Can HSV-1 cause the first episode of genital herpes?
Yes, however, the majority of infections is due to HSV-2
The majority of genital herpes infections are transmitted by persons unaware that they have the infection or who are asymptomatic when transmission occurs. True or false?
What is fomite transmission?
This route requires an inanimate object to carry a pathogen from one susceptible animal to another.
Is fomite transmission likely to occur with HSV?
Unlikely because soap and water inactivates HSV
HSV remains latent in the paraspinous ganglia and is reactivated by________?
Trauma, fever, ultraviolet light, stress, and unknown factors
When would HSV-2 antibodies be present in a patient with a newly acquired case of HSV-2?
It may take from 3 weeks to a few month for antibodies to appear
A patient is concerned that over the weekend they may have been exposed to HSV-2 and want to be tested. Will serum antibodies be present?
Primary infections with HSV-2 tend to be moderate to severe and the herpetic lesions are often (bilateral or unilateral)?
How do the lesions progress in an HSV infection?
Describe the systemic manifestations that can occur with an initial HSV-2 infection.
Fever, headache, malaise, myalgia, & urinary retention in women
What are the local symptoms of an initial infection with HSV-2?
Pain, itching, dysuria, vaginal discharge, and adenopathy
What percent of patient with an initial acquisition of HSV-2 have inguinal adenopathy?
80% have firm, nonfluctuant tender nodes
How long do the genital lesions from an initial HSV-2 infection persist?
On average 11-12 days
Can HSV-2 infection cause dysuria?
Yes, 80% of women report dysuria
Describe the prodrome for a recurrent HSV-2 infection
Localized tingling and irritation
Are recurrent episodes of HSV-2 shorter than in a primary infection?
Yes. The lesion lasts 4-6 days with milder symptoms
What percentage of patients with a symptomatic HSV-2 infection will have a recurrence in the first 12 months of infection
How many occurrences would you expect in the first year of HSV-2 infection?
The median recurrence rate is 4.5 per year
Is it true that the frequency of recurrences of HSV-2 decreases over time?
Does antiviral suppressive therapy eradicate viral HSV-2 shedding?
No, however, it dramatically reduces viral shedding
Is screening for HSV-1 or HSV-2 in the general population indicated?
What is the preferred test for HSV if lesions are present?
All patients with genital ulcers should be tested for__________?
What drugs are used to treat HSV?
Acyclovir, valacyclovir, famciclovir
Is topical treatment of HSV recommended?
What dose of valacyclovir is recommended for treatment of the first clinical episode of HSV-2?
1 gram orally every 12 hours for 7-10 days
Suppressive therapy can reduce the frequency of genital herpes recurrences by________%
When would suppressive therapy for HSV-2 be suggested?
With frequent recurrences (>6 per year)
The dose for suppressive therapy of HSV-2 infection with valacyclovir is______?
500 mg- 1000 mg daily
Why is valacyclovir preferred in the management of HSV-2 infections?
The dosing is less frequent and thus more convenient
The dose for episodic therapy for recurrent infection of HSV-2 infection with valacyclovir is______?
500 mg every 12 hours for 3 days or 1000 mg daily for 5 days
Can episodic treatment of HSV-2 shorten the duration of recurrent episodes?
Yes if started within 1 day of lesion onset
Do genital ulcers from HSV-2 infection increase the risk of HIV infection?
Why is it important to ask women about HSV prior to delivery?
HSV can be transmitted to the baby
Can HSV-2 infection cause cancer?
Can a woman with HSV-2 infection deliver vaginally if she has no signs of herpetic lesions or prodrome at the onset of labor?
Approximately how many types of HPV can infect the genital tract?
More than 30 types of HPV are sexually transmitted
Genital HPV types are divided into two groups based on their association with_____________?
What are the two types of HPV infection classification?
Low-risk and high risk
Do low risk types of HPV cause cervical cancer?
Which type of HPV cause genital warts?
Low-risk HPV (6 and 11)
Which HPV types are considered high risk or oncogenic?
16, 18, 31, 33, 35, 39, 45
Is it true that most genital HPV infections (high risk or low risk) are transient, asymptomatic, and have no clinical consequences?
Yes, most HPV infections go away on their own
Is HPV a reportable condition?
No, however genital warts are reportable in some states
What approximate percentage of the population acquire genital HPV infection at some point in their lives?
Can HPV be transmitted by fomites?
Fomite transmission of HPV has never been documented
Is HPV more likely to be detected in HIV-infected individuals?
Immune-suppressed individuals are at higher risk of infection with HPV
What are other risk factors for genital HPV infection?
