Viral STIs

Question 1

Types of viral STIs

Answer 1

HPV, Molluscum contagiosum, herpes simplex 1 & 2, EBV, Human herpes virus 8, hepatitis viruses, HIV

Question 2

Which viruses predominantly cause dermatological symptoms

Answer 2

HPV, MC, HSV 1&2

Question 3

Pathophysiology of Herpes simplex

Answer 3

DNA viruses which establish latency in dorsal root ganglia, which can recur and are infectious for life.

Question 4

Diagnosis of Herpes simplex

Answer 4

Nucleic acid identification

Question 5

Which HPVs are high risk and oncogenic

Answer 5

Types 16 and 18

Question 6

Which HPVs are low risk and non-oncogenic

Answer 6

Types 6 and 11

Question 7

What do HPV 16 and 18 cause

Answer 7

> 95% SCC of cervix

Question 8

What do HPV 6 and 11 cause

Answer 8

> 90% external ano-genital warts

Question 9

What is monkeypox

Answer 9

Orthopox virus related to smallpox, cowpox, it is a DNA virus

Question 10

How is monkeypox transmitted

Answer 10

Contact with infectious rashes, scabs, bodily fluids, fomite, respiratory secretions

Question 11

Prodromal symptoms of monkeypox

Answer 11

Swelling of lymph nodes, muscle pains, headache, fever, followed by the development of rash, can cause a proctitis syndrome

Question 12

Incubation period of monkeypox

Answer 12

10-14 days, although asymptomatic carriage in the pharynx and rectum has been found in MSM

Question 13

What is the manifestation of molluscum contagiosum

Answer 13

Benign epidermal eruption of the skin

Question 14

Diagnosis of monkeypox

Answer 14

NAATs testing from lesion

Question 15

When can social contact resume in someone with monkeypox

Answer 15

When scabs have fallen off or protected by clothing

Question 16

How long are condoms advised for in monkeypox patients

Answer 16

12 weeks

Question 17

Cause of genital warts

Answer 17

HPV

Question 18

Common STI causes of genital lumps

Answer 18

Molluscum, warts, syphilis, scabies, LGV, herpes, monkeypox

Question 19

Transmission rate of genital lumps

Answer 19

Around 65% to susceptible partners

Question 20

Symptoms of anogenital warts

Answer 20

Usually little physical discomfort but irritation and soreness can occur, commonly at site of micro-trauma during sex

Question 21

Symptoms of internal genital warts

Answer 21

Distortion of urine flow, bleeding from urethra or anus

Question 22

What does treatment of genital warts depend on

Answer 22

Site
Number
Pregnancy status
Keratinised or non-keratinised

Question 23

Topical treatment options for genital warts

Answer 23

Podophyllotoxin 0.15% cream or 0.5% solution
Imiquimod 5% cream
Green tea extract 10% ointment (Cetaphem)

Question 24

Uses of podophyllotoxin

Answer 24

Local tissure necrosis so used on externally on non-keratinised warts. Not used in pregnancy

Question 25

Uses of imiquidmod cream

Answer 25

Stimulates immune response acting on keratinised and non-keratinsed warts. Not used in pregnancy

Question 26

Clinical treatments of genital warts

Answer 26

Cryotherapy, hyfrecation, excision - safe in pregnancy and internal warts. Very painful

Question 27

Which malignancies are associated with HPV

Answer 27

Cervical, vulval, penile and anal

Question 28

Non STI transmission of molluscum contangiosum

Answer 28

Routine physical contact or fomites

Question 29

When is MC most severe

Answer 29

In immunocompromised patients

Question 30

Appearance of molluscum contangiosum

Answer 30

Commonly 1-30 lesions at a time in clusters. Can become keratinised. Can affect almost any part of the body. Often asymptomatic. Usually regress spontaneously within months

Question 31

Treatment of MC

Answer 31

Often no treatment but educate. Can use podophyllotoxin, imiquimod or cryotherapy

Question 32

What may MC be a first indication of

Answer 32

HIV

Question 33

Diagnosis of MC

Answer 33

Clinical appearance, biopsy rarely

Question 34

STI causes of genital ulceration

Answer 34

Herpes, syphilis, LGV, chancroid, donovanosis, monkeypox

Question 35

What does HSV1 cause

Answer 35

Oro-labial herpes (coldsores) but now most common cause of genital herpes

Question 36

What does HSV2 cause

Answer 36

Used to be the most common cause of genital herpes but now most likely to cause recurrent anogenital symptoms

Question 37

Symptoms of genital herpes

Answer 37

Asymptomatic, local symptoms such as painful ulceration, dysuria, vaginal/urethral discharge, systemic symptoms of fever, myalgia, more common in primary infection

Question 38

How long does it take for infection of herpes to cause symptomatic episodes

Answer 38

2 days to 2 weeks (in one third of patients)

Question 39

What happens in the majority of patients who are infected with herpes

Answer 39

2/3 of patients have the virus lie latent in the dorsal root sensory ganglia

Question 40

What are the outcomes of reactivation of herpes

Answer 40

Symptomatic recurrent disease or asymptomatic shedding - both can cause transmission

Question 41

What does serology detect in HSV infection

Answer 41

HSV type specific antibody is detected, IgM is undetectable but IgG indicates infection at some point.

Question 42

Progression of herpes lesions

Answer 42

Erythema -> blisters no erythematous base with clear/purulent fluid -> ulcers -> scabbing -> healed skin

Question 43

Complications of herpes

Answer 43

Superinfection of lesions with candida or strep species (usually in second week) Autonomic neuropathy leading to urinary retention Autoinoculation to fingers and adjacent skin Aseptic meningitis Herpes proctitis

Question 44

Management of first episode of herpes

Answer 44

Supportive care Immediate antivirals within 5d of episode / while new lesions are forming - aciclovir 400mg TDS PO 5 days or valaciclovir 500mg BDPO 5 days

Question 45

Supportive care of herpes

Answer 45

Saline bathing, analgesia, topical anaesthetics

Question 46

Management of recurrent episode of herpes (episodic antivirals)

Answer 46

Early treatment is most effective (prior to papules) Aciclovir 800mg TDS 2 days Famaciclovir 1g BD 1 day Valaciclovir 500mg BD 3 days

Question 47

Management of recurrent episode of herpes (suppressive antiviral)

Answer 47

Aciclovir 400mg BD PO

Question 48

When is suppressive antiviral therapy used for herpes

Answer 48

>6 occurances pa, severe anxiety/morbidity, not controlled by episodic therapy, reduction of transmission

Question 49

Ways to prevent transmission of herpes

Answer 49

Condoms by 50%, suppressive antiviral by 50%, abstinence during recurences, disclosure

Question 50

How protective is the monkeypox vaccine thought to be

Answer 50

80%

Question 51

What are the three main tropical STIs

Answer 51

Chancroid - haemophilus ducreyi LGV - chlamydia trachomatis L1, L2, L3 Donovanosis - klebsiella granulomatosis