Repro Buxton Microbial Causes Of Genital Ulcers Or Growths; Kct

Front 1

What are the 3 causes of genital ulcers?

Back 1

1. Treponema pallidum: syphilis
2. Haemophilus ducrei-chancroid
3. HSV-genital herpes

Front 2

What are the causes of genital warts?

Back 2

HPV

Front 3

What are the general characteristics of Treponema Pallidum (cause of Syphilis)?

Back 3

-Spirochetes
-Gram -, spiral shaped bacteria;
-hard to see w/ LM b/c thin cell wall
-other spirochetes: Leptospira (disseminated dz can get meningitis), Borrelia (lyme dz), Treponema.

Front 4

What is the role of virulence factors in path of syphilis?

Back 4

sex-->outer membrane proteins of organism adhere to host mucosal cells-->hyaluronidase secreted which lets organism migrate into tissues & into blood stream-->org coats itself w/ host fibronectin to avoid phagocytosis-->lesions & clinical dz's from HOST IMMUNE RESPONSE to bacterial antigens;

Front 5

What are the epidemiological factors assoc w/ Syphilis?

Back 5

-Since 1990, infection rate dec (b/c of safer gay men sex), but currently inc;
-Infection rates vary in US:GA one of highest states 3/100,000.
-Rates of syphillis vary w/ race/ethnic group; highest in blacks.
-Rates of syphilis vary w/ age and gender, most common group: MEN 30-44

Front 6

Describe the stages of syphilis.

Back 6

1. Primary Syphilis: regional lymphadenopathy, ulcer (chancre) formation @ initial infection site (painless ulcer, has abundant T. Pallidum, chancres on penis, anal canal, mouth, cervix, labia, or external genitalia); heals w/o tx in 2-6 wks.
2. Secondary syphilis (tissue replication from widespread dissemination of T. Pallidum-fever, generalized rash incl PALMS & SOLES, highly variable rash, lesions contain organisms, malaise, myalgias, arthralgias, lymphadenopathy. 30% spontaneously clear body of organism. Condyloma lata.
3. Latent syphilis
-Early phase: primary or secondary syphilis acquired or diagnosed during preceding yr.
-Late phase: defined as seroreactivity, in absence of sx's, >2 yrs post infection.
4. Tertiary syphilis
-uncommon in US b/c of tx. result of chronic, progressive inflam process producing clinical manifestatopms yrs-decades to post infection.
-wide spread tissue destruction secondary to host response to organism.

Front 7

Describe the characteristics of Condylomata lata.

Back 7

-type of rash assoc w/ secondary syphilis.
-knob-like or warty papular lesions.
-on folds of moist intertriginous areas esp around genitalia & anus.
-typically 1-3 cm in diameter.
-highly infectious: T. pallidum orgs can be seen by exam of surface exudate under darkfield micro.

Front 8

What diseases are associated w/ Tertiary syphilis

Back 8

1. Inflammatory lesions w/ gumma-->gumma is coalescent granulomatous lesions (T cell macrophages leading to local destruction) that usually affect skin, bone, mucus membranes, but can involve any organ system, cause local destruction of affected organ system;
2. Organ systems most affected: cardio, musculoskeleta, CNS
3. Vascular dz: endarteritis of aorta, subsequent medial necrosis, aortitis, aneurysm formation;
4. Musculoskeltal: CHARCOT jt--> bone overgrowth & instability of hts.
5. Neurosyphilis: syphilitic meningitis, meningovascular syphilis, or parenchymatous neurosyphilis, tabes dorsalis.

Front 9

When does local replication & dissemination of syphilis begin?

Back 9

incubation period (3 wks)

Front 10

How is Syphilis diagnosed?

Back 10

-won't grow in culture-too thin;
-microscopy of exudates to look for organisms: darkfield, direct fluorescent Ab.
-Serology: non-treponemal Ab's, treponemal Abx.

Front 11

What are the non-treponemal serologic tests (VDRL & RPR)?

