Buxton 11-19-07 Microbial Causes Of Genital Ulcers Or Growths

Front 1

Causes of genital ulcers

Back 1

Treponema pallidum- syphilis
Haemophilus ducrei- chancroid
Herpes simplex viruses-genital herpes

Front 2

Causes of Genital Growths

Back 2

Human papilloma viruses- genital warts

Front 3

For each organism, describe the :
Microbiologic characteristics
Epidemiology
Pathogenesis and immunity
Disease associations and clinical manifestations
Diagnosis
Treatment
Prevention

Back 3

Objectives

Front 4

Etiologic agent of Syphilis

Back 4

Treponema pallidum

Front 5

State with the highest syphilis infection rate (2005)

Back 5

GA

Front 6

Primary and secondary syphilis is more common in men age ____ yr

Back 6

20-55

Front 7

Secretion of ______ allows t. pallidum to migrate into tissues, and into blood stream

Back 7

hyaluronidase

Front 8

T pallidum coats itself with host ______ to avoid phagocytosis

Back 8

fibronectin

Front 9

What stage of syphilis is this?
Regional lymphadenopathy
Ulcer (chancre) formation at site of initial infection

Back 9

Primary syphilis

Front 10

painless chancre of primary syphilis heals with what treatment?

Back 10

no treatment
heals in 2-6 weeks

Front 11

What features are noted in secondary syphilis?

Back 11

Fever
Generalized rash including palms and soles
Rash is highly variable (macular, papular, pustular, or mixed)
Lesions contain organisms
Malaise
Myalgias and arthralgias
Lymphadenopathy

Front 12

Quickly describe the appearance of Condylomata lata

Back 12

Knob-like or warty papular lesions

1-3 cm in diameter

Front 13

Secondary syphilis

~____% spontaneously clear body of organism

Back 13

~30% spontaneously clear body of organism

Front 14

Define "late phase" latent syphillis

Back 14

Defined as seroreactivity, in the absence of symptoms, greater than 2 years after infection


Early phase
Primary or secondary syphilis acquired or diagnosed during preceding year

Front 15

The inflammatory lesions of tertiary syphilis are called _____

Back 15

gumma

Front 16

Gumma cause local destruction of the affected organ system.
Organ system most often affected
are what?

Back 16

Cardiovascular
Musculoskeletal
CNS

Front 17

Describe a musculoskeletal issue found with tertiary syphilis

Back 17

Charcot joint
Bone overgrowth and instability of joints

Front 18

describe cardiovascular disease associated with tertiary syphillis

Back 18

endarteritis of the aorta, subsequent medial necrosis, aortitis, and aneurysm formation

Front 19

describe neuro issues with tertiary syphillis

Back 19

Neurosyphilis
Syphilitic meningitis, meningovascular syphilis, or parenchymatous neurosyphilis.
Tabes dorsalis

Front 20

Laboratory Diagnosis of Syphilis

Culture shows what?

Back 20

nothing. no culture

Front 21

most common way to make syphilis diagnosis?

Back 21

Serology
Non-treponemal antibodies
Treponemal antibodies

Front 22

How would you visualize t. pallidum?

Back 22

Darkfield
Direct fluorescent antibody

Front 23

******
there are 2 tests used for screening syphilis. what are they?

Back 23

VDRL
venereal disease ref lab
RPR
rapid plasma reagin (red tube)

Must be followed by specific tests to look antibodies to T. pallidum

Front 24

Patients with syphilis make antibodies that react with a lipid (cardiolipin) found on mitochondrial membranes. What are the other conditions that will make cardiolipin Abs?

Back 24

SLE, pregnancy, others

Front 25

What are 2 tests to Test for antibodies to T. pallidum in the patient’s serum

Back 25

FTA-ABS- fluorescent treponemal antibody absorption
MHA-TP- microhemagglutination assay for T. pallidum

Front 26

Treatment
Primary and Secondary syphilis

Back 26

Benzathine penicillin G IM in a single dose

Front 27

Treatment
Early Latent syphilis

Back 27

Benzathine penicillin G IM in a single dose

Front 28

Treatment
Late Latent Syphilis

Back 28

Benzathine penicillin G IM 3 doses (1/week)

Front 29

Follow-up

Back 29

Repeat VDRL or RPR should be done at 3, 6 and 12 months
If adequately treated, VDRL or RPR becomes non-reactive
Treatment failure can occur and may be due to lack of penetration of drug into CNS
Organisms enter CNS early in infection

Patients who have signs or symptoms that persist or recur or who have a sustained fourfold increase in nontreponemal test titer (i.e., compared with the maximum or baseline titer at the time of treatment) probably failed treatment or were reinfected. These patients should be retreated and reevaluated for HIV infection.

