Viral hepatitis & Sexually transmitted infections

Hepatitis

Hepatitis = inflammation of the liver

Causes of Hepatitis

Hepatitis can be caused by:

• Infectious agents

  • Viruses

  • Bacteria

  • Fungi

• Drugs/medications

• Alcohol

• Food intoxication → example: poisonous mushrooms

• Obesity

• Autoimmune diseases

Viral Hepatitis

Almost any virus can potentially cause liver inflammation, but usually the virus causes other symptoms/clinical manifestations too.

There are 5 viruses that specifically target the liver:

Hepatitis A, B, C, D, and E

HAV = Hepatitis A

HBV = Hepatitis B
HCV = Hepatitis C
HDV = Hepatitis D
HEV = Hepatitis E

Easy way to remember:

Hepatitis = inflamed liver

A → B → C → D → E = the major hepatitis viruses that target the liver.

Acute hepatitis

Acute hepatitis = sudden liver damage/inflammation that develops over days to weeks.

1. Incubation Period

• Usually 2–12 weeks

• The virus is present, but symptoms may not appear yet.

2. Preicteric Stage (~1 week)

Preicteric = before jaundice

Symptoms are usually nonspecific, meaning they can look like many other illnesses:

• Fever

• Nausea/vomiting

• Myalgia → muscle/body aches

• Headache

• Fatigue

• Pain in the upper right abdomen

• Liver enlargement (hepatomegaly)

3. Icteric Stage

Icteric = jaundice develops

• Jaundice → yellow skin and eyes

• Choluria → dark urine

• Acholia → pale/white-colored stool

• Duration can vary.

4. Convalescence Stage

Convalescence = recovery

• Symptoms gradually improve.

• Duration varies depending on the person and type of hepatitis.

Easy sequence to remember:

Incubation → Preicteric → Icteric → Convalescence

Think:

Nothing → Sick → Yellow → Recover

Important:
Preicteric = before jaundice
Icteric = jaundice

Bilirubin metabolism

Bilirubin comes from the breakdown of old RBCs.

1. RBC breakdown

• Old RBCs are broken down by macrophages.

• This produces heme.

• Heme → unconjugated bilirubin

• Unconjugated bilirubin = NOT water-soluble

2. Liver processes bilirubin

• Unconjugated bilirubin travels to the liver.

• Liver cells (hepatocytes) add glucuronic acid.

• This is called conjugation.

• Unconjugated → conjugated bilirubin

• Conjugated bilirubin = water-soluble

3. Bilirubin leaves the body

• Conjugated bilirubin is released into bile.

• Bile carries it to the intestine.

• Gut bacteria convert it to urobilinogen.

From there:

Most urobilinogen → stercobilin → feces
Small amount → kidneys → urine

Super simple pathway

Old RBC → Heme → Unconjugated bilirubin → Liver → Conjugated bilirubin → Bile → Intestine → Urobilinogen

Mostly → feces
Small amount → urine

What you REALLY need to know

Unconjugated = before the liver = not water-soluble

Conjugated = after the liver = water-soluble

This becomes important when you learn why hepatitis can cause jaundice, dark urine, and pale stools.

Acute hepatitis: Laboratory

Acute hepatitis → liver cells are damaged → liver enzymes increase in the blood.

1. Increased liver enzymes

Blood tests may show increased:

• ALT (alanine transaminase)

• AST (aspartate transaminase)

• Alkaline phosphatase (ALP)

• Lactate dehydrogenase (LDH)

These increases indicate liver injury/damage.

2. Increased bilirubin

If the liver isn't working properly:

• Direct (conjugated) bilirubin ↑

• Indirect (unconjugated) bilirubin ↑

Increased bilirubin can lead to jaundice (yellow skin/eyes).

3. Urine findings

• Urine may contain urobilinogen, a metabolite produced during bilirubin breakdown.

Easy way to remember:

Hepatitis = liver damage →

Liver enzymes ↑
ALT + AST + ALP + LDH

Bilirubin ↑
Direct + Indirect

Urine → urobilinogen

Big picture:
Damaged liver → enzymes leak into blood + bilirubin builds up → jaundice.

Fulminating hepatitis

Fulminant hepatitis = massive, rapid destruction of liver tissue → severe liver dysfunction.

What happens?

1. Liver can't clear toxins

A damaged liver cannot properly remove toxins from the blood.