Back 11

-Pts w/ syphilis make Ab's that react w/ lipid (cardiolipin) found on mitochondrial membranes but also + in SLE, pregnancy, so need further testing.
2 tests available:
a) VDRL (venereal dz reference laboratory) test
b) RPR (rapid plasma reagin) test.
-these are non-specific but cost-effective, can't rule in dz: sensitivity of tests: 80% in pts w/ symptomatic primary syphilis & virtually 100% in pts w/ secondary syphilis.
-Must be followed by specific tests to look Ab's to T. pallidum.

Front 12

What are the TREPONEMAL Serologic Tests: FTA-ABS & MHA-TP?

Back 12

-tests for Ab's to T. Pallidum in pt's serum.
-Commercially available tests incl:
-->FTA-ABS-fluorescent treponemal Ab absorption
-->MHA-TP: microhemagglutination

Front 13

What is the tx for primary and secondary syphilis?

Back 13

Benzathine PCN IM in single dose.

Front 14

What is the tx for Latent Syphilis?

Back 14

-Early Latent Syphilis: Benzathine PCN IM in single dose;
-Late Latent Syphilis or Latent Syphilis of Unknown Duration: Benzathine PCN 3 doses IM at 1 wk intervals.

Front 15

What are the 3 causes of genital ulcers?

Back 15

1. Treponema pallidum: syphilis
2. Haemophilus ducrei-chancroid
3. HSV-genital herpes

Front 16

What are the causes of genital warts?

Back 16

HPV

Front 17

What are the general characteristics of Treponema Pallidum (cause of Syphilis)?

Back 17

-Spirochetes
-Gram -, spiral shaped bacteria;
-hard to see w/ LM b/c thin cell wall
-other spirochetes: Leptospira (disseminated dz can get meningitis), Borrelia (lyme dz), Treponema.

Front 18

What is the role of virulence factors in path of syphilis?

Back 18

sex-->outer membrane proteins of organism adhere to host mucosal cells-->hyaluronidase secreted which lets organism migrate into tissues & into blood stream-->org coats itself w/ host fibronectin to avoid phagocytosis-->lesions & clinical dz's from HOST IMMUNE RESPONSE to bacterial antigens;

Front 19

What are the epidemiological factors assoc w/ Syphilis?

Back 19

-Since 1990, infection rate dec (b/c of safer gay men sex), but currently inc;
-Infection rates vary in US:GA one of highest states 3/100,000.
-Rates of syphillis vary w/ race/ethnic group; highest in blacks.
-Rates of syphilis vary w/ age and gender, most common group: MEN 30-44

Front 20

Describe the stages of syphilis.

Back 20

1. Primary Syphilis: regional lymphadenopathy, ulcer (chancre) formation @ initial infection site (painless ulcer, has abundant T. Pallidum, chancres on penis, anal canal, mouth, cervix, labia, or external genitalia); heals w/o tx in 2-6 wks.
2. Secondary syphilis (tissue replication from widespread dissemination of T. Pallidum-fever, generalized rash incl PALMS & SOLES, highly variable rash, lesions contain organisms, malaise, myalgias, arthralgias, lymphadenopathy. 30% spontaneously clear body of organism. Condyloma lata.
3. Latent syphilis
-Early phase: primary or secondary syphilis acquired or diagnosed during preceding yr.
-Late phase: defined as seroreactivity, in absence of sx's, >2 yrs post infection.
4. Tertiary syphilis
-uncommon in US b/c of tx. result of chronic, progressive inflam process producing clinical manifestatopms yrs-decades to post infection.
-wide spread tissue destruction secondary to host response to organism.

Front 21

Describe the characteristics of Condylomata lata.

Back 21

-type of rash assoc w/ secondary syphilis.
-knob-like or warty papular lesions.
-on folds of moist intertriginous areas esp around genitalia & anus.
-typically 1-3 cm in diameter.
-highly infectious: T. pallidum orgs can be seen by exam of surface exudate under darkfield micro.

