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158 Cards in this Set
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Causes of genital ulcers
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Treponema pallidum - syphilis
Haemophilus ducrei - chancroid Herpes simplex viruses - genital herpes |
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Causes of Genital Growths
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Human papilloma viruses - genital warts
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What is the etiologic agent of syphilis?
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Treponema pallidum
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What is the Microbiologic Characteristics of Treponema Pallidum?
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In the Order Spirochaetales
It is Gram Negative and spiral-shaped bacteria. It is hard to visualize under light microscope because cell wall is too thin to pick up enough stain. |
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What are the important members of the Order Spirchaetales?
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Leptospira
Borrelia Treponema |
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What is the Epidemiology of Syphilis?
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-Rate of Infection has declined since 1990; but is currently increasing
-Infection rates vary geographiclly in the US -Rates of syphilis vary with race/ethnic group. -Rates of syphillus vary with age and gender |
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Where are the highest rates of syphilis infection?
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GA, LA, NV, CA, FL, IL
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What is the national average rate of infection in the U.S.
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3 per 100,000
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What is the rate of syphilis infection in GA?
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7.3 per 100,000 according to 2005 data
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What race/ethnic group has the highest rate and increase of syphilis infection.
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African Americans have the highest rate and increase of syphilis infection
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What is the rate of syphilis infection in men?
Women? |
In men the rate is 5.1 per 100,00
In women the rate is 0.9 per 100,000 |
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What gender & age group is primary and secondary syphilis most common?
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In men aged 30 - 44 yrs
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Where is the rate of syphilis infection increasing most
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Rates of syphilis are increasing most rapidily in men, especially in MSM (Men having sex with Men)?
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Rate of Infection has decline since 1990 but is currently increaing
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~ 24 per 100,000 in men &15 per 100,000 in women in 1990
to ~5 per 100,000 in men & women in 2000 to earlier numbers. |
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How is syphilis transmitted?
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It is transmitted by sexual contact
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How does Treponema Pallidum adhere to host mucosal cells?
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Outer membrane proteins of organism adhere to host mucosal cells.
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Secretion of ______________ allows organisms to migrate into tissues, and into blood stream
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hyaluronidase
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Treponema pallidum coats its self with host ____________ to avoid phagocytosis
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fibronectin
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Why does Treponem pallidum coats itself with host fibronectin?
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To avoid phagocytosis.
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What are the lesions and other clinical manifestations of syphilis due to?
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Host immune response to bacterial antigens.
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What are the Stage of Syphilis disease?
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Primary Syphilis
Secondary Syphilis Latent Syphilis Tertiary Syphilis |
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What are the symptoms of Primary syphilis?
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Regional lymphadenopathy & Ulcer (chancre) formation at site of intial infection
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What are the characteristics of ulcer (chancre) of primary syphilis?
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The ulcer is painless.
It contains abundant Treponema Pallidum. It heals with out treatment in 2-6 weeks |
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Where are ulcer (chancre) found?
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They are found on the penis, anal canal, mouth, cervix & labia, or external genitalia.
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Ulcer is painless
It contains abundant T. pallidum Heals without treatment in 2 - 6 wks. Chancres are found on the penis, anal canal, mouth, cervix & labia, or external genitalia. |
What are the characteristics of the Ulcer (chancre) formation at the site of intial infection?
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What are the symptoms of Secondary Symphilis?
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Fever
Generalized Rash including palms & soles Malaise Myalgias and arthralgias Lymphadenopathy |
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Two big things to remember about secondary syphilis?
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-Results from wide spread dissemination of T. Pallidum
-Approximately 30 % of patients spontaneously clear the body of the organism. |
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What diseases does this patient have?
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Secondary Syphilis
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This type of rash is associated with secondary syphilis.
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Alex, What is Condylomata lata?
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Condylomata lata are described as?
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Knob-like or warty papular lesions
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Where are condylomata lata found?
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They are located on the folds of moist intertrignious areas especially around the genitalia and anus.
Violators of Jason's Law!!! |
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What is the typical size of condylomata lata?
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Condylomata lata are typically 1-3 cm in diameter.
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Are condylomata lata infectious?
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Yes, they are highly infectious. Treponem Pallidum organisms can be seen by examination of surface exudate under darkfield microscopy.
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This image is associated with what disease?
What is this lesion called? |
Secondary Syphilis
Condylomata lata |
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What are the phases of Latent syphilis?
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Early & Late.
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What is the definition of Early phase latent syphilis?
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Primary or secondary syphilis acquired or diagnosed during preceding year.
