10- Sexually transmitted disease (viral) Flashcards

Question

other areas affected by HSV

Answer 1

- cause aphthous ulcers (small painful oral sores in the mouth) - herpes keratitis (inflammation of the cornea in the eye) and - herpetic whitlow (a painful skin lesion on a finger or thumb).

Answer 2

direct contact with affected mucous membranes or vrial sheeding in mucous secretions - can be spread by asymptomatic (more common in first 12 months where recurrent symptoms present)

Answer 3

cold sores It is often contracted initially in childhood (before five years), remains dormant in the trigeminal nerve ganglion and reactivates as cold sores, particularly in times of stress. - can cause herpes in genitalia through oral sex

Answer 4

Genital herpes caused by HSV-1 is usually contracted through oro-genital sex, where the virus spreads from a person with an oral infection to the person that develops a genital infection.

Answer 5

incubation- 2 weeks - asymptomatic - initial presentation most severe * Ulcers or blistering lesions affecting the genital area * Neuropathic type pain (tingling, burning or shooting) * Flu-like symptoms (e.g. fatigue and headaches) * Dysuria (painful urination) * Inguinal lymphadenopathy -> symptoms can last for 3 weeks in primary infection

Answer 6

Ask about sexual contacts, including those with cold sores, to establish a possible source of transmission. They may have caught the infection from someone unaware they are infected and not experiencing any symptoms. The diagnosis can be made clinically based on the history and examination findings. **A viral PCR swab from a lesion can confirm the diagnosis and causative organism.**

Answer 7

antiviral: aciclovir additional measures - paracetamol - topical lidocaine 2% gel (instillagel) - **cleaning with warm salt water**- key prevents secondary bacterial infection and drys up lesion - topical vaseline - additional oral fluid - loose clothing - avoid intercourse with symptoms

Answer 8

not related to pregnancy related issues or congenital abdnormalities. - women can pass antibodies to the fetus to give passive immunity - main risk: neonatal herpes simplex infection contracted during labour and delivery

Answer 9

high rate of morbidity and mortality - should be avoided and treated early

Answer 10

depends on scenario 1) primary genital herpes **before** 28 weeks gestation 2) primary genital herpes **after** 28 weeks

Answer 11

treatment: - aciclovir during initial infection - prophylactic aciclovir starting from 36 weeks to reduce risk of genital lesion during labour and delivery - women who are asymptomatic at delivery can have a vaginal delivery - woemn who are symptomatic should have a caesarean

Answer 12

- treated with aciclovir during inittial infection - followed immediately by prophylactic aciclovir - caesarean section recommended in all cases to reduce risk of neonal infection

Answer 13

human immunodeficiency virus.

Answer 14

Being infected with HIV is referred to as being HIV positive. AIDS refers to acquired immunodeficiency syndrome. - AIDS occurs as an HIV infection progresses, and the person becomes immunodeficient. - This immunodeficiency leads to opportunistic infections and several AIDS-defining illnesses, such as Kaposi’s sarcoma. AIDS is now mostly referred to as late-stage HIV.

Answer 15

an RNA retrovirus.

Answer 16

HIV-1 is the most common type, and HIV-2 is rare outside West Africa.

Answer 17

The virus enters and destroys the CD4 T-helper cells of the immune system.

Answer 18

The virus enters and destroys the CD4 T-helper cells of the immune system.

Answer 19

1) An initial seroconversion flu-like illness occurs within a few weeks of infection. 2) The infection is then asymptomatic until the condition progresses to immunodeficiency. 3) Immunodeficient patients develop AIDS-defining illnesses and opportunistic infections. This progression occurs potentially years after the initial infection.

Answer 20

HIV is not transmitted through day-to-day activities, including kissing. It is spread through: - Unprotected anal, vaginal or oral sexual activity - Mother to child at any stage of pregnancy, birth or breastfeeding (called vertical transmission) - Mucous membrane, blood or open wound exposure to infected blood or bodily fluids, for example, through sharing needles, needle-stick injuries or blood splashed in an eye

Answer 21

1) Seroconversion illness 2) Asymptomatic stage of HIV 3) Symptomatic stage of HIV 4) Symptomatic stage of HIV 5) Late stage HIV

Answer 22

Some people experience a short illness soon after they contract HIV. This is known as seroconversion illness or primary or acute HIV infection. Presentation - fever - fatigue - headache - sore throat - swollen lymph nodes - diarrhea Seroconversion is the period when someone with HIV is at their most infectious.

