viral STIs 2 Flashcards
(31 cards)
symptoms associated with herpes simplex virus/genital herpes
- fever, inguinal adenopathy, malaise
- painful lesion lasting 3 wks- on butt, thighs, penis, peritoneum, cervix and vulva
initial genital infection vs primary infection
initial- patient has been exposed to herpes simplex but on mouth or elsewhere besides genitals
primary infection- first time pt has ever seen virus
after initial infection, what can a patient expect
recurrent lesions that are less painful and may even show up as vulvar irritation in women
preceding outbreak- tingling and pain
heal within 7-10 days
what other conditions can herpes simplex virus cause
- herpetic whitlow- infection of digits
- herpes simplex keratitis- can lead to blindness
- herpes labialis
- herpes simplex encephalitis
when is the risk for neonates contracting herpes from mom the highest
when mom is experiencing primary infection
can be lethal to baby
what are the three types of neonatal herpes infections
1) localized in skin, eyes and mouth
2) skin lesions and encephalitis
3) disseminated
characteristics of neonatal herpes of the skin, eyes and mouth
- not lethal
- 10 days post birth
- recurrences in first 6 mo
- 30% untreated lead to blindess, microcephaly and spastic quadraplegia
characteristics of encephalitis/skin lesion neonatal herpes
1/3 of infections
seizures, lethargy, tremors, poor feeding, temp instability, BULGING FONTANEL
50% mortality if untreated
survivors often have neuro probs
disseminated neonatal herpes
-lesions in visceral organs and skin- liver, cns, lungs, eyes, adrenals
-symptoms- seizures, respiratory distress, jaundice, bleeding, shock
-80% mortality untreated- antiviral reduce by 23%
complications- pneumonia and DIC
prevention of neonatal herpes
- c section
- healthcare worker precautions for herpetic whitlow and orolabial lesions
treatment of neonatal herpes
IV admin of antivirals for all neonates with herpes
herpes simplex virus characteristics
- dsDNA
- enveloped
- encodes many of its own enzymes including DNA polymerase that is often targeted by ANTIVIRALS
pathogenesis of herpes simplex virus
1) infiltrates epithelial cells - replicates
2) taken up by a host neuron via retrograde transportation
3) stays latent in ganglia of neuron-either sacral ganglia = genital herpes or trigeminal ganglia = cold sores
4) recurrence -herpes sim comes back down the neuron and out to epithelial cells
- triggers: stress, UV light, trauma, hormone change
what are the types of herpes viruses and what are they associated with? when are you expected to get them?
- HSV1 and 2
- HSV1 = oral, HSV2 = genital
- HSV1- before age 4, HSV2- sexual activity
how is HSV transmitted
sexually, direct contact with lesions, saliva
diagnosis of herpes simplex virus
- clinical appearance of lesions that are 1-2 mm in GROUPS
- PCR to detect genome
- immunocytochem to detect antigens
- microscope- do TZANCK SMEAR- where you scrape a part of lesion and look for nucleated cells
- for dendritic lesion in eye- can see with fluorescent dye
treatment of herpes simplex virus
oral- nothing
genital- oral antiviral, recurrent- long term antiviral
neonatal herpes-IV and antiviral treatment
ocular-topical antiviral
treatment goals for hsv
- not to cure
- decrease time to heal
- increase time between outbreaks
treatment for HSV
acyclovir- (mnemonic- cycle like herpes)
1) nucleoside inhibitor: enters the system and is immediately phosphorylated by VIRAL thymidine kinase
2) further phosphorylated and pretends it’s a nucleotide analog
3) binds polymerase chain and terminates viral dna replication
foscarnet
1) nonnucleoside inhibitor- no HSV phosphorylation needed, active right away stops viral DNA polymerase -used in immunosuppressed pt
why is acyclovir such a successful drug
because it is phosphorylated and able to infiltrate viral genome by the cells that have the virus.. of no virus, no phosphorylation and thus those cells that are not infected are unharmed
Genital warts- condyloma acuminatum
what do they look like? how do you see them better
- hyperkeratotic, firm, exophilic papules
- 1mm-2 cm
- causes itching, pain, burning
- cervical warts- exophilic, endophilic, flat
- see them better with 3-5% acetic acid spray
what is respiratory papillomatosis/laryngeal papillomas
- nodules on ciliated and squamous epithelial jxn of larynx
- usually found in babies
- HPV infection
- causes altered cry, horseness, stridor, respiratory distress
treatment for respiratory paillomatosis/laryngeal paillomas
- surgical removal of growth but they often come back
- c section rarely prevents
HPV charcteristics
- non-enveloped
- dsDNA