Front 22

What diseases are associated w/ Tertiary syphilis

Back 22

1. Inflammatory lesions w/ gumma-->gumma is coalescent granulomatous lesions (T cell macrophages leading to local destruction) that usually affect skin, bone, mucus membranes, but can involve any organ system, cause local destruction of affected organ system;
2. Organ systems most affected: cardio, musculoskeleta, CNS
3. Vascular dz: endarteritis of aorta, subsequent medial necrosis, aortitis, aneurysm formation;
4. Musculoskeltal: CHARCOT jt--> bone overgrowth & instability of hts.
5. Neurosyphilis: syphilitic meningitis, meningovascular syphilis, or parenchymatous neurosyphilis, tabes dorsalis.

Front 23

When does local replication & dissemination of syphilis begin?

Back 23

incubation period (3 wks)

Front 24

How is Syphilis diagnosed?

Back 24

-won't grow in culture-too thin;
-microscopy of exudates to look for organisms: darkfield, direct fluorescent Ab.
-Serology: non-treponemal Ab's, treponemal Abx.

Front 25

What are the non-treponemal serologic tests (VDRL & RPR)?

Back 25

-Pts w/ syphilis make Ab's that react w/ lipid (cardiolipin) found on mitochondrial membranes but also + in SLE, pregnancy, so need further testing.
2 tests available:
a) VDRL (venereal dz reference laboratory) test
b) RPR (rapid plasma reagin) test.
-these are non-specific but cost-effective, can't rule in dz: sensitivity of tests: 80% in pts w/ symptomatic primary syphilis & virtually 100% in pts w/ secondary syphilis.
-Must be followed by specific tests to look Ab's to T. pallidum.

Front 26

What are the TREPONEMAL Serologic Tests: FTA-ABS & MHA-TP?

Back 26

-tests for Ab's to T. Pallidum in pt's serum.
-Commercially available tests incl:
-->FTA-ABS-fluorescent treponemal Ab absorption
-->MHA-TP: microhemagglutination

Front 27

What is the tx for primary and secondary syphilis?

Back 27

Benzathine PCN IM in single dose.

Front 28

What is the tx for Latent Syphilis?

Back 28

-Early Latent Syphilis: Benzathine PCN IM in single dose;
-Late Latent Syphilis or Latent Syphilis of Unknown Duration: Benzathine PCN 3 doses IM at 1 wk intervals.

Front 29

What is the follow to tx for Syphilis?

Back 29

-Repeat VDRL or RPR should be done @ 3, 6, & 12 months.
-If adequately treated, VDRL & RPR becomes non-reactive.
-Tx failure can occur & may be b/c of lack of penetration of drug into CNS (organisms enter CNS early in infection)

Front 30

If pt has a sustained 4x inc in nontreponemal test titer (ie compared w/ max or baseline titer @ time of tx) or have sx's recur or persist what does this mean?

Back 30

They probably failed tx or were reinfected. These pts should be retreated & reevalauted for HIV infection

Front 31

Describe the characteristics of HSV.

Back 31

-DNA virus, replicating in nucleus
-they have an envelope that they get from nuclear membrane.
-HSV-1: oral> genital
-HSV-2: genital.
-Latent in ganglia.

Front 32

Describe the epidemiology of HSV-1.

Back 32

-70% of adults in US infected.
-Get virus from saliva contact--kissing, sharing toys, eating utensils.
-Can cause genital infections-oral-genital contact.

Front 33

Describe the epidemiology of HSV-2.

Back 33

-20-35% of adults in US are infected.
-transmitted by contact w/ sexual secretions containing virus.
-infection rate inc especially among teens.
-many not aware of infection.

Front 34

Describe the pathogenesis of HSV infections.

Back 34

Virus get in-->replicates in epithelial cells (may or may not cause lesion but still have virus replication & shedding in latent pt)-->ascend to ganglia-->latent in ganglia-->descends to skin, mucous membranes.

Front 35

What are the results of primary genital infection w/ HSV?