Answer 23

Once seroconversion is over, most people feel fine and don’t experience any symptoms. This is often called the asymptomatic stage and it can last for several years. Though you might feel well at this stage, the virus is active, infecting new cells, making copies of itself and damaging your immune system’s ability to fight illness.

Answer 24

If HIV has a chance to cause a lot of damage to your immune system, you may become ill from certain serious opportunistic infections and cancers. These illnesses are also known as AIDS-defining.

Answer 25

These occur where the CD4 count has dropped to a level that allows for unusual opportunistic infections and malignancies to appear. Examples of AIDS-defining illnesses include: * Kaposi’s sarcoma * Pneumocystis jirovecii pneumonia (PCP) * Cytomegalovirus infection * Candidiasis (oesophageal or bronchial) * Lymphomas * Tuberculosis

Answer 26

- most people do not know thye are infected and are at risk of spreading the disease - the earlier the treatment the better the prognosis

Answer 27

3 months to develop anitbodies to virus

Answer 28

Patients need to give consent for a test. Verbal consent should be documented before a test. Consent only needs to be as simple as “are you happy for us to test you for HIV?” Patients no longer require formal counselling or education before a test.

Answer 29

1) Antibody testing (4th generation combo assay (EIA) - can do self sampling at home 2) Testing for P24 antigen - checks directly for HIV antigen in blood - can give earlier result 3) PCR testing - useful for measuring viral load

Answer 30

1) CD4 count 2) Viral load

Answer 31

The CD4 count is the number of CD4 cells in the blood. These are the cells destroyed by the virus. The lower the count, the higher the risk of opportunistic infection: * 500-1200 cells/mm3 is the normal range * Under 200 cells/mm3 is considered end-stage HIV (AIDS) and puts the patient at high risk of opportunistic infections

Answer 32

Viral load is the number of copies of HIV RNA per ml of blood. “Undetectable” refers to a viral load below the lab’s recordable range (usually 50 – 100 copies/ml). The viral load can be in the hundreds of thousands in untreated HIV.

Answer 33

1) Antiviral therapy 2) Prophylactic antibiotics 3) Prevention of cardiovascular disease 4) Cervical smears 5) Vaccinations

Answer 34

- everyone is offered ART irrespective of viral load of CD4 count - specialist blood tests can establish resistance of each HIV strain to tailr treatment - aim to ac hieve normal CD4 count and undetectable viral load - Current recommendation: ** 2 NRTIs (type of ART) + a 3rd agent**

Answer 35

Highly Active Anti-Retrovirus Therapy (HAART) Medication There are a number of classes of HAART medications that work slightly differently on the virus: * Protease inhibitors (PIs) * Integrase inhibitors (IIs) * Nucleoside reverse transcriptase inhibitors (NRTIs) * Non-nucleoside reverse transcriptase inhibitors (NNRTIs) * Entry inhibitors (EIs)

Answer 36

Prophylactic co-trimoxazole (Septrin) is given to patients with a CD4 under 200/mm3 to protect against pneumocystis jirovecii pneumonia (PCP).

Answer 37

Patients with HIV have close monitoring of cardiovascular risk factors and blood lipids. Appropriate treatment (e.g. statins) may be required to reduce their risk of developing cardiovascular disease.

Answer 38

influenza, pneumococcal, hepatitis A and B, tetanus, diphtheria and polio vaccines. Patients should avoid live vaccines.

Answer 39

Advise condoms for vaginal and anal sex and dams for oral sex, even when both partners are HIV positive. If the viral load is undetectable, transmission through unprotected sex is unheard of, even in extensive studies, although infection is not impossible. Partners should have regular HIV tests. Where the affected partner has an undetectable viral load, unprotected sex and pregnancy may be considered. It is also possible to conceive safely through techniques like sperm washing and IVF.

Answer 40

The mother’s viral load will determine the mode of delivery: * Normal vaginal delivery is recommended for women with a viral load < 50 copies / ml * Caesarean section is considered in patients with > 50 copies copies / ml and in all women with > 400 copies / ml * IV zidovudine should be given during the caesarean if the viral load is unknown or there are > 10000 copies / ml

Answer 41

* Low-risk babies, where the mother’s viral load is < 50 copies per ml, are given zidovudine for four weeks * High-risk babies, where the mother’s viral load is > 50 copies / ml, are given zidovudine, lamivudine and nevirapine for four weeks

Answer 42

HIV can be transmitted during breastfeeding, even if the mother’s viral load is undetectable. Breastfeeding is not recommended for mothers with HIV. However, if the mother is adamant and the viral load is undetectable, sometimes it is attempted with close monitoring by the HIV team.