Toxins build up → acute encephalopathy (brain dysfunction)

Possible symptoms:

• Asterixis → “flapping” movement of the hands

• Confusion

• Disorientation

• Agitation

• Coma in severe cases

2. Coagulopathy

The damaged liver cannot make enough clotting factors.

Blood takes longer to clot → increased bleeding

Can lead to:

• Prolonged coagulation time

• Bleeding

• Disseminated intravascular coagulation (DIC)

Easy way to remember:

Fulminant hepatitis = Liver destruction → 2 major problems

Toxins → brain problems
confusion → coma

Less clotting factors → bleeding problems
coagulopathy → DIC

BIG IDEA: The liver is failing rapidly and severely, affecting both the brain 🧠 and blood clotting.

Fulminating hepatitis: Laboratory

Fulminant hepatitis = massive liver destruction → severe liver dysfunction.

1. Liver enzymes increase

There is a major increase in:

• ALT

• AST

• Alkaline phosphatase (ALP)

• Lactate dehydrogenase (LDH)

Important: In very late stages, these enzyme levels may drop.

Why? A severe drop does not necessarily mean the liver is recovering—there may be fewer functioning liver cells left to release enzymes.

2. Bilirubin increases

Because the liver is not functioning properly:

• Direct (conjugated) bilirubin ↑

• Indirect (unconjugated) bilirubin ↑

Can cause jaundice.

3. Coagulopathy

The damaged liver cannot make enough clotting factors.

• Prothrombin time (PT) ↑ → blood takes longer to clot

• Increased risk of bleeding

4. Thrombocytopenia

• Platelet count ↓

• Further increases the risk of bleeding

Easy way to remember:

Fulminant hepatitis =

Enzymes ↑
Bilirubin ↑
PT ↑

Platelets ↓

Most important:
Late-stage enzyme drop ≠ improvement. It can indicate massive liver cell destruction.

Chronic hepatitis

Chronic hepatitis = long-term inflammation/damage of the liver lasting months to years.

Important points

• Can occur with or without a previous episode of acute hepatitis.

• Causes ongoing liver damage and inflammation.

• Can lead to poor liver function.

Complications

1. Cirrhosis

• Long-term liver damage → scarring of the liver

• Scarring can interfere with normal liver function.

2. Hepatocarcinoma

• Chronic infection + inflammation can increase the risk of liver cancer.

Late-stage chronic hepatitis

• Ascites → buildup of fluid in the abdomen

• Hepatic encephalopathy → brain dysfunction caused by liver failure/toxin buildup

  • Can start mildly and become more severe.

Easy way to remember:

Chronic hepatitis = months/years → ongoing damage → complications

Chronic inflammation → Cirrhosis → Liver cancer

Late stage:
Ascites + Encephalopathy

Acute vs. Chronic:

Acute	Chronic
Days–weeks	Months–years
Sudden liver damage	Long-term liver damage
Can recover	Can progress to cirrhosis
—	Increased risk of liver cancer
—	Ascites + encephalopathy in late stages

Chronic hepatitis: Laboratory

Chronic hepatitis → long-term liver damage → abnormal liver tests.

1. Liver enzymes increase

• ALT ↑

• AST ↑

• Alkaline phosphatase ↑

• LDH ↑

The increase is usually lower than in acute hepatitis because the damage is occurring more slowly over a long period.

2. Signs of poor liver function

Bilirubin ↑

• Direct (conjugated) bilirubin ↑

• Indirect (unconjugated) bilirubin ↑

• Can contribute to jaundice.

Albumin ↓

• The liver normally makes albumin.

• Damaged liver → less albumin production → low blood albumin.

Coagulopathy

• Liver makes many clotting factors.

• Liver damage → fewer clotting factors → increased bleeding risk.

3. Urine

• Urine may contain urobilinogen, a metabolite of bilirubin.

Easy way to remember:

Chronic hepatitis =

ALT, AST, ALP, LDH ↑ (but lower than acute)
Bilirubin ↑
Albumin ↓
Coagulopathy
Urobilinogen in urine

Key difference from acute hepatitis

Acute: enzymes can become very high because of sudden liver cell injury.

Chronic: enzymes are persistently elevated but usually lower, while signs of poor liver function become more important.

Hepatitis A - HAV

Definition: Hepatitis A is an RNA virus and a common cause of acute hepatitis.

