VII- Viral STI HPV and HSV

Question 1

clinical pres of genital HSV

Answer 1

lesions in sex organ areas
-painful grouped macules > papules > vesicles > pustules > ulcers + fever, inguinal adenopathy, malaise

will recur more discreetly and cause vulvar irritation, tingling, pain

more severe in women

Question 2

clinical pres of neonatal HSV

Answer 2

1. lesions localized to skin, eyes, mouth 10-11 days after birth + recur often in first 6 mo
   -if untreated then blindness, microcephaly, spastic quadriplegia
2. encephalitis with or without lesions so poor feeding, seizures, lethargy, bulging fontanel
3. disseminated lesions in viscera and skin so respir distress, jaundice, shock, DIC, pneumonitis

Question 3

transmission of HSV

Answer 3

1. direct contact with lesions
2. saliva
3. sexual transmission for genital

HSV-1 more oral lesions, 2 for genital

Question 4

HSV prevention

Answer 4

1. for neonates: physical exam, C sections, ward precautions if staff has herpetic whitlow or orolabial lesions

Question 5

HSV treatment

Answer 5

1. for neonates: IV admin of antivirals for all cases
2. oral lesions self limit and not need antiviral
3. genital herpes: oral antiviral for primary + long term if recurrent
4. ocular: topical AV

Question 6

herpesvirus antiviral mechanism

Answer 6

phosphoylation of viral thymidine kinase leads to inhibiting viral DNA polymerase
-acyclovir, famciclovir, valacyclovir

Question 7

common mutations in acyclovir resistant infections HSV

Answer 7

thymidine kinase so resistant virus are TK-

Question 8

treating acyclovir resistant HSV

Answer 8

use foscarnet bc no HSV phosphorylation needed > still inhibits viral DNA polymerase
-nonnucleoside inhibitor

Question 9

latent vs lytic HSV

Answer 9

latent if virus in sensory neuron ganglia (sacral for genital or trigeminal for cold sores)
-can have spontaneous reactivation to lytic

Question 10

HPV mechanism in cervical cancer

Answer 10

shifts from genome amplification and virus production to genome integration and cancer cells via in E6 and E7 expression

Question 11

HPV E6

Answer 11

will inhibit p53 so impact apoptosis and cellular senscence

Question 12

HPV E7

Answer 12

will inhibit Rb so impact cell cycle progression into replication phase (G1 to S)

Question 13

common HPV types in genital warts

Answer 13

either high risk: HPV 16, 18, 31, 33
or low risk: HPV 6, 11

for mucosal specifically

Question 14

common HPV in laryngeal papillomas

Answer 14

HPV 6, 11
same as low risk genital

Question 15

common HPVs in cervical cancer

Answer 15

majority HPV 16 > 18 > 31, 33, 45

Question 16

transmission of HPV genital warts

Answer 16

sexually transmit via cuts and abrasions for entry
-incubate for 3-4 months

Question 17

diagnosing HPV genital warts

Answer 17

clinical appearance sufficient
-histological markers of hyperkeratosis and koilocytes
-PCR for detecting high risk strains

Question 18

treating HPV genital warts

Answer 18

1. self admin- podophyllotoxin, sinecatechins, imiquimod
2. clinician admin - cryotherapy, surgery, laser, interferon

if low grade = cauterize, cryo, laser, surgery loop excision
if high grade = radiation, chemo, hysterectomy

Question 19

HPV vaccine guidelines

Answer 19

-routine for kids 11-12, 2 doses
-catch up for indivs up to 26 not previously vac, 3 doses for age 15-26
-consider for 27-45 based on risks

Question 20

how HPV vaccine generated

Answer 20

made in yeast
-from viral capsid protein L1

Question 21

pres of genital warts HPV

Answer 21

hyperkeratotic, firm, exophytic papules + itching/pain/burning

if cervical then can be exophitic, endophytic, or flat