L 94 Viral Urogenital Tract Diseases Flashcards
When in the lifecycle of HSV is the virus most likely to be spread?
HSV goes latent and can recrudesce
However, it is most often spread when the patient is asymptomatic.
Patient presents with a skin infection with multiple small nodular or wart-like lesions in genital and peri-anal region. Lesions can also be on the face. What is the likely diagnosis?
Molluscum Contagiosum
What is the difference between HSV-1 and HSV-2?
Type 1 tends to be acquired early in life and is above the belt in its effects–labial sores, etc.
Type 2 is below the belt and is acquired by sexual activity
Describe the significance of cervical dysplasia
Cervical dysplasia is a manifestation of HPV strains 16 & 18 and is precancerous
Patient presents with soft, gray, cauliflower like lesions on genitals. What is the likely diagnosis and specific strains?
Condyloma Acuminata are genital warts that are caused by HPV strains 6 & 11
How are HPV and HIV related?
HPV is usually taken care of by the immune system. However, HIV patients have a depressed immune system and therefore allow the virus to establish itself more often.
How are HSV and HIV related?
HSV creates a perfect point for HIV to infect the patient. They are at least 2x more at risk of infection with HIV.
Describe the recurrence of HSV-2
Recurrence rates vary by individual
Important to remember that some recurrence can be asymptomatic and the patient is able to spread the virus during these times
A histological view of a cell shows cytoplasmic vacuolization in epithelial cells from a skin lesion. What is the likely diagnosis?
HPV
What is the preferred way to screen for HPV?
Pap smear with a Digene test which looks for HPV DNA
How is Gardasil used?
Gardasil is a tetravalent vaccine against strains 6, 11, 16, 18
It is only useful for prevention. No effect on those already infected.
Explain the difference between initial, primary, and recurrent infections with HSV
Primary infection is the first exposure to HSV either type 1 or 2
Initial infection is exposure to the other strain after having been exposed to onn type previously
Recurrent is recrudescence
Patient presents with genital skin macules, papules, vesicles, pustules, ulcers, and fever and malaise that has lasted several weeks. How did they get the disease? How would you diagnose this disease and is it curable?
This is the presentation of infection with HSV-2 which is the type of HSV that tends to infect below the belt and have worse symptoms than HSV-1.
Type 2 is generally acquired with onset of sexual activity.
Diagnosis is done by PCR and Culture
Treatment is to suppress the virus by Acyclovir or Famciclovir, but virus will never go away. It will go latent.
How is HPV able to cause cancer?
HPV strains 16 & 18 cause malignant transformation by viral genes E6 and E7
E6 degrades p53 and E7 binds RB. This allows cell progression through the cell cycle so the virus can replicate.
When the virus is in the episome form/stage, the E2 gene of the virus keeps E6/7 silent. When the genome gets integrated into the host DNA, gene E2 is suppressed and E6/7 are overexpressed leading to a precancerous condition. This is why not all people with HPV will get cancer.
Smoking, sunlight, radiotherapy can all lead to activation of this cancer causing process.
