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Gen Med: Ob/gyn > Syphilis and HSV1 > Flashcards

Syphilis and HSV1 Flashcards

1
Q

What is the causative agent for syphilis?

A

Treponema pallidum

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2
Q

What are the stages of syphilis?

A
  1. Primary
  2. Secondary
  3. Latent
  4. Tertiary
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3
Q

What is the incubation period for syphilis?

A

10-90 days

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4
Q

true/false: syphilis is a reportable dz

A

True. Reportable Dz to CD via local county Health Dept.

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5
Q

How is syphilis transmitted?

A
  1. Direct contact w/ infected person’s moist lesion(s) usually
    A. Intimate sexual contact
    B. Mother to infant: transplacental, intrapartum
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6
Q

What are the characteristics of primary syphilis?

A
  1. Chancre
    2, Lympadenopathy
  2. Frequently asymptomatic in females
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7
Q

What is a chancre? Where is it locate?

A

A. painless, indurated, firm papule or ulcer w/ raised border

  1. Sites: nose, mouth, breast, vulva, vagina, cervix, penis
  2. Appears 3-4 wks after exposure
  3. Heals w/in 6 wks
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8
Q

How is syphilis diagnosed?

A
  1. Serology (RPR)

A. If (-), repeat in 6 wks if strong suspicion

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9
Q

When does secondary syphilis appear?

A
  1. Appears few wks after chancre heals

2. Can be intermittent over 1 year

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10
Q

What are the characteristics of secondary syphilis?

A
  1. Systemic involvement as spirochetes multiply & spread
    A. Flu-like symptoms
    B. Dermatitis: pustular, macules, papular rash on body, esp. trunk, ventral surface of hands & feet
    C. Iritis
  2. May involve liver & kidneys
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11
Q

When does latent syphilis occur?

A
  1. Infectious 1-2 years after exposure

2. Can have relapses of 2° syphilis

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12
Q

What are the characteristics of secondary syphilis?

A
  1. All lesions have resolved or sudden finding of (+) serology indicates Latency
    A. Early latent: syphilis contracted w/in last year
    B. Late latent: latent syphilis of unknown duration
    C. Commonly asymptomatic
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13
Q

What are the common manifestations of tertiary syphilis?

A 
1. Destructive lesions affecting:
A. Skin & bone	
B. CV: 
-Aortic aneurysm
C. CNS: 
-Meningitis, tabes dorsalis (degeneration of nerves that control proprioception, vibration & discriminative touch), movement impairment
D. Eye conditions: 
-Involves ophthalmic nerves 
-Argyll-Robertson pupils: small & non-reactive to light
E. Auditory nerve involvement
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14
Q

What is the prognosis for tertiary syphilis?

A

Almost always fatal

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15
Q

How is syphilis assessed during pregnancy?

A
  1. Misdiagnosed:
    A. Chancre often thought to be HSV
  2. Goal is ID T. pallidum
    A. Dark field exam microscopy:
    -Sample from chancre or 2° syphilitic lesion by pressing lesion against a glass slide
    B. Spirochetes appear as bright spiral objects against a black background
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16
Q

What is a common manifestation of syphilis during pregnancy?

A
  1. Polyhydramnios (excess amniotic fluid) is common
    A. Serial USN during pregnancy if (+)syphilis
    B. Pregnancy becomes high risk
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17
Q

When are GC/Chlymydia tests done in prenatal care?

A

GC/chlamydia Cx @ 1st prenatal visit & 36 wk visit

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18
Q

What is the transplacental infection risk for congenital syphilis?

A
  1. Transplacental infection risk of fetus → 60%-80%
  2. Untreated 1° or 2°→ syphilis usually transmitted
  3. Latent or tertiary syphilis usually not
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19
Q

What is early congenital syphilis?

A

Birth to 2 yrs

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20
Q

What is late congenital syphilis?

A

Greater than 2 yrs

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21
Q

When do babies with congenital syphilis develop sxs? What are they?

A
  1. Babies born w/ syphilis infection or develop S/S w/in weeks of delivery
    A. S/S like 2° syphilis in adults; no chancre
    B. Rash, fever, hepatosplenomegaly, anemia, jaundice
    Developmental delays
    C. CP, hydrocephalus, sensorineural hearing loss, MSK deformity
    D. Hutchinson’s teeth-central notching in incisors
    E. Can cause death
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22
Q

What is the optimal treatment to prevent congenital syphilis?

A
  1. Optimum treatment to mother prior to birth, before 16 weeks gestation
    A. Procaine Pen G 50,000U/kg IM daily x 10 days
  2. Tx does not reverse deformities already existing in the child
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23
Q

What is the non-treponemal testing for syphilis?

A

1, RPR (rapid plasma reagin)
A, Tests for Ab in blood
B, Titre should ↓ after Tx

24
Q

When may a false positive syphilis test occur?

A
  1. False (+) may occur w/ other conditions due to low titre
    A. Lyme disease
    B. IV drug user
    C. SLE
25
Q

When should a pt be retested if you think they had a false negative syphilis test?

A

repeat 6 wks

26
Q

What are the treponemal antibody tests? How do they work?

A
  1. FTA-ABS:flourescent treponemal AB asbsorbed test
  2. MHA-TP: Microhemagglutination assay test for T. pallidum
  3. Both detect Ab in blood specific to spirochetes
    A. More specific & senstive
    B. Remain (+) despite therapy
27
Q

How are all stages of syphilis treated?

A
  1. Pen G for all stages of syphilis
  2. All sexual contacts should be treated
  3. Repeat serology @ 6 &12 mo
28
Q

What is the dose for treatment of early syphilis?