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What is the definition of Late phase latent syphilis? How is it determined?
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It is the absence of symptoms more than 2 years after infection, defined by seroreactivity.
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What is Tertiary syphilis?
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Wide spread tissue destruction secondary to host response to organism.
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What is Tertiary syphilis the result of?
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It is the result of a chronic progressive inflammatory process producing clinical manifestations years to decades after infection.
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What is the frequency of Tertiary syphilis in the US
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It is uncommon.
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Which patients does tertiary syphilis occur?
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It occurs in untreated patients.
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What kind of lesions are associated with Tertiary Syphilis?
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Inflammatory lesions that contain Gumma.
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What is Gumma?
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Coalescent granulomatous lesions.
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What do Gumma lesions affect
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Gumma lesions affect skin, bone, and mucous membranes, but they can involve any organ system.
Gumma cause local destruction of the affected organ system. |
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What organ systems are most often affected by inflammatory gumma containing lesions?
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Cardiovascular
Musculoskeletal CNS |
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What is this lesion?
Where is it located What disease is this associated with? |
It is a gumma.
It is located in a lymph node. It is associated with Tertiary Syphilis |
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Where is this lesion located?
What is it? What disease is this associated? |
This is Gumma located in the supraclavicular fossa.
It is associated with Tertiary Syphilis. |
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What are these lesions?
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Gummas
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What vascular disease(s) are associated with tertiary syphilis?
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Endarteritis of the aorta
subsequent medial necrosis aortitis, & Aneurysm formation |
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What Musculoskeletal disease(s) is associated with tertiary syphilis?
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Charcot Joint
where there is bone overgrowth & instability of joints. |
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What neuropathies are associated with tertiary syphillis?
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Syphilitic meningitis
Meningovascular syphilis or parencymatous neurosypilis. Tabes dorsalis |
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What are these neuropathies that are associated with tertiary syphillus called?
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Neurosyphilis
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How long is the incubation period for syphilis?
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3 weeks.
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What happens during the incubation of syphilis?
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Local replication & dissemination in blood stream.
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How long does primary syphilis last?
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2 to 6 weeks.
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How long does secondary syphilis last?
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2 to 6 weeks.
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How long does latent syphilis last (Asymptomatic)?
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3 to 30 years.
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What happens in latent syphilis?
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Replication of residual organisms in tissues.
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Chancre
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What is the lesion called on a patient with primary syphilis?
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Chancre on a female (Primary syphilis)
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This is an example of what kind of lesion?
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Secondary.
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What stage of syphilis does this patient have?
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Can you culture syphilis?
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No, Treponema Pallidum will not grow in culture.
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How did they get those images then?
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Microscopy of exudates are used to look for the organism.
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What type of microscopy do you need to detect Treponem Pallidum?
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Darkfield or Direct fluorescent antibody?
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What serologies are used in the laboratory diagnosis of syphillis?
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Non-treponemal antibodies &
Treponemal antibodies. |
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Darkfield
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What type of microscopy is this?
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Direct fluorescent antibody.
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What type of microscopy is this?
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What tests are used to detect cardiolipin antibodies made by patients with syphilis?
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VDRL (Venereal Disease Reference Laboratory) Test
RPR (Rapid Plasma Reagin) Test |
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Are the cardiolipin antibody tests specific to syphilis?
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No.
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What conditions or disease states have cardiolipin antibodies?
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SLE, pregnancy, others
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Why are VDRL & RPR used?
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They are nonspecific but cost effective; cannot rule in disease.
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What is the sensitivity of VDRL & RPR in symptomatic primary syphilis?
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80%
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What is the sensitivity of VDRL & RPR in patients with secondary syphilis?
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Virtually 100%
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What do you after a positive VDRL & RPR test?
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Use specific tests to look for antibodies to Treponema Pallidum.
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What are the commercially available specific tests for antibodies to T. pallidum in the patient's serum called?
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FTA-ABS - fluorescent treponemal antibody absorption
MHA-TP - microhemagglutination assay for T. Pallidum |
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What is the treatment for primary & secondary syphilis?
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Benzathine penicillin G 2.4 million units IM in a single dose.
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What is the treatment of Early Latent Syphilis
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Benzathine penicillion G 2.4 million units IM in single dose.
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What is the treatment for Late latent syphillis or latent syphilis of unknown duration
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Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1 week intervals. For 3 weeks obviously.
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What is the follow treatment for syphilis patients?
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Repeat VDRL or RPR at 3, 6, & 12 months.
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If the patient is adequately treated what happens?
