GENITAL WARTS, HPV 6, 11, 16
6 and 11 rarely associated with cervical cancer
not cure just treat the symptoms
which HPV strains are common in subclinical infection and genital cancer?
what does condyloma acuminatum present with?
pale pink with numerous discrete narrow-to-wide projections on a broad base.
surface is smooth or velvety, moist and lacks hyperkeratosis(thickening of the stratum corneum) seen in other warts.
sexually active pt may present with multifocal bilateral red or brown slightly raised smooth papules
50% of genital warts in children are from sexual abuse.
condyloma acuminatum- treatment
remember not curing the patient just treating the symptoms.
enterovirus, echo virus, and coxackeivirus cause most exanthems
usually a generalized rash presenting at any stage of illness
erythematous macules and papules with areas of confluence, but may be vesicular, petechial, urticarial.
palms and soles involved
more common in children
just treat the symptoms, don't usually need to give anything.
5th disease (erythema infectious)-caused by parvovirus B-19
Roseola HHV 6,7
Herpes Simplex (know the 2 types)
Elevated IgG antibody titer, indicates previous infection
primary infection (most intense) establishes a nerve ganglion
spread through direct contact with lesion, virus containing fluid (saliva and cervical secretions)
self-inoculating, infection in one site does not protect a pt from infection at another site.
Herpes Simplex-Physical Exam
grouped vesicles on an erythamatous base and then umbilicate
vesicles are uniform in size
mucous membrane lesions have exudate (leaky fluid), skin lesions form crust. (lasts 2-4 weeks)
prodrome(early symptom) of burning and itching
2-5mm papule, slightly umbilicated, flesh colored dome shaped with gummy material inside. virus is encapsulated, host immune system will not recognize it.
spread by touching and auto inoculation
lesions last 6-8 weeks
KOH prep will show inclusion bodies
curettage- scraping with a curette
cryosurgery- if mom wants the papules removed!
chicken pox, lesions will be at different stages (papules, vesicles, pustules, crusts)
DEWDROP ON A ROSE PETAL
transmission via airborne droplets or vesicular fluid
contagious until all lesions have crusted.
eventually becomes latent and moves into neuroaxis.
skin infections, neurologic (encephalitis), pneumonia, dangerous in pregnancy
varicella- diagnosis and treatment
lab tests- serologic testing IgM antibodies, IgG indicates post exposure
tzank smear will tell you if there is a virus infection, will not tell you whether its HSV or varicella.
vaccine- live attenuated, lasts 6 yrs
acyclovir in kids > 12 or high risk
SHINGLES, usually involvers a single dermatome
T-cell immunosuppression greatest risk
occurs once in a lifetime
direct contact with vesicle can transmit varicella
elderly greatest risk of post hepatic neuralgia (PHN)zo
must have varicella or varicella vaccine in order to get zoster.
one sided pain may mean shingles, not necessarily a heart attack or back pain.
peripheral facial nerve palsy with vesicular rash on ear or in the mouth.
bell's palsy is just facial palsy.
goal is suppress pain, inflammation, and infection
Valtrex (name brand) 3X greater bioavailability