ID- viral infections + STIs

Question 1

Name the HHVs

Answer 1

HHV1- HSV1
HHV2- HSV2
HHV3- VZV
HHV4- EBV
HHV5- CMV 
HHV8- Kaposi's sarcoma related

Question 2

Describe the infections caused by HSV 1+2

Answer 2

Oral/ labial herpes: more commonly 1
Genital herpes : 1/2
Ramsay-Hunt syndrome: 1
Encephalitis: 1
Disseminated infection

Question 3

Describe the presentation of oral + genital herpes

Answer 3

Prodrome- tingling, pain, burning sensation
-> vesicles -> ulceration
Genitals: typically several small, very tender ulcers + lymphadenopathy

Question 4

Describe the diagnostic investigation for HSV infection

Answer 4

Diagnostic: swab for viral PCR
Genital- do other STI screen
Recurrent- consider HIV testing

Question 5

Describe the management of HSV infections

Answer 5

Topical/PO/IV aciclovir depending on type/severity

eg. labial - topical, genital - PO, encephalitis - IV

Question 6

Describe the type of infections caused by VZV

Answer 6

1st infection: Chickenpox

Subsequently -> shingles

Question 7

Describe the presentation of VZV infections

Answer 7

Chickenpox: viral illness -> itchy vesicles -> burst -> scab (5-7 days)
Shingles: viral illness -> painful vesicular rash in dermatomal distribution -> ulceration + scabbing
-Pain may remain for weeks-months (postherpetic neuralgia)

Question 8

Describe the management of VZV infections

Answer 8

Chickenpox: children not treated, adults PO aciclovir
Shingles:
-Aciclovir PO or IV if disseminated/immunocompromise
-Pain: NSAIDs/paracetamol, opioids, gabapentin, TCA

Question 9

Describe the type of infections caused by CMV

Answer 9

Immunocompetent: flu-like illness, mono
Immunocompromise:
-BM suppression
-Colitis
-Pneumonitis
-Hepatitis
-Retinitis

Question 10

Describe the management of CMV infection

Answer 10

Immunocompetent: no antivirals
Compromised:
-PO valganciclovir/ IV ganciclovir
-Cidofovir
-Foscarnet

Question 11

Describe the course of HIV infection

Answer 11

Infection -> seroconversion with flu-like/viral illness

• > primary infection: 6 months, high viral load
• > slowly declining CD4 count, asymptomatic
• > AIDS after 10-15 years

Question 12

Describe the AIDS-defining illnesses

Answer 12

AIDS usually occurs at CD4 <200 
CMV retinitis
Cryptococcal infections eg. meningitis
Disseminated infections eg Candidiasis, HSV 
HIV-related encephalopathy
PCP 
Toxoplasmosis

Kaposi’s sarcoma
Cervical cancer

Question 13

Describe the investigations for HIV

Answer 13

Diagnosis:

• HIV antibody/antigen test or ELISA
• > confirm with Western blot

Further Ix:

• Urine NAAT/genital swabs for other STIs
• Bloods: FBC, U+Es, LFTs, lipids, glucose, CD4 count, PCR for viral load, viral hepatitis serology, syphilis serology
• CXR
• Tuberculin skin test

Question 14

Describe the management of HIV

Answer 14

All positive patients should be started on ART
MDT with HIV/GUM, specialist nurse, psych, dietician etc
-Higher risk of CVD. RF Mx eg. statins
Specific management around pregnancy
-ART, C-section/SVB, no breastfeeding etc

Question 15

Describe the presentation, investigations and management of PCP

Answer 15

Presentation:

• Dry cough, SOB worse on exertion, weight loss
• Desat on walking

Investigations:

• Sputum sample if possible/BAL: silver stain
• Bloods
• CXR: bilateral perihilar interstitial shadowing

Mx:

• Co-trimoxazole
• Given as prophylaxis when CD4 <200

Question 16

What causes a ring-shaped contrast enhancing lesion?

Answer 16

Toxoplasmosis

Question 17

What is the classic investigation findings in cryptococcal meningitis?

Answer 17

CSF:

• Very high opening pressure
• India Ink stain +

Question 18

What are some causes of headache in a patient with HIV?

Answer 18

• Cerebral toxoplasmosis
• Meningitis eg. TB, cryptococcal
• Cerebral abscess
• Malignancy eg lymphoma

Question 19

Describe the presentation of syphilis

Answer 19

Primary: occurs week after infection
-Chancre: painless, single, shallow ulcer

Secondary: weeks-months later

• Palmo-plantar rash, lymphadenopathy, fever
• Condylomata lata

Tertiary: years later

• Neurosyphilis
• Vascular: aortic aneurysms/dissection
• Gummatous lesions

Question 20

Describe the investigations and management of syphilis

Answer 20

Investigations:

• Non-treponemal: VDRL, RPR
• Test for other STIs: swab, serology

Management:

• IM benzathine benzylpenicillin
• Can monitor RPR/VDRL

Question 21

Describe the presentation of gonorrhoea and chlamydia

Answer 21

Often asymptomatic or mild symptoms

• Dysuria, dyspareunia
• Itching, abnormal discharge
• PID: pelvic pain, fever, cervical motion tenderness

Question 22

Describe the investigations and management of gonorrhoea and chlamydia

Answer 22

Ix:

• Swabs/urine for NAAT
• Test for other STIs

Mx:

• Gonorrhoea: IM cef
• Chlamydia: 7 days doxycycline
• PID: IM cef, metronidazole + doxycycline

Question 23

Describe the presentation of Candidiasis

Answer 23

In immunocompetent: usually vulval/sometimes oral
Oral + systemic occurs typically in immunosuppressed eg. HIV, DM
-Vulval: itching, redness, pain, dysuria, dyspareunia, thick white discharge
-Oral: white plaques, pain, dysphagia
-Systemic: many manifestations eg. oesophageal, blood

Question 24

Describe the management of Candidiases

Answer 24

Vulval:

• Topical antifungals eg. Clotrimazole cream/pessary
• PO fluconazole once only

Oral:
-Nystatin wash/ PO antifungal eg. fluconazole

Systemic:
-PO caspofungin, fluconazole, amphotericin B