Viral STIs (and Syphilis) Flashcards
What are the two types of HSV and what do they cause?
HSV1 = usual cause of oral disease, most common cause of genital disease now
HSV2 = more likely to cause recurrent anogenital symptoms
Recurrence rates for HSV subtypes?
HSV1 = approx 1 per year HSV2 = approx 2 per year
Recurrence rates tend to decrease over time
How does herpes present?
Tender left groin lymph node
Shallow uclers underneath foreskin
Recurrent outbreaks limited to infected dermatome - can be asymptomatic but can still shed the virus
Life cycle of HSV?
Primary infection –> latent virus in local sensory ganglia
REACTIVATION –> viral shedding (asymptomatic) or outbreak/recurrence (symptomatic)
Viral shedding occurs more commonly in first year of infection and in those with frequent outbreaks
Treatment for HSV?
Salt water bathing
Topic anaesthetic/oral analgesia
Aciclovir 400mg TDS for 5 days
How is HSV transmitted?
Direct contact with mucous membrane or skin. Most infections acquired subclinically
How to counsel someone about possibility of passing on HSV
Virus is now latent in sensory ganglia - most infectious during recurrence but asymptomatic viral shedding also occurs.
Condoms reduce transmission, avoid sex during recurrences
Advise disclosure
Causes of lumps?
Pearly penile papules - physiological Papillae on vulva - physiological Sebaceous cysts - benign and not painful Fordyce spots - physiological Folliculiits - shaving rash - normal
What is molluscum contagiosum - how is it managed?
Self-limiting infection caused by poxvirus
Clinical diagnosis
Treatment = watch and wait –> cryotherapy, currette, enucleation, podophyllotoxin
What are genital warts?
Flesh coloured skin lesions caused by infeciton with HPV
Multi-centric - not limited to initial site of inoculation
Caused by subtypes 6 and 11
How are genital warts transmitted?
HPV gains entry to basal epithelial layer through small abrasions in skin during sexual contact
6 and 11 can be transmitted via oral-genital contact
Infection unlikely to occur from digital-genial contact
Incubation period of genital warts?
Median = 3 months
Can be as short as 3 weeks or as long as 2 years.
Likely to have acquired HPV from asymptomatic partner (current or previous)
If in long-term relationship partner likely to be infected already
How long do genital warts last?
Most resolve by 3 months with appropriate treatment
Median duration of HPV DNA detectability in genital skin is 1 year
When are genital warts most infectious?
When warts visible - viral transmission can occur from sub-clinical lesions and from latent infection.
Condoms reduce transmission but do not eliminate it.
Treatment for genital warts?
Ablative - cryotherapy, podophyllotxin cream (teratognic), electrocautery
Immune modulation - imiquimod cream
Surgical - curettage, excision, debulking
Smoking cessation