1. Characteristics

• RNA virus

• Incubation period: about 4 weeks

• Causes acute hepatitis

• Does NOT become chronic

• Rarely causes fulminant/fulminating hepatitis (severe liver failure)

2. Transmission

• Fecal–oral route

• Usually spread through contaminated:

  • Food

  • Water

  • Hands

3. Treatment

• No specific antiviral treatment

• Usually treated with supportive care while the body clears the infection.

4. Prevention

• Vaccine-preventable

Easy way to remember:

Hepatitis A = Acute + fecal-oral + no chronic infection + vaccine

Feature	Hepatitis A
Virus	RNA
Incubation	~4 weeks
Transmission	Fecal-oral
Chronic?	No
Fulminant hepatitis	Rare
Specific treatment	No
Vaccine	Yes

Hepatitis B - HBV

Definition: Hepatitis B is a DNA virus that can cause acute or chronic liver infection.

1. Characteristics

• DNA virus

• Can cause:

  • Acute hepatitis → may look similar to Hepatitis A

  • Asymptomatic acute infection → person may have no symptoms

• About 10–15% of adults develop chronic hepatitis

2. Transmission

HBV is transmitted through:

• Blood

• Sexual contact

3. Chronic Infection

If chronic HBV is untreated for years or decades, it can lead to:

• Cirrhosis → permanent liver scarring

• Liver cancer (hepatocellular carcinoma)

Important: Chronic HBV is a major risk for cirrhosis + liver cancer.

4. Prevention & Treatment

• Vaccine: highly effective

• Specific treatment: available to control chronic infection

• A complete cure can be difficult

Easy way to remember:

Hepatitis B = Blood + Sex + DNA + Chronic risk

Feature	Hepatitis B
Virus	DNA
Transmission	Blood + sexual
Acute infection	Yes
Chronic infection	~10–15% of adults
Cirrhosis	Can occur
Liver cancer	Can occur
Vaccine	Highly effective
Treatment	Controls infection, cure is difficult

Hepatitis B: Diagnosis

HBV diagnosis is based on blood tests that detect viral antigens and antibodies.

1. HBsAg — Hepatitis B surface antigen

• Appears early after infection

• Means HBV is currently present

• If it stays positive for a long time → suggests chronic infection

2. Anti-HBc

There are two types:

• IgM anti-HBc

  • Appears during recent/acute infection

  • Helps indicate a new infection

• IgG anti-HBc

  • Appears later

  • Can remain for life

  • Shows the person has been infected with HBV at some point

3. Anti-HBs

• Appears after the person clears the virus

• Indicates immunity

• Can also appear after vaccination

4. HBV DNA

• PCR can detect HBV DNA

• Used to detect/measure the amount of virus in the blood.

Easy way to remember

HBsAg = virus is present
IgM anti-HBc = recent infection
IgG anti-HBc = past/current infection
Anti-HBs = immunity
HBV DNA = viral genetic material

Big exam point: Anti-HBs = immunity, while HBsAg = active infection.

Hepatitis C - HCV

Definition: Hepatitis C is an RNA virus that is mainly spread through blood and has a high chance of becoming chronic.

1. Characteristics

• RNA virus

• Discovered in the late 1980s

• Acute hepatitis can occur, but it is usually mild

• Up to 80% of infections become chronic

2. Transmission

• Mainly bloodborne

• Sexual transmission is rare

• Common in:

  • People who received blood products before the 1990s

  • People who inject drugs

3. Chronic Hepatitis C

Chronic HCV can eventually cause:

• Cirrhosis → liver scarring

• Liver cancer

Important: HCV has a very high risk of becoming chronic compared with Hepatitis A or B.

4. Diagnosis

Step 1: Anti-HCV antibody test

• Used as a screening test

• Positive = the person has been exposed to HCV

• It does NOT prove the virus is still present because antibodies can remain even after the person clears the infection.

Step 2: PCR-HCV

• Confirms whether HCV is currently present

• Detects HCV RNA

5. Treatment

• New, highly effective specific antiviral drugs have been developed.

• Most cases respond well to treatment.

Easy way to remember:

Hepatitis C = Blood + Chronic + PCR + Curable

Feature	Hepatitis C
Virus	RNA
Main transmission	Blood
Sexual transmission	Rare
Acute infection	Usually mild
Chronic infection	Up to 80% ⚠
Cirrhosis	Can occur
Liver cancer	Can occur
Screening	Anti-HCV
Confirmation	PCR-HCV
Treatment	Highly effective

Hepatitis D (Delta) - HDV

Definition: Hepatitis D is an RNA virus that cannot replicate on its own. It needs Hepatitis B (HBV) to reproduce.

