Lecture 35: genital ulcers and genital lesions Flashcards Preview

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Flashcards in Lecture 35: genital ulcers and genital lesions Deck (13):
1

Epidemiology of syphilis

-Uncommon in NZ except MSM

2

Pathology of syphilis?

-Spirochaetal infection
-T. pallidum
-Immune evasion responses important in maintenance of latency
-CMI is critical and to the control of proliferation of T. pallidum
-Immune response causes much of clinical disease

3

Early manifestations of syphilis/Primary syphilis?

-Ulceration
-Rash
-Ocular lesions
-neurological signs

4

Early confirmation of syphilis diagnosis?

-Dark field microscopy
-Direct fluorescent antibody test

5

Secondary syphilis

-appears 4-10 weeks after primary lesions
-due to haematogenous spread therefore may have systemic symptoms
-rash: macular...papular...papulosquamous
-rash on trunk, extremeties, pamls and soles
-

6

Late syphilis?

-no longer infectious

7

Syphilis test


EIA test: overall pretty good, although might have to wit some timeas for primary syphilis not perfect
RPR: detects and AB against lipoidal Ag. Positive 3-5 weeks post exposure
TPPA: confirmatory, in early and late disease.

8

Treatment for syphilis?

-Infected <2 years, benzathine penicillin IM
- Contacts are treated
-Allergy: doxycycline
-Pregnant: benzatine penicillin

9

Herpes infection

Transmission: mucosa more vulnerable
Replicates in epidermis
Travels via unmyelinated sensory neurons, where it can enter a latent phase
HSV1 and HSV2

10

Herpes treatment (Aciclovir facts)

Aciclovir- 15-20% bioavailability
-Activation involves viral thymidine kinase
- host cell metabolises to ACV triphosphate
-This competitively inhibits DNA polymerase, incorporates into DNA chain and terminates chain
-HSV resistance uncommon
-L-valine ester makes valaciclovir, more bioavailable

11

Chlamydia trachomatis and serovars L1,L2 and L3 (most common here is L2)

Presentation depends on site, and gender: transient anogenital ulcer, cervicitis , proctitis
Causes lymphogranuloma vereneum

12

HPV features

-DNA virus
-needs differentiating epithelial tissue to grow
-Anogenital warts it can cause, with some association with anogenital neoplasia
-E6 and E7 gene target TS genes and drive replication

13

HPV complications

Intraepithelial neoplasia
Most are benign, small number can cause anogenital cancer.
Smoking and immune status important co-factors
cervical cancer well described
oro-pharyngeal cancer and anal cancer becoming important theme

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