Habif Chapter 11 Sexually Transmitted Viral Infections Flashcards

Human papillomavirus
Terms Definitions
Genital Warts
HPV 6, 11, 16
Genital cancer, subclinical infection
HPV 16, 18
Bowenoid papulosis
HPV 16
Buschke-Lowenstein Tumor
verrucous carcinoma
large wart
locall aggressive rare mets
HPV 6, 11
Genital warts or herpes mc?
warts
mc STD
genital warts
HPV infection inceidence
30 to 50% sexually active
1% to 2 % clinical anogenital warts
transmission HPV?
decrease with condoms
rare vaginal delivery
Condyloma aquminata
venereal warts
no hypereratosis
discrete nearrow projections
moist areas
broad base

smooth small papular do not repsond as well to topical tx
mc area oral condyloma?
tongue

50% patients with multiple widesspread who had oral sex also had oral lesions
asymptomatic need manification to see
mutliple small white or pin papules sessile or pedunculated papillary growth wih filiform
HPV 16, 18, 6, 11
Pearly penile papules
corona
shaft just proximal to corona
10% males
angiofibromas
Imiquimod
Aldara
podofilox
Condylox
Genitoanal HPV?
HPV 6, 11, 16, 18
cervical cancer
HPV 16 (84%), 18 (8%)of genital tumors
HPV in normal tissue?
yes
HPV 16 2 - 5 cm
HPV cancer?
squamous anal cancer
Podophyllin and podofilox preg?
genital papillary lesions during preg?
no podophyllin or fodofilox during preg
genital papillary lesions profliferate firable during preg
laryngeal papillomatosis infants
HPV 6, 11
route unknown
infants via vag and c-section
HPV c-section?
no
yes rate if pelvic outlest obstructed or vag delivery bleeding
kids tx?
spon resolution 5 years
ok no tx
imiquimod
aldara
induces cytokines, interferon, tnf, il-6, il-8, il-13
enhances cell-mediated cytolytic activity against HPV
preg not studied
podofilox
podophyllotixin
main cytotoxic ingredient of podophyllin
condylox
BID x 3 days then 4 days off repeat 4 to 6 wees
no perianal, vaginal, or urethral
no preg
cyrotx preg genital warts?
2nd and 3rd trimester
trichloracetic acid
trichloroacetic (TCA) and bichloracetic acid (BCA) then water or bicarboneate of soda
HPV
ok preg
podophyllum resin
cells arrest in mitosis leading to tissue necrosis
moist warts, large surface area , many surface projections
not effective in dry areas (scrotum, penile shaft, labia majora)
no cerivcal vaginal, or intraurethral warts
apply then rinse 1 hr then in 1 week
only large warts on perineal or rectal area
podophyllum resin systemic toxicity
paresthesia, polyneuritis, paralytic ileus, leuopenia, thromobytopenia, coma, death
no preg
podophyllum histo?
can produce atypical squamous cells
tell path
5-flurouracil cream
cara
Efudex
Carbon Dioxide Laser
treatment of choice preg womene fail TCA treatment
large warts
isotretinoin
accutane
intron-a
inerferon alfa-2B recombinant
base of eleison
Alferon N injection
interferon alfa-n3
base of lesion inject
bowenoid papulosis
uncommon
young adults
vulva and circumcised penis
hiso similar to bowen's
30 men and 32 women
spon regerss
invasive carcinoma rare
asymptomatic discrete red violaceous borwn coalescent smooth velvety surface
bilateral hyperpig
autoinoculation
HPV 16 women
bowenoid papulosis women HPV?
HPV 16
molluscum contagiousm
RNA or DNA?
double or single stranded?
replicates where?
family?
latency?
protection from immune system?
double stranded DNA
replicates in cytoplasm [email protected]
POXIVIRDAE
no latency
protective sac protects from immune system
HSV risk factors?
women, homosexual men, blacks
HSV primary lesion umbilicated?
yes
HSV genital scarring?
no
primary vs non-primary first time infections
primary sero-neg
non-primary not sero-neg (prior infection with HSV1 or HSV2 at another site)
HSV pharynx
HSV first-episode 10 to 15% also have pharynx infection with primary infection oral sex