Back 35

-Asymptomatic infection
-Symptomatic infection (Constitutional signs: pain, urethral, vaginal discharge, fever, meningitis (more HSV2 in women; Genital lesions;

Front 36

Does one get recurrences of Herpes?

Back 36

-Recurrences prevented by strong cellular immune response by CD4 & CD 8 cells;
-High Ab titer does NOT prevent recurrences

Front 37

Is HSV-1 or 2 more likely to be recurrent?

Back 37

HSV-2

Front 38

What changes from primary to non-primary to recurrent syphilis?

Back 38

-# of lesions (multiple-->several-->absent)
-Sx's (present, mild, absent)
-Days/lesion: 21-->14-->7
-Days/shedding: 15-20, 10, 5.

Front 39

How is genital HSV diagnosed?

Back 39

Clinical appearance (ulcers), virus isolation w/ typingYPE A INCLUSION BODIES & PYKNOTIC NUCLEUS), viral antigen detection, serology w/ typing.

Front 40

What is the tx for HSV?

Back 40

-Antiviral drugs won't prevent latency, recurrences or transmission, but they will dec them.
-Antivirals: Acyclovir, Valacyclovir, Famciclovir-->can be given for 1st episorde or to tx or suppress recurrences.

Front 41

Whats the recommended tx of first clinical episode of genital herpes?

Back 41

Acyclovir, Famciclovir, Valacyclovir (about a week, extend w/ incomplete therapy)

Front 42

What are the suppressive therapies for HSV w/ by how much will these recurrences be reduced post treatment?

Back 42

-Acyclovir, Famiciclovir, Valacyclovir, dec frequency of genital herpes recurrences by 70-80%.

Front 43

If someone presents w/ a chancroid (painful papule w/ erythematous base) w/ tender inguinal lymphadenopathy, what do you need to rule out? What do you think it is?

Back 43

Its STD from Haemophilus ducreyi-->need to rule out syphilis & genital herpes

Front 44

What are the general characteristics of the Human Papilloma virus?

Back 44

Family Papovavirus, genera papillomavirus (30 types cause genital infection); double stranded DNA, nonenveloped, cause CHRONIC infection. Causative agents of benign squamous cell lesions that can progress to carcinomas.

Front 45

Are chronic infections always replicating?

Back 45

Yes, they are always replicating even if in small amts.

Front 46

Whats the epidemiology of HPV?

Back 46

-very common ST in US.
-20 million people inUS have genital papillomavirus infection.
-5.5 million new infections/yr
-by 50, 80% of women get HPV infection
-Spread by direct contact.

Front 47

Describe the pathogenesis of Genital HPV infection?

Back 47

-Virus infects epithelial cells-->Benign lesion (6, 11)-->condyloma to regression or persistence or Potentially malignant (16,18)-->premalignant lesion-->regression or progression-->malignant lesion

Front 48

What are the clinical manifestations of HPV?

Back 48

-Benign lesions (Condyloma accuminatum)
-Pre-Malignant lesions (Flat condyloma, CIN)
-Malignant lesions (cervical CA)

Front 49

How is HPV diagnosed?

Back 49

-Genital warts-->clinical appearance.
-Pre-Cancerous lesions: initially dx w/ Pap; HPV DNA can determine if hi risk HPV type is present (nucleic acid hybridization done on cells collected from cervix, detects DNA of high-risk HPV type, doesn't detect individual types or low risk types)

Front 50

What on a pap smear would indicated HPV infection?

Back 50

Koilocytes

Front 51

What is the tx for HPV?

Back 51

-Topical: podophyllin, salicylic acid, trichloroacetic acid.
-Surgery: laser, cryosurgery, cauterization, traditional.
-Immunomodulation:Imiquimod: stimulates IFN secretion, promotes Th1 cell inflamm response
-alpha-interferon injected.

Front 52

How can HPV be prevented?

Back 52

Quadrivalent vaccine 6, 11, 16, 18: these are responsible for 70% of cervical Ca's and 90% of genital warts.