Syphilis and HSV1 Flashcards
1
Q
What is the causative agent for syphilis?
A
Treponema pallidum
2
Q
What are the stages of syphilis?
A
- Primary
- Secondary
- Latent
- Tertiary
3
Q
What is the incubation period for syphilis?
A
10-90 days
4
Q
true/false: syphilis is a reportable dz
A
True. Reportable Dz to CD via local county Health Dept.
5
Q
How is syphilis transmitted?
A
- Direct contact w/ infected person’s moist lesion(s) usually
A. Intimate sexual contact
B. Mother to infant: transplacental, intrapartum
6
Q
What are the characteristics of primary syphilis?
A
- Chancre
2, Lympadenopathy - Frequently asymptomatic in females
7
Q
What is a chancre? Where is it locate?
A
A. painless, indurated, firm papule or ulcer w/ raised border
- Sites: nose, mouth, breast, vulva, vagina, cervix, penis
- Appears 3-4 wks after exposure
- Heals w/in 6 wks
8
Q
How is syphilis diagnosed?
A
- Serology (RPR)
A. If (-), repeat in 6 wks if strong suspicion
9
Q
When does secondary syphilis appear?
A
- Appears few wks after chancre heals
2. Can be intermittent over 1 year
10
Q
What are the characteristics of secondary syphilis?
A
- 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 - May involve liver & kidneys
11
Q
When does latent syphilis occur?
A
- Infectious 1-2 years after exposure
2. Can have relapses of 2° syphilis
12
Q
What are the characteristics of secondary syphilis?
A
- 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
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
14
Q
What is the prognosis for tertiary syphilis?
A
Almost always fatal
15
Q
How is syphilis assessed during pregnancy?
A
- Misdiagnosed:
A. Chancre often thought to be HSV - 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
16
Q
What is a common manifestation of syphilis during pregnancy?
A
- Polyhydramnios (excess amniotic fluid) is common
A. Serial USN during pregnancy if (+)syphilis
B. Pregnancy becomes high risk
17
Q
When are GC/Chlymydia tests done in prenatal care?
A
GC/chlamydia Cx @ 1st prenatal visit & 36 wk visit
18
Q
What is the transplacental infection risk for congenital syphilis?
A
- Transplacental infection risk of fetus → 60%-80%
- Untreated 1° or 2°→ syphilis usually transmitted
- Latent or tertiary syphilis usually not
19
Q
What is early congenital syphilis?
A
Birth to 2 yrs
20
Q
What is late congenital syphilis?
A
Greater than 2 yrs
21
Q
When do babies with congenital syphilis develop sxs? What are they?
A
- 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
22
Q
What is the optimal treatment to prevent congenital syphilis?
A
- Optimum treatment to mother prior to birth, before 16 weeks gestation
A. Procaine Pen G 50,000U/kg IM daily x 10 days - Tx does not reverse deformities already existing in the child
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
- False (+) may occur w/ other conditions due to low titre
A. Lyme disease
B. IV drug user
C. SLE
25
When should a pt be retested if you think they had a false negative syphilis test?
repeat 6 wks
26
What are the treponemal antibody tests? How do they work?
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
How are all stages of syphilis treated?
1. Pen G for all stages of syphilis
2. All sexual contacts should be treated
3. Repeat serology @ 6 &12 mo
28
What is the dose for treatment of early syphilis?
1. Early (1°, 2°, latent
29
What is the dose for treatment of late syphilis?
1. Late: (latent, tertiary):
| A. Pen G 2.4 M units IM weekly x 3 weeks
30
What is the alternative to Pen G for syphilis treatment?
Doxycycline 100 mg bid x 14 days
31
How long may neurosyphilis be dormant before it presents?
10-20 yrs
32
How is neurosyphilis treated?
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
How is syphilis treated in pregnancy?
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
What is type 1 HSV asst with?
1. Oral lesions
| 2. Most genital problems type II; can have type I in genital area
35
What is type 2 HSV asst with?
1. Genital lesions
| 2. Most genital problems type II; can have type I in genital area
36
True false: HSV affects fertility
False. does not affect fertility
37
How is HSV transmitted?
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
What is the incubation period for both HSV 1 and 2?
2-12 days, avg ≈ 4 days
39
How long do sxs last for both types of hsv?
~2-3 days
40
What is the prodrome that precedes an outbreak?
1. Flu-like syndrome (1° outbreak)
| 2. Burning, tingling , itchy sensation where outbreak will occur
41
What is the primary outbreak of HSV?
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
What are the sxs of a recurrent episode of hsv?
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
How can secondary infections of an hsv ulcer be prevented?
Good hygeine
44
How can frequent recurrent episodes be prevented?
Suppressive therapy
45
How is HSV diagnosed?
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
What are the potential complications from HSV? How are they treated?
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
How is HSV transmitted to children during pregnancy?
1. Transmitted to infants intrapartum
| 2. No transplacental transmission
48
How is HSV treated in pregnancy?
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
How does hsv 2 present in infants?
```
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
What is the treatment for hsv in infants?
Hospital admission: IV Antiviral therapy x 21 days
51
What is the prognosis for hsv in infants?
Can be fatal for infants-60% mortality rate
52
How can HSV be prevented?
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
When is hospitalization and IV antiviral tx indicated to treat hsv?
1. Severe primary outbreak
2. Severe H/A
3. Fever >102° F
4. Sick immunosuppressed pt
5. Urinary retention
54
How is the first episode of hsv 2 treated?
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
What is the treatment for recurrent episodes of hsv?
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
What is used for the suppression of hsv 2?
1. Valacyclovir (Valtrex) 500mg po daily ( 9 episodes/yr)