HSV timeline primary infection
6 days s/p sex
2 - 3 days umbilicated then erode
1 - 2 weeks crusts heal
scars if a lot of inflammation
DC, syuria, LAD common
70% fever, lethargy, photophobia (MC in women)
may not be painful or multiple
cerivx in most patients
erosive cervicitis
no vesicles under foreskin or moist vulva or vagina (recurrent infections)
no crusts under foreskin
HSV > 10 recurrences Men or Women mc?
Men (26%) > women (14%)
lowest recurrence HSV 1 or 2 anal or oral?
HSV-2 oral
definitve dx of HSV?
active lesions
recurrent infections 50% neg culture
vesicles and wet erosions
use vesicle fluid
tzank smear
HSV
multinucleated giant cells
HSV-1 serology oral or genital?
could be both oral or gential
HSV-2 serology oral or genital?
genital
POCit HSV-2
in office HSV-2 capillaries or serum
6 minutes
neonatal herpes HSV-1?
30% neonatal herpes
HSV increase risk for HIV?
CD4+ cells in erosions
HSV-1 or HSV-2 genital greater recurrences?
HSV-2
HSV-1 first-episode genital
10 - 30% genital first episode
neonatal herpes
asymptomatic or symptomatic mothers?
asymptomatic primary infection third trimester cervical shedding
time?
detected early by?
skin, eye, mouth (17%)
SEM (2)
CNS 32%)
encepthalitis
disseminated hapatitis, pneumonitis, intravas coagulaopthy, CNS
minority no viesciles
days 1 to 7
delay in dx
dx culutre blood, spinal fluid, urine, eyes, nose, mm
PHARYNGEAL SWABS earliest(days 2 to 5 days)
mortality neonatal herpes
57% dissemeninated visceral
15% encepalitis
HIV
DNA or RNA
single or double stranded?
retrovirus
positive sranded RNA and use DNA polymerase enzyem reverse trnascriptase convert viral RNA to DNA
CD4+ T [email protected]
cellular immunity
incubation unkown 3 to 6 weeks
acute mono like syndrome (maculopapular eruption) last s8 to 12 days
seroconerstion 1 week to 3 months
dx ELISA and confirm with Wesern blot ab test
+/- p24 ag, DNA tests, HIV culture
HIV RNA PCR measure virus
T cell [email protected] catagories
Category 1: > 500 cells/cc
Category 2: 200 to 499 cells/cc
Category 3: < 200 cells/cc
HIV highest frequency of cutaneous disoders CD4?
100 cells/cc
Oral hairy leukoplakia
approx 500 cells/cc
Thrush, anemia, thrombocytopenia, hypergammaglobulinemia, neuorpenia, fever, fatigue
CD4?
Approx 600 cells/cc
HIV ab begins to decrease
CD4?
Approx 300 cells/cc
Partial or complete cutaneous anergy CD4?
Approx 350 cells/cc
Opportunistic infecions CD4?
< 100 cells/cc
Kaposi's sarcoma
Approx 80 cells/cc
Wasting, fever, diarrhea, weight loss CD4?
approx 50 cells/cc
Cutaneous presenting dx HIV?
pruritic papular rash 11.4%
Herpes Simplex 10.8%
Kaposi's sarcoma
Molluscum contagiosum
condyloma acuminatum
seb derm
drug
xerosis
eosinophilic folliculitis
tinea
verruca vulgaris
scabies
bacerial cellulitis
syphilis
psoriasis
zoster
nonmelaonma sin cancer
highest CD4 counts cutaneous HIV?
zoser and drug reactions
dark blue nails med?
zidovudine
Hairy Leuoplaia
Epstein-barr Virus
whitish nonremovalble verruccous hariy plaque on sides of nogue
bx acanthosis and parakeraosis with alrge pale staining cells with pynotic nuclei
HIV onychomycoses
proximal subungual onychomycosis
Cyrptococcus neoformans
rare HIV
white papules similar to molluscum conagiousm
Histoplasam capsulatum
rare
multiple papules, nodules, macules and oral and sin ulcers on arms, face runk,
travel to South America
BX PAS Stain
crushed tissue prepartation rapid dx
cx several wees
Penicilium marneffei
SE AAsia
feer, anemia, wt los, molluscum lie papuels cough LAD, heaptomegaly
culture sin blood bm
sin torch prep
yeast forms with central septae
Yellow nails HIV
nail plate yellow
asoc with penumocystis carinii pneumonia
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