STIs part 2 (HIV syphilis) Flashcards
(36 cards)
what are genital warts caused by?
- sexually transmitted HPV subtype 6 and 11
- (occasionally 16 and 18 but associated with malignant potential)
who is most likely to get florid lesions in genital warts?
- DM
- pregnancy
- OCP
- smoking
- immunosuppression
what is the incubation period for genital warts?
what do genital warts look like?
how do they feel on palpation?
- up to 8 months
- pink papular lesions, single or multiple, keratotic or plaques
- multiple raised papillomatous lesions, feel hard to touch and are irregular
what investigations would you perform for genital warts?
- biopsy atypical lesions
- cervical smear and cytology
- colposcopy and biopsy cervical lesions
- STI screen
how can genital warts be managed?
- ablation (<6 and keratinised)
- immune modulation (imiquimod cream)
- surgical:
curettage, excision - advice on cervical smears and eliminating sexual contacts
how might vaginal warts affect pregnancy?
what are the complications of vaginal warts?
- consider LSCS only if large vaginal introitus lesions
- infection of confluent lesions, CIN, cervical carcinoma
what organism is syphilis caused by?
who is most at risk?
- treponema pallidum
- re-emerged in MSM, many with HIV
how does primary stage syphilis present?
- chancre- at site inoculation, small painless ulcer, indurated with exudate
- may be on anal margin, tonsils, lips or nipples
- incubation period a few weeks
how does secondary stage represent?
- widespread maculopapular rash, palms, soles, generalised
- mouth ulcers
- alopecia
- systemic symptoms: headaches, malaise, fever, meningitis, CN nerve dysfunction
how does tertiary stage present?
- neurosyphilis (dementia, meningeal involvement)
- cardiovascular symptoms
- latent stage: positive blood test, no symptoms
what investigations would you do?
- take sample from open skin lesions to do microscopy
- serology
- syphilis PCR
- STI screen, especially HIV
what is the management of syphilis?
neurosyphilis?
- benzathine penicillin 2.4g IM
- procaine benzylpenicillin, 750mg for 10 days
what are the complications of syphilis in pregnancy?
- pregnant women with untreated syphilis 70-100% infants infected
- 1/3 chance of stillbirth if infected
- growth problems up to 2 years
- all pregnant women with positive serology should be treated for syphilis
- outcome depends on gestational age infection acquired
what is the pathology of HIV?
- kills CD-4 cells
- HIV 1 most common
- reverse transcriptase RNA inserted into DNA and causes latent infection
what is the normal CD4 range?
what is the timecourse of HIV?
- 500-1500
- infection, seroconversion (acute illness), asymptomatic, HIV related illness, AIDS , death
what happens in seroconversion in HIV?
- initial massive proliferation of viral load, body can not cope and drops CD4
- body recovers and makes more CD4 cells
- HIV RNA conc increases, CD4 conc decreases, then they become symptomatic
what are the risk factors to ask about?
- sex worker
- MSM
- unprotected sex with foreign people
- IVDU
what are the symptoms of seroconversion?
- occurs 2-6 weeks after exposure
- only 60% of people get it
- glandular fever like symptoms:
- sore throat
- fever
- lymphadenopathy, malaise and lethargy, arthralgia/myalgia
- rash (maculopapular on trunk)
- ulcers on mouth and penis
What would make you think HIV in a patient presenting with another problem?
- atypical
- severe
- recurrent
what are the aids related malignancies?
- Kaposi sarcoma
- non-hodgkins lymphoma
- invasive cervical carcinoma
- (all NHL patients should be screened for HIV)
10% of them will get a malignancy
what are the bacterial conditions which are AIDS defining in people with HIV?
fungal?
- TB
- recurrent pneumonia
- salmonella septicaemia
- mycobacterium avid complex (MAC)
- candidiasis (oesophageal, bronchial, tracheal, lungs)
- pneumocystis pneumonia
what viral infections are associated with it?
parasitic infections associated with it?
- CMV (retinitis, liver, spleen, glands)
- HSV
- cerebral toxoplasmosis
- cryptosporidiosis
- leishmaniasis
What is HAART?
- the use of at least 3 anti- HIV drugs from at least 2 different drug classes
- two nucleoside reverse transcriptase inhibitors (NRTIs)
- one non nucleoside reverse transcriptase inhibitor (NNRTIs)
what is the aim with viral load?
what may affect viral load coming down?
- it should be kept below 50
- monitor treatment to make sure it is coming down
- compliance,over 95% of people who are 100% compliant will have an undetectable viral load