Smoking, oral contraceptive use, poor nutrition and lack of circumcision of male partners
Which of the HPV types are oncogenic and account for more than half of the HPV types found in anogenital cancer?
HPV types 16 and 18
Which of the HPV types cause visible genital warts?
HPV types 6 and 11
Do visible genital HPV warts cause cancer?
Most women with an effective immune response will clear a new cervical HPV infection in approximately__________years?
What is the most important risk factor for precancerous (high-grade) cervical cell changes and cervical cancer in women with HPV infection?
HPV infection that persists
What are the factors associated with persistent HPV infection?
Older age, high-risk HPV types, and immune suppression
Recurrent respiratory papillomatosis is a rare condition of respiratory tract warts in a baby due to HPV transmitted during delivery. Which type of HPV is associated with this condition?
HPV types 6 and 11
Where do genital warts most commonly appear?
In areas of coital friction
Can HPV types causing genital warts cause lesions on oral, upper GI, and ocular locations?
How is the diagnosis of genital warts usually made?
By visual inspection
Is colposcopy recommended if genital warts are present?
Should you screen for other STIs in patients with newly diagnosed genital warts?
Can genital warts recur once they are treated?
There is a 20-50% recurrence rate at 3-6 months after treatment
Why should genital warts in preadolescent children be evaluated?
There is a likelihood of sexual abuse
How do you detect cervical cell abnormalities caused by HPV infection?
By Pap test, colposcopy, or biopsy
What are the Bethesda System classifications of cervical cellular abnormalities?
ASC-US, ASC-H, LSIL, HSIL
Which of the above classifications is associated with a persistent infection with a high-risk HPV and has a higher risk for progression to cervical cancer?
High-grade squamous intraepithelial lesion (HSIL)
Risk factors that increase the risk of developing cervical cancer include all of the following except: Early age of first intercourse (16 years or younger), multiple partners, active or passive smoking, long term use of oral contraceptives, high number of pregnancies, immune suppression and co-infection with other STIs.
All of these increase the risk of cervical cancer
Most women with high-risk HPV types have (normal or abnormal) Pap test results?
What is the definitive diagnosis of HPV?
HPV DNA testing of cells scraped from the surface of the cervix
When is colposcopy or biopsy indicated?
When lesions are visible on the cervix or Pap is HSIL
What is one of the CDC-recommended patient applied regimens for external genital warts?
Podofilox 0.5% bid for 4 days, skip 4 days, and repeat for up to 4 cycles
Is there a limit on the amount of podofilox that can be used daily?
Use no more that 0.5mL per day
Imiquimod 5% cream (Aldara) is used 3 times a week for up to 16 weeks to treat genital warts. The patient should be instructed to wash the area with soap and water ______hours after the daily treatment?
Can Imiquimod or podofilox be used to treat genital warts during pregnancy?
Provider-administered regimens for external genital warts include_________?
Cryotherapy, podophyllin resin, trichloroacetic acid or surgical removal
Does a woman with genital warts need to increase the frequency of Pap testing?
Are condoms effective in preventing transmission of genital HPV infection?
Condoms can decrease but not prevent transmission
Does treating genital warts reduce infectivity?
It is not known
Which vaccine has been shown to decrease the risk of cervical cancer?
Which type of HPV does Gardasil confer protection?
HPV types 6, 11, 16, and 18
Is Gardasil approved in males?
Does Gardasil protect from genital warts?
It confers protection against 90% of genital warts cases
At what age is it recommended to give Gardasil?
Girls and boys as young as 9 can get vaccinated
What is the schedule for vaccination with Gardasil?
Given intramuscularly at 0, 2 and 6 months
How long should you observe a patient for syncope after administration of Gardasil?
Can Gardasil be given during pregnancy?
Safety during pregnancy has not been established
Is chlamydia a reportable infection?
Chlamydia is reportable in all 50 states
The rate of chlamydia among African Americans is (higher or lower) than the rate among whites?
The rate of chlamydia is about 8 times higher in African Americans
Why are adolescent females more susceptible to chlamydia?
Risky sexual behavior and cervical ectopy are risk factors
What is cervical ectopy?
The presence of columnar epithelial cells present in younger females
Why are adolescents using oral contraceptives at higher risk for chlamydia infections?
Oral contraceptives contribute to cervical ectopy
When there is vertical transmission of chlamydia (perinatal), exposed babies can contract____________?
Conjunctivitis and pneumonia
Do individuals with chlamydia infection have symptoms?
Greater than 50% are asymptomatic
Describe the clinical manifestations of chlamydia (if present).