Front 30

Where does HSV replicate?

Back 30

nucleus of epithelial cells

Front 31

____% of adults in US are infected with HSV-1

Back 31

70

Front 32

____% of adults in US are infected with HSV-2

Back 32

20-35

Front 33

Where does HSV reside in latency?

Back 33

ganglia

Front 34

Signs of a symptomatic genital infection with HSV

Back 34

Constitutional signs
Pain
Urethral, vaginal discharge
Fever
meningitis
Genital lesions

Front 35

Recurrences of HSV are lessened by strong _______ immune response

Back 35

cellular

CD4, CD8 cells

High antibody titer does not prevent recurrences

Front 36

Comparison of Primary, Non-Primary and Recurrent Genital Herpes

a)Lesions
b)Symptoms
c)Days /lesions
d)Days/
shedding

Back 36

Primary, Non-primary, Recurrent

a)Multiple, Several, 1-2
b)Present, Present mild, absent
c)21, 14, 7
d)15-20, 10, 5

Front 37

Diagnosis of Genital HSV

Back 37

Clinical appearance
Virus isolation with typing
Viral antigen detection
Serology with typing

Front 38

Antiviral drugs prevent

a)latency
b)recurrences
c)transmission
d) all of the above
e) none of the above

Back 38

none

Front 39

Antiviral drugs- Acyclovir, Valacyclovir, Famciclovir

Back 39

Acyclovir,
Valacyclovir,
Famciclovi

Front 40

bug causing Chancroid

Back 40

Haemophilus ducreyi

Front 41

Haemophilus ducreyi Papule progresses to painful ulcer with tender ____ lymphadenopathy

Back 41

inguinal

Front 42

How's the skin lesion chancroid different from syphilis?

Back 42

it is tender

Front 43

How do you diagnose Haemophilus ducreyi chancroid

Back 43

Diagnosed by ruling out syphilis and genital herpes

Front 44

treatment of Haemophilus ducreyi chancroid

Back 44

Azithromycin
Ceftriaxone
Ciprofloxacin
Erythromycin

Front 45

What type of virus is genital warts (family papovavirus, genera papillomavirus)

Back 45

Ds DNA; nonenveloped

Front 46

Papillomavirus are causitive agents of benign _____cell lesions that can occasionally progress to carcinomas

Back 46

squamous

Front 47

By age 50, ___% of women acquire genital HPV infection

Back 47

80

Front 48

How is HPV virus spread?

Back 48

Spread by direct contact

Front 49

HPV ___ and ___ lead to condyloma

Back 49

6, 11

Front 50

HPV ___ and___ can cause malignant lesions

Back 50

16 and 18

Front 51

Pre-Malignant lesions casused by HPV

Back 51

Flat condyloma
CIN

Front 52

Benign lesions caused by HPV

Back 52

Condyloma accuminanta

Front 53

Pap Smear may show _________ (cells) indicative of HPV infection

Back 53

Koilocytes

Front 54

Topical Treatment of HPV

Back 54

Podophyllin
Salicylic acid
Trichloroacetic acid

Front 55

Surgical treatment of HPV

Back 55

Laser,cryosurgery, cauterization, traditional

Front 56

Immunomodulation med that Stimulates IFN secretion, promotes Th1 cell inflammatory response

Back 56

Imiquimod

Front 57

The quadrivalent vaccine, Gardasil®, protects against four HPV types (6,11,16, 18), which are responsible for 70% of cervical cancers and 90% of genital warts.
Who can get get the vaccine?

Back 57

Recommended for 11-12 year-old girls, but can be administered to girls as young as 9 years of age. The vaccine also is recommended for 13-26 year-old females who have not yet received or completed the vaccine series