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Oral medicine > STDs key points > Flashcards

STDs key points Flashcards

1
Q

what organism is trichomonas vaginalis?

A

protozoa

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2
Q

tx of trichomonas

A

metronidazole

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3
Q

oral effects of trichomonas

A

oral ulcers
rare
if IC

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4
Q

chlamydia organism

A

chlamydia trachomatis

bacteria

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5
Q

chlamydia forms

A

elementary body - metabolically inactive. EC

reticulate body - replicative form. IC

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6
Q

chlamydia tx

A

azithromycin or doxycycline

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7
Q

chlamydia oral effects

A

rare - tonsillopharyngitis
cervical and oropharyngeal lymphogranuloma
rarely vesicles/erosive nodules L lip, ulcers frenum tongue

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8
Q

gonorrhoea organism

A

neisseria gonorrhoeae

bacteria

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9
Q

gonorrhoea oral effects

A

gonococcal tonsillar infection (rare)

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10
Q

gonorrhoea tx

A

IM ceftriaxone

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11
Q

syphilis organism

A

bacteria

treponema pallidum

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12
Q

primary syphilis

A

painless “chancre” ulcer/papule
regional lymphadenopathy
lasts 6-8wks

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13
Q

secondary syphilis

A

typically several weeks after untreated primary. Wide spectrum

  • rash - palms and soles
  • oral: erosions, polymorphic aspect, bullous, erythematous, L lip, tongue, white border surrounding erythematous areas
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14
Q

latent syphilis

A

early (1st year, infectious) and late (usually non-infectious and doesn’t respond well to tx)
absence of clinical manifestations in the setting of serologic detection of syphilis

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15
Q

tx of syphilis

A

IM penicillin x2

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16
Q

congenital syphilis oral effects

A

approx 6yrs
hutchinson teeth
mulberry molars

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17
Q

hutchinson teeth

A

centrally notched, widely spaced, peg shaped U1s

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18
Q

mulberry molars

A

surface has numerous poorly formed cusps surmounting a dome shaped tooth

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19
Q

tertiary syphilis

A 
systemic multiorgan disease process
15% untreated pts progress to this
3 main systemic manifestations:
 - neurological
 - CV (aneurysms)
 - gummatous (MC) lesions
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20
Q

what type of virus is HSV?

A

dsDNA

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21
Q

HSV1

A

oral (usually)

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22
Q

HSV2

A

genital

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23
Q

genital herpes lifelong infection

A

viral genome maintained within ganglia for life (latency - episomes
reactivation

24
Q

primary HSV 2 infection outcome

A

usually resolves approx 3 wks

25
Q

HSV2 recurrent infections

A

can get prodrome (travelling along axons)
lesions more likely to be fewer in number, unilateral and generally without systemic symptoms
more mild

26
Q

HSV non-primary infection

A

infection with HSV 1 or 2 in an individual with pre-existing ABs to the other virus
manifestations tend to be milder than those of primary infection
- presumably due to cross-immunity protection from prior infection with the other HSV type

27
Q

HSV and antivirals

A

reduce symptoms and likelihood of transmission

28
Q

main risk factor for genital herpes

A

number of lifetime sex partners

29
Q

what type of virus is HPV?

A

dsDNA

30
Q

non-oncogenic low risk HPV

A

6 and 11

31
Q

oncogenic high risk HPV

A

16 and 18

32
Q

low-risk HPV oral features

A 
variety - solitary/multiple
verruca vulgaris (common wart)
condyloma acuminatum (cauliflower like)
squamous papilloma - hairy like (pedunculated) lesions
33
Q

squamous cell papilloma

A

neoformation epithelial origin
HPV 6 and 11
slow exophytic growth with wide base or pedicle
HPV related - STD screen?

