Viruses / STD's Flashcards
At home treatment for warts
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
incubation time for molluscum
poxvirus in the epidermis for 6-8 weeks
where does molluscum NOT occur on the body?
Palms
Soles
Rarely mucosal
How to use podofilox in the treatment of molluscum?
2x daily for 3 consecutive days per week for up to 4 weeks
Clinical presentation of HSV
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)
Systemic symptoms of primary HSV infection (may or may not have)
fever
malaise
HA
pharyngitis
lymphadenopathy
Precipitating factors of recurrence of HSV infection (flare)
-immunodeficiency
-stress
-sunlight
-fever
-can also be reactivated by trauma to the area / dental procedures
First line therapy for HSV
Oral antiviral
FDA approved topical for genital herpes
acyclovir 5%
For which patients is HSV suppressive therapy appropriate?
> 6 outbreaks a year
Triggers for herpes zoster reactivation
-immunosuppression
-medications
-infections
-physical/emotional stress
Clinical presentation of herpes zoster
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
what is positive “Hutchinson’s Sign” ?
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
When is a patient flaring from herpes zoster considered no longer contagious?
once the lesions have crusted (around 7-10 days)
Treatment of choice for Herpes Zoster to decrease post-herpetic neuralgia and acute neuritis
Valacyclovir
How is syphilis transmitted?
- direct contact with a syphilis ulcer (sexual intercourse typically)
- blood transfusion
- transplacentally to fetus
When does primary syphilis lesion present in relation to exposure?
10-90 days after exposure (average of 21 days)
Clinical presentation of primary syphilis lesion
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
What happens if primary syphilis goes untreated?
ALL patients will develop secondary syphilis
When do clinical manifestations of secondary syphilis begin?
3-10 weeks after primary chancre
last 3-12 weeks then resolve spontaneously
What is buschke - ollendorff sign?
Secondary Syphilis
Tenderness on palpation of lesions to palms and soles
When does tertiary syphilis present?
Months - Years after secondary syphilis resolves
What are the “nontreponemal” tests ?
VDRL
RPR
STS
Next step if nontreponemal test reactive?
Order treponemal-specific tests (more specific but more expensive)
EIA’s
-FTA-ABS (most common)
-TPPA
-TP-EIA
CIA
If RPR negative?
May be too early (primary syph) - usually neg in primary syph
If clinical signs consistent with primary syph, treat anyways with benzathine penicillin G
If RPR positive but treponemal test neg?
Syph is unlikely
If patient is high risk, repeat RPR in several weeks
Treatment for primary and secondary syphilis
Benzathine penicillin G 2.4 million units IM x 1 dose
Treatment for tertiary syphilis
Benzathine Penicillin G 7.2 mil units IM administered as 2.4mill units IM weekly x 3 doses
Post treatment plan after syph tx
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