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VDRL or RPR becomes non-reactive.
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Why does treatment failure occur?
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It may be due to lack of penetration of drug into the CNS
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When do Treponema Pallidum enter the CNS
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T. Pallidum enters the CNS early in the infection
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What should be done patients who have signs or symptoms persist or recur or who have sustained fourfold increase in nontreponemal test titer compared with maximum or baseline titer at time of treatment.
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These patients probably failed treatment or were reinfected. These patients should be retreated and reevaluated for HIV infection.
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For your viewing pleasure
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Sit back & Enjoy the show
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Herpes simplex viruses
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-DNA virus, replicates in the nucles
HSV-1: oral > genital HSV-2: Genital -Latent in ganglia |
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Epidemiology of HSV-1
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-70% of adults in US are infected
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How is HSV-1 virus acquired?
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HSV-1 is acquired by contact with saliva e.g kissing, sharing toys &/or eating utensils
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What kind of infections can HSV-1 cause?
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Genital infections through oral-genital contact.
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Epidemiology of HSV-2
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20-35% of adults in the U.S. are infected
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How is HSV-2 transmitted?
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Transmitted by contact with sexual secretions that contain the virus
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What is the infection rate of HSV-2?
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It is increasing. Especially among teens. Many not aware of their infection.
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Pathogenesis of herpes simple viruses
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10 Virus Repilicate in epithelial cells
20 Ascend to ganglia 30 Descend to skin, mucous membrane 40 GOTO LINE 10 |
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What is the result of primary genital infection with HSV?
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Asymptomatic infection
Symptomatic infection |
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What is seen in a symptomatic primary genital infection with HSV?
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Consitutional signs
-Pain -Urethra, vaginal discharge -Fever -Meningtitis Genital Lesions |
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Primary genital infection with HSV
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What is this lesion?
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What kind of lesion is this?
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New genital herpes lesions
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What kind of lesion is this?
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Healing genital herpes lesion.
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For some questions. Even though like there seems to be enough..
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We will use this
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Can HSV recurrences happen without lesions?
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Yes. Recurrence can occur with or without lesions.
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What prevents HSV recurrences?
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Strong cellular immune response i.e. CD4 & CD8
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Do high antibody titers prevent HSV recurrences?
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No. High antibody titer does not prevent recurrences of HSV.
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In primary genital herpes lesion/infection what viruses are responsible?
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HSV-2 > HSV-1
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In Non-primary genital lesion which virus is responsible
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HSV-2 >> HSV-1
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In a Recurrent genital herpes infection/attack which virus is responsible?
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HSV-2 >> HSV-1
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In a primary herpes infection/attack how many lesions are present?
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Multiple
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In a Non-primary herpes infection/attack how many lesions are present?
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Several
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In a recurrent genital herpes infection/attack how many lesions are present?
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1-2
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In a primary gential herpes infection/attack are symptoms present?
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Yes, symptoms are present.
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In a non-primary genital herpes attack/infection, are symptoms present?
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Yes they are present but they are mild.
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In a recurrent genital herpes attack/infection, are symptoms present?
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No, they are absent.
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How long does a primary herpes genital lesion last?
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21 days
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How long does a non-primary herpes genital lesion last?
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14 days
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How long does a recurrent genital lesion last?
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7 days
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How many days does a primary genital herpes lesion shed?
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15-20 days
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How many days does a non-primary herpes lesion shed?
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10 days
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How many days does a recurrent genital herpes lesion shed?
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5 days
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How do you diagnose Genital HSV?
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-Clinical Appearance
-Virus isolation testing -Viral Antigen testing -Serology with typing |
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Treatment of HSV - antiviral drugs
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-Antiviral drugs will not prevent latency, recurrences, or transmission
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What do antiviral drugs do?
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-they do decrease recurrences, shorten duration of lesions, & may reduce risk of transmission
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What antiviral drugs are used for the treatment of HSV?
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Acyclovir, Valacyclovir, & Famciclovir
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When are antivirals used for treatment?
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They can be give for the first episode or to treat or suppress recurrences.
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What is the recommended regimens for the treatment of the first clinical episode of genital herpes?
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Acyclovir 400 mg PO tid 7-10 d or
Acyclovir 200 mg PO q4.8h(5X/day) 7-10 d or Famciclovir 250 mg PO tid 7-10 days or Valacyclovir 1 g PO bid 7-10 days |
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Do you extend treatment if healing is incomplete after 10 days of therapy?
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You might.
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What are the results of suppressive therapy for Recurrent Genital Herpes?