Answer 43

- PEP is not 100% effective and must be commenced within a short window of opportunity (less than** 72 hours)**. - The sooner it is started, the better. - A risk assessment of the probability of developing HIV should be balanced against the side effects of PEP.

Answer 44

PEP involves a combination of ART therapy. The current regime is - Truvada (emtricitabine and tenofovir) - and raltegravir for 28 days. HIV tests are done immediately and also a minimum of three months after exposure to confirm a negative status. Individuals should abstain from unprotected sexual activity for a minimum of three months until confirmed as negative.

Answer 45

prevents HIV before exposure for those at risk of HIV There are two pills approved for use as PrEP: Truvada® and Descovy®. * Truvada® is for people at risk through sex or injection drug use. * Descovy® is for people at risk through sex. Descovy is not for people assigned female at birth who are at risk for HIV through receptive vaginal sex

Answer 46

**DNA vaccine** It is transmitted by direct contact with blood or bodily fluids. - Sexual intercourse or sharing needles, for example amongst IV drug users or tattoos. - Contaminated household products such as toothbrushes or contact between minor cuts or abrasions. - It can also be passed from mother to child during pregnancy and delivery.

Answer 47

Most people fully recover from the infection within 2 months, however 10% go on to become chronic hepatitis B carriers. In these patients the virus DNA has integrated into their own DNA and so they will continue to produce the viral proteins.

Answer 48

* Surface antigen (HBsAg) – active infection * E antigen (HBeAg) – marker of viral replication and implies high infectivity * Core antibodies (HBcAb) – implies past or current infection * Surface antibody (HBsAb) – implies vaccination or past or current infection * Hepatitis B virus DNA (HBV DNA) – this is a direct count of the viral load

Answer 49

A serum-sickness-like illness, characterized by fever, arthralgias, and rash, may occur in the prodromal period, followed by constitutional symptoms, anorexia, nausea, jaundice, and right upper quadrant discomfort.

Answer 50

yes- heptitis B surgace antigen - patients are tested for HBsAb to confirm response. tovaccine - requires 3 doses

Answer 51

* Have a low threshold for screening patients that are at risk of hepatitis B. * Screen for other blood born viruses (hepatitis A and B and HIV) and other sexually transmitted diseases * Refer to gastroenterology, hepatology or infectious diseases for specialist management * Notify Public Health (it is a notifiable disease) * Stop smoking and alcohol * Education about reducing transmission and informing potential at risk contacts * Testing for complications: FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma * Antiviral medication can be used to slow the progression of the disease and reduce infectivity * Liver transplantation for end-stage liver disease

Answer 52

Hepatitis C is an RNA virus. It is spread by blood and body fluids. No vaccine is available

Answer 53

* 1 in 4 fights off the virus and makes a full recovery * 3 in 4 it becomes chronic * Complications: liver cirrhosis and associated complications and hepatocellular carcinoma

Answer 54

1. Hepatitis C antibody is the screening test 2. Hepatitis C RNA testing is used to confirm the diagnosis of hepatitis C, calculate viral load and assess for the individual genotype

Answer 55

NOOOOOO but hep CCCC for curable

Answer 56

* Have a low threshold for screening patients that are at risk of hepatitis C * Screen for other blood born viruses (hepatitis A and B and HIV) and other sexually transmitted diseases * Refer to gastroenterology, hepatology or infectious diseases for specialist management * Notify Public Health (it is a notifiable disease) * Stop smoking and alcohol * Education about reducing transmission and informing potential at risk contacts * Testing for complications: FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma * Antiviral treatment * Liver transplantation for end-stage liver disease

Answer 57

Antiviral treatment with direct acting antivirals (DAAs) is tailored to the specific viral genotype. They successfully cure the infection in over 90% of patients. They are typically taken for 8 to 12 weeks

Answer 58

* If you’re having **protected** sex there’s no law saying you must tell your partners that you have HIV. It’s your choice whether you tell them or not. However, in England and Wales there’s a risk of being prosecuted for reckless transmission of HIV if: you had sex with someone who didn’t know you had HIV you knew you had HIV at that time you understood how HIV is transmitted you had sex without a condom, and you transmitted HIV to that person.

Answer 59

Hep B in 3 Hep C 1 in 30 HIV 1 in 300

10- Sexually transmitted disease (viral) Flashcards

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