Viral STIs II Flashcards
What is the progression of symptoms for Herpes?
Macules, papules, vesicles, pustules, ulcers
How long do the herpes lesions last for?
about 3 weeks
In which sex are symptoms more severe for herpes?
Women
What is the prodrome for Herpes recurrent lesions?
tingling, pain
How long does it take for herpes lesions to heal?
7-10 days
True or false: neonatal herpes infections are usually fatal, but asymptomatic
False,
Lethal yes, but rarely asymptomatic
What is the primary infection of herpes?
First time ever exposed
Is herpes painful? Pruritic?
Yes, and yes
What are the associated symptoms of herpes?
Fever
Inguinal lymph nodes
Malaise
Are recurrent lesions of herpes more or less severe than the initial infection?
Less
What is herpetic whitlow?
Infection in the digits
What is herpetic labialis?
Cold sores
What are the two scary herpes infections?
keratitis
Encephalitis
Who is usually infection with herpetic whitlow?
Healthcare workers
What infants are at the highest risk of developing neonatal herpes?
in infants born to mothers experiencing a primary infection during delivery
Can herpes pass through the placenta?
No
What is the least severe neonatal herpes infection?
Disease localized to skin, eyes, mouth
What are the serious consequences of babies not treated for herpes?
Blindness
Microcephaly
Spastic quadraplegia
What are the symptoms of encephalitis neonatal herpes infection?
Szs
poor feeding
Bulging fontanelle
What fraction of neonate infections with herpes develop microcephaly? What is the mortality rate?
1/3
50% mortality
What are the symptoms of disseminated neonatal herpes infections? What is the mortality rate?
Depends on organs involved
80% mortality rate
Are c-section indicated for herpes?
Yes
What is the family of herpes virus? Enveloped? Genome?
Herpesviridae family
Enveloped
dsDNA genome
What is the target of antivirals for herpes?
HSV pol
Where does herpes establish a latent infection?
Sensory neurons
Which nerve is responsible for holding cold sore herpes on the face? Genitalia?
CN V
Sacral plexus
What are the two types of HSV? Which are each associated with?
1= oral lesions
2= genitalia
How is HSV transmitted?
Saliva
Sex
Lesion contact
What are people usually exposed to HSV 1 and 2?
1= <4 yo 2 = sexual activity
How do you diagnose HSV?
Lesion appearances
PCR/serology
Tzanck smear
What is the Tzanck smear? Which HSV viruses will this be positive for?
Seeing large, multinucleated cells
HSV 1 and 2
How can you detect a dendritic lesion in the eye d/t HSV?
Fluorescent dye
What is the treatment for oral lesions of HSV?
Not treated with antivirals
What is the treatment for genital herpes?
Oral antivirals
What is the treatment for neonatal herpes?
IV antivirals
What is the treatment for ocular HSV infections?
Topical antivirals
What are the treatment goals for HSV?
Shorten time
Increase recurrence time
Do antiherpetic drugs work in the latent stage of HSV infection?
No
What is the MOA of nucleoside analogues like acyclovir?
Viral DNA pol inhibitor by guanosine analogue
Are there many side effects of acyclovir? Why?
No, because it needs to be activated by a viral enzyme
What is the viral enzyme that is needed to activate acyclovir?
Viral thymidine kinase
What are the non-nucleoside inhibitors for HSV? MOA?Is an enzyme needed? How is it administered?
Foscarnet
Inhibitors of viral DNA pol
no enzyme needed, but more side effects
IV administration
What is the viral cause of genital warts?
HPV
What are the lesions associated with genital warts?
Hyperkerotitic , firm, exophilic papules
What are the symptoms of genital warts
Asymptomatic to itching, burning painfil
What are the three way cervical warts present?
Exophilic
Endophilic
Flat
How can you identify cervical warts?
Add acetic acid
What are the symptoms of respiratory papollomatisis of HPV?
Hoarseness
Stridor
Respiratory distress
What is the treatment for respiratory papillomatosis/laryngeal papillomas caused by HPV?
surgical removal
Is c-section helpful to prevent respiratory papillomatosis/laryngeal papillomas caused by HPV?
no
What is the family of HPV? Enveloped? genome?
Papvaviridae
Non-enveloped
dsDNA genome
Replication of HPV is closely associated with what property of the epithelial cells that it infects?
The differentiation status
What is the MOA of increased CA risk of HPV?
Increased expression of E6 and E7 via genome integration into host genome
What is E2?
Gene that regulates the expression of E6 and E7 (decreases)
What happens when E2 binds to E2BS? What happens in CA?
inhibits E6/E7 production
Integration into host cell genome, thus no regulation
What is the MOA of E6 and E7?
Inhibiting p53 and Rb respectively
What is the MOA of p53 and Rb?
Control cell cycle from G1 to S phase
When do precancerous lesions appear (what age)?
around 30 years
What age do cancerous HPV infections usually develop?
40ish yo
What is the progression of the histology of HPV?
CIN 1, CIN2, CIN3
What is the cytology progression of HPV?
LSIL, HSIL
How is HPV transmitted?
Sexually
Cuts/abrasions
What is the incubation period for genital warts?
3-4 months
How do you diagnose HPV?
Clinical appearance of warts
PCR if necessary
What are koilocytes?
Enlarged keratinocytes that contain irregular hyperchromatic nuclei surrounded by a halo in a pap smear
Which serotypes of HPV have PCR dection?
16, 18, and 12
What is the treatment for gential warts caused by HPV?
cryotherapy
CO2 laser
What is the treatment for low grade neoplasms caused by HPV?
get wart off
What is the treatment for high grade neoplasms caused by HPV?
Hysterectomy
Radiation
Chemo
What are the prevention techniques for HPV?
Pap smears
HPV vaccine
What are the two vaccines for HPV?
Gardasil
Cervarix
What are the serotypes that Gardasil protects against? Cervarix?
Gardasil = 6, 11, 16, 18 Cervarix = 16, 18
Which HPV vaccine should males get?
Gardasil
Which HPV serotypes cause laryngeal papillomas?
6 and 11
Which HPV serotypes cause anogenital warts?
6, 11, 16, 18, 31, 33,
Which HPV serotypes cause common warts?
2, 3, 10
Which HPV serotypes cause plantar warts?
1, 4
Which HPV serotypes cause carry a high risk of CA development?
16, 18, 31, 33
Which HPV serotypes cause carry a lower risk for CA development?
6, 11
What is an “initial genital infection” with herpes? Primary infection?
Initial genital = had before, but not in genitalia
Primary = first time exposure
What are the three types of neonatal infections of herpes?
- Localization to skin, eyes, mouth
- Encephalitis
- Disseminated
Are neonatal Herpes infection localized to the skin, eyes, and mouth lethal?
No
What is the mortality rate for disseminated neonatal herpes infection? Complications?
80%
HSV pneumonitis
Disseminated intravascular coagulation
Can HSV cross the placenta?
No
What part of the epithelium does cervical neoplasia have to breach to be considered invasive squamous cell carcinoma?
Basal membrane
What do the HPV vaccines contain as the active compound? How is this produced?
L1 capsid
Produced through yeast