Mucopurulent, mucoid or clear urethral discharge, and dysuria
What are the uncommon complications in men with chlamydia infections?
Epididymitis, and Reiter’s syndrome (rare)
What are the clinical manifestations of epididymitis?
Fever, scrotal and epididymal pain and swelling
What are the characteristic manifestations of Reiter’s syndrome?
Conjunctivitis, urethritis, oligoarthritis, and skin lesions
When present, what are some of the signs and symptoms of cervicitis due to chlamydia?
Mucopurulent endocervical discharge, edema, erythema, and cervical friability
Can women with chlamydia infections be distinguished from uninfected women by clinical examination?
Is the Pap test a sensitive or specific indicator of chlamydial infection?
Can women with chlamydia have dysuria?
Yes, 50% of women have chlamydia in both the cervix and urethra
What are some of the complications from chlamydia infection in women?
Mucopurulent or purulent cervical discharge, and easily induced cervical bleeding (friability)
Is it possible to be asymptomatic when cervicitis is present?
Yes, 50% of women with clinical cervicitis have no symptoms
What are the potential complications from GC infections in women?
Accessory gland infection, PID, and perihepatitis
What other parts of the body can become infected with GC?
Rectum, pharynx, eyes and the blood
What are the clinical manifestations of disseminated gonococcal infection?
Skin lesions, arthralgias, arthritis, hepatitis, myocarditis, endocarditis, and meningitis
How is GC diagnosed if sexual abuse is suspected?
Culture is the legal standard
Why is it important to treat for both GC and chlamydia?
There is a high rate of coinfection
What is the recommended treatment for GC?
Ceftriaxone (Rocephin) 250 mg IM X 1 and 1 gram of azithromycin
Why are ceftriaxone and azithromycin recommended for the treatment of GC
Using both antibiotics decreases the incidence of resitant organisms
Can you use an oral agent to treat GC?
Cefixime (Suprax) 400 X 1 and azithromycin together
Are fluoroquinolones recommended for gonorrhea therapy in the U.S?
Do you need to perform a “test of cure” after treatment of chlamydia or GC?
Yes, new recommendations include a retest at 3 months
What is expedited partner treatment (EPT)?
Providing medication or prescription for partners of infected patients
Can you provide EPT in the state of Florida?
When can sexual partners resume activity after being diagnosed with GC?
When therapy is completed and both partners no longer have symptoms
Syphilis (Treponema pallidum) remains an important problem in the southern region of the U.S. and areas where there are large populations of_____________?
Men who have sex with men (MSM)
Can you culture the organism that causes syphilis?
It can not be cultured in vitro or seen by normal light microscopy
What is the painless skin lesion produced by the primary syphilis infection?
What is the progression of the chancre?
Macule→ papule→ ulcer→spontaneous healing in 1-6 weeks
Are serologic tests for syphilis positive during early primary infection of syphilis?
Serologic test are the highest during the (primary or secondary) stages of syphilis?
In the secondary stage of syphilis a___________appears in 75-100% of the cases?
Describe a syphilitic rash.
Nonpruritic macular, papular rash, may appear on the palms and soles
What are other clinical manifestations of secondary syphilis?
Lymphadenopathy, malaise, mucous patches, wart-like papules, and alopecia
Does neurosyphilis occur during the primary or secondary stage of syphilis?
T. pallidum can invade the CNS at any of the stages
What are the clinical manifestations of neurosyphilis?
Paresis, cranial nerve involvement, tabes dorsales, stroke-like symptoms with seizure
____________ is a syphilitic myelopathy complication of untreated syphilis that involves muscle weakness and abnormal sensations. It consists of abnormal sensations, often called "lightning pains", difficulty walking, loss of coordination, loss of reflexes, muscle weakness and wide-based gait (the person walks with the legs far apart).
What are gummas lesions?
Lesions that occur in late syphilis which destroy tissue, cartilage and bone
Why is it important to do a neurological exam in a patient with syphilis?
CN II, III, VI, VII, and VIII can be affected in neurosyphilis
Why is it important to examine the abdomen in a patient with syphilis?
Liver evolvement with late syphilis can cause liver tenderness or splenomegaly
Which type of syphilis looks similar to genital warts caused by HPV?
Condylomata lata occurs in late syphilis
What are some of the lab tests used to diagnosis syphilis?
VDRL, RPR, FTA-ABS
Is it adequate to diagnose syphilis from a VRDL or RPR (nontreponemal) test?
A treponemal test such as FTA-ABS or TP-PA is needed for confirmation
What are some of the disorders that can cause false positive serologic tests for syphilis?