A
  1. Early (1°, 2°, latent
29
Q

What is the dose for treatment of late syphilis?

A
  1. Late: (latent, tertiary):

A. Pen G 2.4 M units IM weekly x 3 weeks

30
Q

What is the alternative to Pen G for syphilis treatment?

A

Doxycycline 100 mg bid x 14 days

31
Q

How long may neurosyphilis be dormant before it presents?

A

10-20 yrs

32
Q

How is neurosyphilis treated?

A
  1. Aqueous pen G 3-4M units q4 hrs for 10-14 days

2. One IM injection pen G + oral probenecid 500mg po qid x 10-14 days

33
Q

How is syphilis treated in pregnancy?

A
  1. Pen G 2.4M units IM x1; repeat injection 1 wk
    A. If allergic, should be desensitized in hospital
  2. Congenital syphilis:
    A. Pen G always, dose depends on clinical presentation
34
Q

What is type 1 HSV asst with?

A
  1. Oral lesions

2. Most genital problems type II; can have type I in genital area

35
Q

What is type 2 HSV asst with?

A
  1. Genital lesions

2. Most genital problems type II; can have type I in genital area

36
Q

True false: HSV affects fertility

A

False. does not affect fertility

37
Q

How is HSV transmitted?

A
  1. fluid in ulcer contains virus
    A. Unrecognized active infection w/ viral shedding
    B. Asymptomatic person w/ intermittent shedding
    C. knowledgeable person spreads it
38
Q

What is the incubation period for both HSV 1 and 2?

A

2-12 days, avg ≈ 4 days

39
Q

How long do sxs last for both types of hsv?

A

~2-3 days

40
Q

What is the prodrome that precedes an outbreak?

A
  1. Flu-like syndrome (1° outbreak)

2. Burning, tingling , itchy sensation where outbreak will occur

41
Q

What is the primary outbreak of HSV?

A
  1. Intensely painful vesicles emerge in area where prodrome was located and blisters progress to ulcerations
  2. Flu-like sx’s persist
  3. Primary outbreak is most severe outbreak; recurrent outbreaks not nearly as severe
42
Q

What are the sxs of a recurrent episode of hsv?

A
  1. HSV goes dormant-immune system suppression
  2. Reactivation is recurrent outbreak
    A. Burning and tingling in area of previous outbreak
    B. Milder outbreak
    C. Shorter duration
    D. Usually no flu-like sx’s
  3. Virus can be auto-inoculated
43
Q

How can secondary infections of an hsv ulcer be prevented?

A

Good hygeine

44
Q

How can frequent recurrent episodes be prevented?

A

Suppressive therapy

45
Q

How is HSV diagnosed?

A
  1. Mostly clinical diagnosis
  2. Polymerase chain reaction (PCR)
  3. Viral culture
  4. Serology w/ IgM and IgG Abs
    A. Type I & II
  5. Viral Cx needs moist specimen: fluid from vesicle/ulcer
    A. Painful for patient
  6. Can type HSV I & II
46
Q

What are the potential complications from HSV? How are they treated?

A
  1. Urinary retention due to contact dysuria
    A. Catheterize
    B. Advise warm water w/voiding to dilute urine
    C. 2% Lidocaine jelly prn
    D. Pain med prn
  2. Disseminated infection if immunocompromised
    A. Pneumonitis
    B. CNS (meningitis/encephalitis)
    C. Admit to ICU & IV antiviral therapy
47
Q

How is HSV transmitted to children during pregnancy?

A
  1. Transmitted to infants intrapartum

2. No transplacental transmission

48
Q

How is HSV treated in pregnancy?

A
  1. Patient to report prodrome/vesicles/ulcers at any time during pregnancy & at labor
  2. Acute treatment during pregnancy
  3. Suppressive therapy at 36 weeks
  4. If active lesions upon admission to L&D, delivery is C-section to avoid complications to fetus
49
Q

How does hsv 2 present in infants?

A 
1. Initially, mild illness:
A. Low grade fever 
B. Poor feeding 
C. +/- skin blisters (2-12 days postpartum) 
2. Then progression to:
A. High fevers 
B. Seizures
C. Lethargy
50
Q

What is the treatment for hsv in infants?

A

Hospital admission: IV Antiviral therapy x 21 days

51
Q

What is the prognosis for hsv in infants?

A

Can be fatal for infants-60% mortality rate

52
Q

How can HSV be prevented?

A
  1. Responsibility HSV (+) pt
  2. Abstinence when sx’s present
  3. Educate about asymptomatic transmission
  4. Condoms (latex)
  5. Suppressive Tx
  6. Monogamous relationship
  7. Good hand-washing after touching area w/ vesicles
53
Q

When is hospitalization and IV antiviral tx indicated to treat hsv?

A
  1. Severe primary outbreak
  2. Severe H/A
  3. Fever >102° F
  4. Sick immunosuppressed pt
  5. Urinary retention
54
Q

How is the first episode of hsv 2 treated?

A
  1. Most effective when started w/in 48 hrs of prodrome
    A. Valacyclovir (Valtrex) 1g po bid x 10days
    B. Acyclovir (Zovirax) 400 mg po tid x 7-10 days
    C. Famciclovir (Famvir) 250mg po tid x 7-10 days
55
Q

What is the treatment for recurrent episodes of hsv?

A
  1. Valacyclovir (Valtrex) 500mg bid x 5 days w/ refills for future use
    A. Start ASAP for burning, tingling
    B. Acyclovir generally not used unless pt request RX or Valtrex not available
56
Q

What is used for the suppression of hsv 2?

A
  1. Valacyclovir (Valtrex) 500mg po daily ( 9 episodes/yr)

Gen Med: Ob/gyn (13 decks)

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