7 – Genital Herpes and Genital Warts/Cervical Cancer – Flashcards
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human-human transmission prevention
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respiratory/saliva fecal oral sexual - chronic suppression therapy to prevent genital herpes simplex virus HSV-2 infection of newborn in birth process
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peak season
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none for sexual route
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DNA viruses for which sexual transmission is major route (not blood-borne like HIV)
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herpes simplex type 2 (HSV-2) - lipid envelope HPV (types 6 and 11, esp. types 16 and 18) - naked icosahedral
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viral vesicular skin lesions characteristic of... major targets
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herpes simplex and varicella-zoster herpesviruses external genitalia and mucosal tissue of vagina of HSV-2
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hallmarks of human herpesviruses (HSV-1 mouth, HSV-2 genitals, varicella chickenpod)
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latency in sensory neurone in dorsal root ganglion after primary infection, and possible reactivation
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symptoms of HSV-1 in children
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oral lesions more common than external skin lesions
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varicella-zoster (chickenpox) lesions
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initial vesicular lesions - dewdrops on a rose petal --> lesions become pusutles, then crust --> new lesions can form in same area as result of new waves of virema
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diseases w/ HSV-1 and 2 and therapy
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rarely, infection of brain and spinal cord --> encephalitis, requiring acyclovir therapy herpes labialis (cold sore, fever blister) w/ HSV-1, therapy w/ penciclover cream more effective than oral acylclovir
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secondary infection or recurrence/activation of HSV, VZV due to
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HSV: fever, sunlight, menstruation, nerve stimulation btw neurone and spinal cord - number/duration of lesions may be reduced in HSV-2 VZV: age, immunocompromise, local injury --> leads to shingles in all, virus activated in neurone and transported down peripheral nerve
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herpes zoster/shingles at later stage cause
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lesions coinciding w/ chest dermatome post-herpatic neuralgia major problem w/ elderly
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majority of persons w/ latatent HSV-1 do/do not get recurrent cold sores?
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do not - recent evidence for genetic susceptibility
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effect of male circumcision circumcisors
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less protective effect against HSV-2 and genital HPV than for HIV serious/fatal HSV-1 acquired from oral herpes of Orthodox Jew
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HSV-2 infection of newborn in birth process disease/therapy other perinatal viral infections
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highest risk w/ primary infection of pregnant femael late in pregnancy, b/c more virus shed and no transplacental anti-HSV-2 IgG compared to reactivated skin lesions / therapy: antiviral IV drug acyclovir HSV-2, HIV, HPV, HBV
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genital herpes and anogenital warts/cancers vaccine
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HSV - no vaccine HPV - vaccine
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recombinant envelope glycoprotein vaccine against HSV-2
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no protection found in large scale study
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warts (papillomas) are tumors caused by all benign except
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HPV types 1-80+, specific types w/ distinct anatomical location/apearance HPV-16 and 18, causing cervial/other genital cancers
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transmission of cutaneous warts incubation virus type of common warts plantar warts on soles of feet sexually transmitted anogenital warts
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direct introduction of microbe into epithelium 2-4 months HPV-2 (treeman unusual case) HPV-1 90% by HPV-6 and 11 (low cancer risk)
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sexually transmitted HPVs and cervical cancer
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- cervical and other ano-genital lesions caused by HPV-16, 18, many others have potential to progress to cancer - HPV responsible for 99% of cervical cancer (16 - 50%, 18 - 20%) - 2005: 12000 cancer diagnoses, 4000 deaths - also cause of 3200 vulvar cancers and 800 deaths
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determination of genital HPV infection prevalence diganostic tests for cervical cancer or pre-cancerous cervical lesions
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DNA extraction from cervico-vaginal swab 20-24 yrs - classically, pap smear and microscopic examination for lesions, graded CIN 1-3 - hybrid capture nucleic acid assay for DNA for high-risk HPV's in conjunction w/ pap smear for females >30 likely to have CIN grades 2 or 3 and in need of colposcopy
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oncogenic mechanisms of HPV-16 and HPV-18 in development of cervical cancer
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first step in HPV-16: infection of epithelial cells of cervix additional independent genetic mutations necessary for full progression to malignancy - smoking increases chance of cancer development for many high risk HPV's
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other anal-genital cancers assoc. w/ HPV's detection increased risk to
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- squamous cell carcinoma of penis, more common in Africa/Asia/S. America - anal cancer (90% of cases) high risk HPV DNA detected in lesions uncircumsised males
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perinatal transmission of HPV-6/11 also transmitted by
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from genital warts to lesions in mouth (boy that can't speak) oral sex
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other HPV cancers
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oral cancers: tonsillar and tongue-base cancer
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HPV vaccine structure vaccine:
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recombinant virus-like particles produced as inactivated subunit vaccine - self-assemble into empty, non-infectious icosahedral capsids GARDASIL, 1st of 3 doses at ~11 for females (HPV 16, 18, 6, 11 +) and later males (protect against genital warts from HPV 6 and 11) 9-26
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Herpes simplex and HPV... structure of viruses
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herpes simplex: lipid-envelope and icosahedral capsid with donut-shaped capsomers HPV: naked icosahedral
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Herpes simplex and HPV... major routes of transmission:
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respiratory/salivary fecal-oral venereal (no peak seasonal influence) infant during birth process
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Herpes simplex... specific disease: localized/generalized infection: incubation period:
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vesicular skin lesions in external genitalia and mucosal tissue of vagina; oral lesions
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What do the herpes simplex virus (HSV) and varicella virus (VSV) have in common?
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latency after primary infection and possible reactivation reactivation in HSV-1 leads to cold sore due to fever, sunlight, menstruation reactivation in HSV-2 in same genital/vaginal area as primary infection reactivation of VSV leads to zoster (shingles) due to age, immunocompromise, local injury
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Herpes virus... protection:
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reduced number of sexual partners male circumcision (less protective effect than for HIV) chronic suppression therapy to prevent infection of sexual partner
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What types of perinatal infection are possible as an infant travels down the birth canal?
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HSV-2, HIV, HPV, HBV
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Herpes virus and HPV... vaccination:
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no effective vaccination against HSV noninfectious VLP bivalent and Gardisil vaccines against HPV for females and now males 9-26
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HPV... specific disease: localized/generalized infection: incubation period:
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papillomas (warts) - HPV-2, plantar warts - HPV-1, (anogenital warts - HPV-16 and 18 at high risk for progression to cancer) localized infection 2-4 months also cervical cancer, oral cancer
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HPV - cervical cancer... diagnosis protection
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pap smear and microscopic examination for precancerous lesions; hybrid capture nucleic acid assay quit smoking