34
Q

squamous cell papilloma histology

A 
hyperkeratotic surface
papillary (finger-like) projections
projections have fibrovascular CT cores
SSE covers cores
no dysplasia
35
Q

condyloma acuminatum

A

wart
HPV 6, 11, 16, 18
tongue and palate
acanthotic and sometimes hyperkeratotic epithelium with occasional koilocytosis

36
Q

focal epithelial hyperplasia (Heck’s)

A

asymptomatic benign mucosal disease
multiple, painless, soft, sessile papules/plaques/nodules, can coalesce to give larger lesions
HPV 13 and 32 associated etc
usually need histopathology to confirm exact diagnosis

37
Q

focal epithelial hyperplasia (Heck’s) - onset

A

mostly in specific groups in certain geographical regions
- often poverty/low SES
usually childhood/adolescence

38
Q

focal epithelial hyperplasia (Heck’s) - tx

A

sometimes resolves spontaneously but tx often indicated - aesthetics/any interference with occlusion
no specific tx
- SR, laser excision or possibly topical antiviral agents may be of benefit
no evidence that it is potentially malignant

39
Q

oncogenic HPV

A

if infection fails to clear and persists for long time, viral E2 protein fct gets abrogated, leading to overexpression of main viral oncoproteins E6 and E7

40
Q

what type of virus is HIV?

A

enveloped ssRNA virus

41
Q

revised WHO HIV/AIDS clinical staging system

A

4 clinical stages for adults

demonstrate at least one clinical condition in that stage’s criteria

42
Q

stage 1 acute HIV infection

A

asymptomatic/persistent generalised lymphadenopathy
may remain for several years
CD4+ cell count >500 cells/uL

43
Q

stage 2 early/mildly symptomatic HIV

A

unexplained WL <10% TBW
recurrent resp infections
dermatological conditions
CD4+ cell count 350-499/uL

44
Q

stage 3 late/moderately symptomatic HIV

A 
WL >10% TBW, prolonged
unexplained diarrhoea
pulmonary TB
severe systemic bacterial infections
MC conditions - ROC, oral hairy leukoplakia, NG/P/S
CD4+ cell count 200-349/uL
45
Q

stage 4 AIDS

A

develop AIDS-defining conditions or a CD4 cell count of <200 cells/uL in HIV-infected pts

46
Q

HIV coinfection

A

TB most prevalent (1 in 4)
chronic HBV
HCV
HPV

47
Q

oral lesions strongly associated with HIV

A 
candidiasis: erythematous, pseudomembranous
hairy leukoplakia
Kaposi sarcoma
PDD
 - LGE
 - NG/P
lymphoma
48
Q

LGE

A

distinct band of erythema of gingival margin

49
Q

HIV oral bacterial infections - TB

A

painful, superficial lingual ulcer, well-circumscribed with crateriform aspect and slightly elevated and indurated borders

50
Q

HIV oral bacterial infections - syphilis - secondary

A

mucous patches appeared as white slightly raised plaques on an erythematous base with a serpentine and white/reddish well-defined outline
shallow ulcers
macular lesions

51
Q

HIV and oral ulcerations

A

freq increases with HIV progression

52
Q

HIV and SGs

A

bilateral parotid gland enlargement

53
Q

Kaposi Sarcoma

A 
associated with HHV8 infection
red/bluish/purplish macular or nodular lesion
can ulcerate and bleed
small to extensive
HP, gingiva and tongue
54
Q

NHL

A 
clinically
 - rapidly enlarging necrotic masses
 - ulcerated/non-ulcerated masses
 - palate and gingivae most common sites
v poor prognosis
55
Q

HAART drugs

A 
NRTIs
NNRTIs
INSTIs
protease inhibitor
entry inhibitor
56
Q

HAART recommended initial regimen

A

2NRTIs plus one from INSTI/NNRTI/PI and a pharmacokinetic (PK) enhancer (also known as a booster) e.g. cobicistat and ritonavir
lots of oral HC drug interactions - check

57
Q

orofacial adverse effects of HAART

A 
EM
ulcers
xerostomia
taste alteration
perioral paraesthesia
facial lipodystrophy
(hyperpigmentation)
(cheilitis)

Oral medicine (14 decks)

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