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Suppressive therapy reduces the frequency of genital herpes recurrences by 70-80% in patients who have frequent recurrency (>= 6 recurrences per year)
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What are the recommended Regimens for Recurrent Genital Herpes?
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Acyclovir 400 mg PO bid or
Famciclovir 250 mg PO bid or Valacyclovir 500 mg PO qd or Valcyclovir 1.0 PO qd |
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What are the recommended Regimens for Episodic Therapy for Recurrent Genital Herpes
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Acyclovir 400 mg PO tid for 5 days OR Acyclovir 800 mg PO bid for 5 days OR Acyclovir 800 mg PO tid for 2 days OR Famciclovir 125 mg orally twice daily for 5 days OR Famciclovir 1000 mg orally twice daily for 1 day OR Valacyclovir 500 mg orally twice a day for 3 days OR Valacyclovir 1.0 g orally once a day for 5 days
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What STD is due to Haemophilus ducreyi?
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Chancroid
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This is manifested as a tender papule with an erythematous base
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Chancroid
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How does the chancroid papule progess?
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It progess to a painful ulcer with tender inguinal lympadenoapathy
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How common is chancroid in the U.S.?
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It is rare in the United states
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Where do localized endemic occur?
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In isolated STD and prostitution populations
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How Chancroid diagnosed?
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By ruling out syphilis & genital herpes.
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How do you treat chancroid?
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Treat with either:
Azithromycin Ceftriaxone Ciprofloxacin Erythromycin |
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What is the lesion?
What micorganism is associated with the lesion |
Chancroid caused by
Haemophilus ducreyi |
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What virus causes genital warts?
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Family Papovavirus
Genera Papillomavirus ~30 types cause genital infection -Ds DNA nonenveloped virus -Cause chronic infections |
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Are genital warts common in US?
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Yes, Very common STD. Approximately 20 million people in US have papillomavirus infections
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How many new papillomavirus infections in the U.S. each year
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5.5 million new infections occur each year
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By age 50, ____ % of women acquire genital HPV infection.
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80
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How is papillomavirus spread?
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Direct contact.
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What is the pathogenesis of genital HPV infection (serotypes 6 @ 11)?
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A benign lesion called a condyloma followed bye either regression or persistence.
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What is the pathogenesis of a genital HPV infection (serotypes 16, 18)?
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A premalignant lesion followed by either regression or progression followed by a malignant lesion that either regresses or progresses.
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What are the benign lesions of a genital HPV infection called?
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Condyloma accuminanta
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What are pre-malignant lesions of a genital HPV infection called?
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-Flat condyloma
-Cervical Intraepithelial Neoplasm (CIN) |
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What are malignant lesions of a genital HPV Infection called?
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-Cervical carcinoma
-Other names |
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How are genital warts diagnosed?
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Clinical Appearance
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How are pre-cancerous lesions diagnosed?
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-Most women are intially diagnosed by abnormal Pap Smear
-HPV DNA test can determine if high risk HPV type is present. |
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What is the basic principle & results of HPV DNA test
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-Nucleic acid hybridization is done on cells collected from cervix
-Detects DNA of high-risk HPV types (16, 18, 31,33, & others) |
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Does the HPV DNA test detect individual types or low risk types?
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No, the HPV DNA test does not detect individual types or low risk types.
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This is a normal Pap Smear
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Tell me about this slide..
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It is a kind of Pap Smear
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Tell me about this slide
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Koilocytes indicative of HPV infection from a Pap Smear
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Pap Smear
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How do you treat HPV infection?
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-Topical
-Surgical -Immunomodulation -Vaccine |
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What are the forms of topical HPV treatment?
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-Podophyllin
-Salicylic acid -Trichloroacetic acid |
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What are the types of surgical HPV treatment
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-Laser
-cyrosurgery -cauterization -traditional (Cold Knife Cone (CKC)) |
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What is immunomodulation treatment of HPV?
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Imiquimod. It stimulates IFN secretion & promotes Th1 cell inflammatory response.
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What is the HPV vaccine?
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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.
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Who is recommended to receive the quadrivalent vaccine, Gardasil?
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It is recommended for 11-12 year-old girls, but can be administered to girls as you as 9 years-old. The vaccine is also reccommend for 13-26 year-old females who have not received or completed the vaccine series.
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What causes genital ulcers?
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Treponema pallidum - syphilis
Haemophilus ducrei - chancroid Herpes simplex viruses - genital herpes |
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What causes genital growths?
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Human papilloma viruses - genital warts.
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