STIs involving genital lesions Flashcards
What are the STDs of concern?
“sores” (ulcers:
- Syphilis (Treponema Pallidum).
- genital herpes (HSV-2, HSV-1).
- Less common in the US: lymphogranuloma venereum, chancroid, granuloma inguinale
What genital ulcers are PAINFUL?
- chancroid (Haemophilus ducreyi)= looks like “school of fish”
- herpes simplex
What genital ulcers are painLESS?
- syphilis
- lymphogranuloma venereum (from Chlamydia).
- granuloma inguinale
** What is important about herpes simplex viruses? (SKETCHY)
- 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.
What are the symptoms of genital herpes?
- symptoms= pain, itching, dysuria.
- lesions= vesicle, wet ulcer (fluid contains virus), crust.
- tender lymph nodes
What is the primary infection of HSV-1 or 2?
- first infection EVER.
- no antibody present when symptoms appear.
- disease is more sever than recurrent disease (progresses form vesicles to ulcers to crusts).
What is a non-primary infection of HSV-1 or 2?
- newly acquired HSV-1 or 2 infection in an individual previously seropositive to the other virus.
- symptoms usually milder than primary infection
What is recurrent symptomatic infection?
- 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.
Is serum antibody present in asymptomatic infection?
YES
What is a possible complication of genital herpes?
- aseptic meningits (more likely with primary infection than reactivation).
- self resolves and neurological sequelae are unlikely.
*** Is HSV-1 or HSV-2 more likely to be associated with encephalitis?
HSV-1 (#1 cause of sporadic encephalitis)
When is MOST herpes simplex virus transmitted?
during asymptomatic shedding
How can we treat the first episode of herpes simplex virus?
- acyclovir, famciclovir or valacyclovir
* you can apply these creams also after primary infection to decrease duration of viral shedding.
Can you eliminate latent herpes infections?
NO because the antivirals only inhibit active viral replication.
** How do we diagnose herpes simplex virus (HSV)?
- PCR (NAAT)= gold standard; more sensitive than culture.
- viral culture of fluid from vesicles
- Cytology (TZANCK SMEAR).
Can tests identify HSV-1 vs HSV-2?
YES via antibody testing
For what should all patients with genital, anal, or perianal ulcers be evaluated?
- a serologic test for SYPHILIS and a diagnostic evaluation for GENITAL HERPES
- in settings where chancroid is prevalent, test for Haemophilus ducreyi
** What are the papillomaviruses (HPV)? (SKETCHY)
- 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).
What is a risk factor for developing cervical cancer?
PERSISTENT HPV infection that is a high risk subtype (16, 18, 31, 33).
Do most HPV-infected individuals become HPV DNA negative within 1 year?
YES 70% and 90% within 2 years! :)
What happens with latent and transforming infections of basal stem cells, respectively?
- 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 :(
** How does HPV 16, 18, 31, or 33 (high risk types) increase the likelihood of a transformation event and subsequent cancer?
- HPV E6 protein binds to host p53 and targets it for degradation.
- HPV E7 protein binds and inactivates Rb.
** What HPV types are associated with laryngeal papillomas and genital warts?
6 and 11 (low risk types)
What are genital warts caused by HPV also called?
CONDYLOMA ACUMINATA= cauliflower-like appearance (skin-colored, pink, or hyperpigmented).
- usually asymptomatic
- associated with HPV 6 and 11.
How do you diagnose HPV?
- usually made by clinical appearance
- type-specific DNA tests (not recommended).
What are some important clinical manifestations of herpes simplex virus (HSV)?
- oral ulcers and targetoid lesions
- erythema multiforme
What is Koebner phenomenon?
development of skin lesions at sites of trauma/UV light
How will herpes manifest?
- grouped vesicles on an erythematous base
Are herpes pts stunned with emotion of guilt, fear and denial?
YES. Explain to pt that this does not make them “damaged goods.” It is a virus, not a judgment.
What is herpetic whitlow?
painful lesion (whitlow) on a finger or thumb caused by the herpes simplex virus. *usually dentists who have fingers in mouth.
** What will you see on a tzanck smear of a pt with herpes?
- multinucleated giant cells
* KNOW PICTURE
** What is important to know about Treponema pallidum (Syphilis)? (SKETCHY)
- 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.
*** What are the stages of syphilis?
- 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.
What is the dory flop sign of syphilis?
- 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).
How do you treat syphilis?
penicillin
What can Treponema pallidum (syphilis) do to the teeth?
- cause notched incisors and mulberry molars.
** What is the Jarisch-Herxheimer reaction in syphilis?
- immune mediated reaction due to the massive release of treponemal antigens with treatment of penicillin causing fever, headache, myalgia and chills.
** What is condyloma LATUM?
condylomas (skin lesions) due to secondary syphilis
*** How do we diagnose syphilis?
- darkfield, direct fluorescent antibody staining
- serology (FTA-ABS)
What is responsible for granuloma inguinale (Donovanosis)?
Klebsiella granulomatis (look for Donovan bodies= biopolar safety pin shaped rods in cytoplasm of macrophage). *treat with doxycycline
