis?

A
  • as the patient retracts the prepuce, it does not roll back smoothly, in the area where chancre is present (tips up slowly and then flips over all at once).
35
Q

How do you treat syphilis?

A

penicillin

36
Q

What can Treponema pallidum (syphilis) do to the teeth?

A
  • cause notched incisors and mulberry molars.
37
Q

** What is the Jarisch-Herxheimer reaction in syphilis?

A
  • immune mediated reaction due to the massive release of treponemal antigens with treatment of penicillin causing fever, headache, myalgia and chills.
38
Q

** What is condyloma LATUM?

A

condylomas (skin lesions) due to secondary syphilis

39
Q

*** How do we diagnose syphilis?

A
  • darkfield, direct fluorescent antibody staining

- serology (FTA-ABS)

40
Q

What is responsible for granuloma inguinale (Donovanosis)?

A 
Klebsiella granulomatis (look for Donovan bodies= biopolar safety pin shaped rods in cytoplasm of macrophage).
*treat with doxycycline

RGU 1 (17 decks)

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