Derm - 3-23 - Viral Infections And Stds

Front 1

Warts regress?

Back 1

Yes - very commonly they spontaneously regress bc of cell mediated immunity.

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Warts caused by...

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HPV - affects skin and mucous membranes.

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HPV - oncogenic types

Back 3

16 and 18 are the main ones. Cervical CA

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HPV - Benign types

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6 and 11 are the main ones. Can cause anogenital warts.

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Immunity/vaccines to HPV

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Only to certain subtypes - so it doesn't affect other subtypes.

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Histo of warts

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papillomatous hyperkeratotic surface

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Clinical pres of a wart

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Can be on nail, mosaic pattern, black dots (thrombosed capillary loops).

No roots - projects into the dermis.

hyperkeratotic surface (making lots of keratin), papillomatosis (epidermis overgrows), mosaic surface pattern, punctate micro hemorrhages.

Front 8

Seborrheic keratosis

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Benign skin growth. Likes like melanoma, mole, wart, etc.

NOT VIRAL!!!

Most common growth of adults.

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Spreading of warts

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often a minor scratch can let the virus get access to basal layer and it begins replication.

easily spread (shaving, picking at them on nails, etc.)

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Plantar warts

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appear as a callus or corn

if painful, treat it. but don't have to if not painful (bc painful to tx it).

if there are many, only need to tx a couple of them. they can spont. resolve (turn black and soft)

punctate microhemorrhages

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Corn

Back 11

a special kind of callus due to repeated friction/pressure.

painful to walk on. very firm. on feet.

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Digitative wart

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certain type of morphology of a wart. looks like raised crystals.

easy to get rid of these.

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plane or flat warts

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hard to get rid of.

easily spread with shaving. can spont regress.

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Genital warts

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typically more shiny and rare to see only one.

can be anywhere in genital tract

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Pearly penile papules

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NOT A WART.

an anatomic variant (Benign). in differential for genital warts.

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anal warts

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if in child, consider abuse. but it isn't always abuse...

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HPV prevalence in US is..

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high!!!

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Cycle of HPV

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most is cleared by body but if it goes into latent phase (a high risk type), can result in cervical CA

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Gardasil

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for only certain HPV strains and needs to be done before HPV exposure!

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Digene HPV test

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do it on material from Pap.

determines presence of high risk HPV type.

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Molluscum Contagiosum

Back 21

A pox virus.

Viral infection of skin - tough to get rid of.

Looks like small doughnuts (umbilication in center)

Easily spread and toughest to get rid of in atopic pts (presents in their popliteal fossas)

with time, they look like inflamed boils due to cellular immunity.

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Viral exanthem

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exanthem means the blossoming of a rash (usually all over the body)

looks like a drug rxn

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Fifth disease - erythema infectiosum

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a type of exanthematic infection

slapped cheek appearance first then a net-like lacy pattern (almost pathognomic except lupus).

due to parvovirus B19. fetal infection can cause death. - CAN BE ASSOCIATED WITH APLASTIC ANEMIA

polyarthropathy.

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Hand foot and mouth disease

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causes anorexia in children.

an exanthem. caused by Coxsackie

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Herpesviridae viruses

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Herpes simplex 1

Herpes simplex 2

Herpes varicella-zoster

Epstein-Barr virus

Cytomegalovirus

Herpes virus-6 (causes roseola infantum)

Herpes virus-8 (causes Kaposi's sarcoma)

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Herpes virus - who spreads it?

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mostly from asymptomatic individuals!!!!!

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HSV-1 general

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NON-GENITAL

Gingivostomatitis
Intraoral
perioral


Mostly orolabial (cold sores and fever blisters)

can get primary genital herpes

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HSV-2 general

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GENITAL

mostly genital herpes and oral infec is rare.

>95% of recurrent genital herpes.

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evolution of herpes lesions

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vesicles then umbilicated pustules then crusts then black crusts.

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grouped vesicles on erythematous base

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usually herpes. especially if umbilical

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Things that can reactivate HSV cold sores

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sun, skin trauma, cold/heat, stress, infection, menstruation

but the antibody levels dont change during recurrences

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When do you get prodrome with herpes 1?

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primary infection, but not before recurrence

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Area of primary vs recurrent herpes-1

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recurrent - smaller area affected but still groups of vesicles.

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cutaneous herpes simplex

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can be on any skin surface
HSV-1
recurrence is where the primary lesion was.

grouped monomorphic vesicles

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herpes-associated recurrent erythema multiforme

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cutaneous rxn to drugs. targetoid lesions.

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Herpes in immunocomp pts

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it is more common in that group

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Eczema herpeticum

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in pts with herpes simplex and atopic dermatitis

very painful

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Tzank prep

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looks for keratinocytes and multinuc giant cells which is typical for herpes.

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HSV-2 findings (primary)

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scattered vesicles and ulcerates.

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Causes of genital ulcers

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Herpes simplex
Syphilis
Chancroid
Scabies
Candidiasis
Trauma

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Prodrome for recurrent HSV-2?

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yes

grouped vesicles again.

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most prev STD in developed world

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herpes.

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most pts with herpes...

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are asymptomatic!!!!

growing in older pts bc of viagra.

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HSV-2 risk

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women more likely to be infected

men are more effective transmitters.

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definition of subclinical HSV shedding

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culture is positive and there is no lesion.

Most with genital HSV2 shed. uncommon in HSV1.

Occurs about 1-10% of days.

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Dx of HSV-1 or 2

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culture, blood test, PCR

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Tx of HSV1 or 2

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acyclovir, famciclovir, valacyclovir.

for some people, tx episodically during prodrome. or more intense with new relationship or on vacation...

Front 48

Herpes Zoster (shingles)

Back 48

this is the recurrent infection of the varicella-zoster virus.

the primary infection is chicken pox.

uusally in older pts in a couple dermatomes. especially in pts with low CD4 counts (HIV, leukemia, HL or NHL).

More likely in whites vs. blacks

if thoracic, can present like an MI

groups of vesicles on a red base.

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diff btwn lesions of zoster vs. herpes simplex

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zoster - lesions vary in size

simplex - same size

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Syphilis general info

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trepenoma pallidum (spirochete)

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Primary syphilis

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21 day incubation

clean PAINLESS hard scabs (chancre)

feels firm like cartilage.

get scars and lymphadenopathy

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Secondary syphilis

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flu-like syndrome.

hepatomegaly and adenopathy

different types of lesions on skin

reddish brown hue that slightly scales

copper pennies on hands

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different btwn psoriasis and secondary syph

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can rub off the organisms with syphilis. (inflammatory)

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secondary syph can look like...

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herpes in an atopic pts or impetigo.

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Condylomata lata

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warts on genitals due to secondary syphilis.

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Gonorrhea

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G (-) diplococci

classically see arthritis and dermatitis. large joint arthritis with hemorrhagic pustules on fingers.

purulent urethral discharge

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lymphogranuloma venereum

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C. trachomatis

Groove sign (linear depression parallel to inguinal lig due to adenopathy) and labial edema.

can cause elephantiasis

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chancroid

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H. ducreyi (gram (-) rod)

highly infectious ulcers

"kissing lesions"

common in prostitutes, homosexual men, etc.

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Difference btwn chancroid and syphilis lesion

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Chancroid - looks dirty, painful, ragged, purulent, not indurated.

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Granuloma inguinale

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C. granulomatis (g (-) rod)

painless beefy red lesions.

pseudo-elephantiasis of the labia.

Parasitizes histiocytes.

Beefy, red, looks like granulation tissue.