Viruses / STD's

Question 1

At home treatment for warts

Answer 1

Salicylic acid 10-60% daily or twice daily for several weeks/months until clear

-keratolytic therapy thought to cause immune response from irritation

-cure rate of 50-70%

-tx is more effective if lesions soaked and paired with pumice stone between applications

Question 2

incubation time for molluscum

Answer 2

poxvirus in the epidermis for 6-8 weeks

Question 3

where does molluscum NOT occur on the body?

Answer 3

Palms

Soles

Rarely mucosal

Question 4

How to use podofilox in the treatment of molluscum?

Answer 4

2x daily for 3 consecutive days per week for up to 4 weeks

Question 5

Clinical presentation of HSV

Answer 5

Prodromal symptoms:
-hours to days prior to eruption
-pain, burning, tingling, pruritus

Lesion appearance:
-typically begins with vesiculopustular rash on erythematous base and progresses to ulceration and eventually crust in 5-8 days (in the absence of treatment)

Question 6

Systemic symptoms of primary HSV infection (may or may not have)

Answer 6

fever

malaise

HA

pharyngitis

lymphadenopathy

Question 7

Precipitating factors of recurrence of HSV infection (flare)

Answer 7

-immunodeficiency
-stress
-sunlight
-fever

-can also be reactivated by trauma to the area / dental procedures

Question 8

First line therapy for HSV

Answer 8

Oral antiviral

Question 9

FDA approved topical for genital herpes

Answer 9

acyclovir 5%

Question 10

For which patients is HSV suppressive therapy appropriate?

Answer 10

> 6 outbreaks a year

Question 11

Triggers for herpes zoster reactivation

Answer 11

-immunosuppression

-medications

-infections

-physical/emotional stress

Question 12

Clinical presentation of herpes zoster

Answer 12

Prodrome:
-1-3 days before outbreak in the SAME area
-itching, burning, paresthesia

Hallmark lesions are painful, unilateral, vesicular eruption on erythematous base

Typically single dermatome but can affect several

Lesions become eroded or hemorrhagic over the course of 3-4 days

Lesions crust or resolve in 7-14 days

Doesn’t cross midline

Question 13

what is positive “Hutchinson’s Sign” ?

Answer 13

vesicular lesions located on the tip of the nose

should raise flag of suspicion of ophthalmic nerve involvement which can be a threat to sight

immediately refer to ophtho

Question 14

When is a patient flaring from herpes zoster considered no longer contagious?

Answer 14

once the lesions have crusted (around 7-10 days)

Question 15

Treatment of choice for Herpes Zoster to decrease post-herpetic neuralgia and acute neuritis

Answer 15

Valacyclovir

Question 16

How is syphilis transmitted?

Answer 16

1. direct contact with a syphilis ulcer (sexual intercourse typically)
2. blood transfusion
3. transplacentally to fetus

Question 17

When does primary syphilis lesion present in relation to exposure?

Answer 17

10-90 days after exposure (average of 21 days)

Question 18

Clinical presentation of primary syphilis lesion

Answer 18

painless, asymptomatic papule followed by a chancre which is painless, shiny, round, firm, pink, punched out ulceration (few mm to few cm)

can be accompanied by bloody stool, rectal pain, some pain if secondary erosion occurs

b/l lymphadenopathy is common

typically lasts 3-10 weeks and resolves spontaneously

Question 19

What happens if primary syphilis goes untreated?

Answer 19

ALL patients will develop secondary syphilis

Question 20

When do clinical manifestations of secondary syphilis begin?

Answer 20

3-10 weeks after primary chancre

last 3-12 weeks then resolve spontaneously

Question 21

What is buschke - ollendorff sign?

Answer 21

Secondary Syphilis

Tenderness on palpation of lesions to palms and soles

Question 22

When does tertiary syphilis present?

Answer 22

Months - Years after secondary syphilis resolves

Question 23

What are the “nontreponemal” tests ?

Answer 23

VDRL

RPR

STS

Question 24

Next step if nontreponemal test reactive?

Answer 24

Order treponemal-specific tests (more specific but more expensive)

EIA’s
-FTA-ABS (most common)
-TPPA
-TP-EIA

CIA

Question 25

If RPR negative?

Answer 25

May be too early (primary syph) - usually neg in primary syph

If clinical signs consistent with primary syph, treat anyways with benzathine penicillin G

Question 26

If RPR positive but treponemal test neg?

Answer 26

Syph is unlikely

If patient is high risk, repeat RPR in several weeks

Question 27

Treatment for primary and secondary syphilis

Answer 27

Benzathine penicillin G 2.4 million units IM x 1 dose

Question 28

Treatment for tertiary syphilis

Answer 28

Benzathine Penicillin G 7.2 mil units IM administered as 2.4mill units IM weekly x 3 doses

Question 29

Post treatment plan after syph tx

Answer 29

Nontreponemal serology
-perform post tx to ensure 4 fold decrease in titer

Check VDRL or RPR every 3 months for the first year. Then every 6 months for the second year. Then annually.
-4 fold increase in titer indicates reinfection or treatment failure