1. Characteristics

• RNA virus

• Needs the HBV envelope to replicate

• Therefore, HDV only occurs with HBV

• You cannot have Hepatitis D without Hepatitis B.

2. Severity

• Occurs as Hepatitis B + D

• Causes more severe hepatitis than HBV alone

• Increases the risk of serious liver disease.

3. Treatment

• Specific treatment is available

• However, treatment is not very effective.

Easy way to remember:

Hepatitis D = Dependent on B

D needs B
B + D = worse hepatitis

Feature	Hepatitis D
Virus	RNA
Needs HBV?	Yes
Can occur alone?	No
Severity	Worse than HBV alone
Treatment	Available, but not very effective

EXAM TIP: If you see “RNA virus that requires HBV” → Hepatitis D.

Hepatitis E - HEV

Definition: Hepatitis E is an RNA virus that is very similar to Hepatitis A and usually causes acute hepatitis.

1. Characteristics

• RNA virus

• Causes acute hepatitis

• Incubation period: about 4 weeks

• Usually does not become chronic

2. Transmission

• Fecal–oral route

• Often associated with travel to less developed regions of the world

• Can spread through contaminated food or water

3. Important Complication

• Can cause fulminant/fulminating hepatitis, especially in pregnant individuals.

• This is a major difference from Hepatitis A.

4. Diagnosis

Two main options:

• PCR-HEV → detects HEV RNA

• IgM for HEV → indicates recent infection

5. Treatment & Prevention

• Can be treated with antiviral medications

• No vaccine available (according to your lecture)

Easy way to remember:

Hepatitis E = “A-like” but dangerous in pregnancy

E = RNA + fecal-oral + 4 weeks + acute
Pregnancy → risk of fulminant hepatitis ⚠

Feature	Hepatitis E
Virus	RNA
Incubation	~4 weeks
Transmission	Fecal-oral
Disease	Acute hepatitis
Fulminant hepatitis	Especially pregnancy
Vaccine	No
Diagnosis	PCR-HEV or IgM
Treatment	Antivirals

STIs or STDs?

Both are used, but STI (sexually transmitted infection) is generally preferred today.

• STI = sexually transmitted infection

  • A person can have an infection without having symptoms or disease.

• STD = sexually transmitted disease

  • Usually implies the infection has caused symptoms or illness.

Easy way to remember:

STI = infection, with or without symptoms
STD = infection that has caused disease

For your Infectious Diseases class, I'd use STI unless your professor specifically uses STD.

Urethritis

Definition: Urethritis is inflammation of the urethra, often caused by an STI.

1. Signs

• Purulent urethral discharge → pus-like discharge

• Pyuria → white blood cells (WBCs) in urine

• Erythema of the meatus → redness around the urethral opening

2. Symptoms

• Pain and discomfort

• Dysuria → burning/pain when urinating

3. Most Common Pathogens

The two most common causes are:

• Neisseria gonorrhoeae → gonorrhea

• Chlamydia trachomatis → chlamydia

Important: The symptoms usually cannot reliably tell you whether it is gonorrhea or chlamydia.

4. Diagnosis & Treatment

• Laboratory testing is needed to distinguish between the two.

• If laboratory testing is not available, treatment should cover both:

  • N. gonorrhoeae

  • C. trachomatis\

Easy way to remember:

Urethritis = Urethra inflammation → discharge + burning

Gonorrhea + Chlamydia = the big 2 causes

Feature	Urethritis
Definition	Inflammation of urethra
Main symptoms	Pain + dysuria
Signs	Discharge + pyuria + redness
Common pathogens	N. gonorrhoeae + C. trachomatis
Can symptoms distinguish them?	Not reliably
Lab testing	Needed
If testing unavailable	Treat for both

Urethritis: Diagnosis

1. Urinalysis

• ↑ WBCs in urine → pyuria

• Positive leukocyte esterase → indicates WBC activity/inflammation

2. NAAT — Main Diagnostic Test

Nucleic Acid Amplification Tests (NAATs), such as PCR, are commonly used.

• >90% sensitive and specific

• Can use:

  • Urine

  • Genital swabs

  • Rectal swabs

  • Throat swabs

• Can detect asymptomatic infections

Easy: NAAT/PCR = highly accurate + can find infections without symptoms.

3. Gram Stain for Gonorrhea

A Gram stain of urethral discharge can show:

Gram-negative intracellular diplococci (GNID)

• >95% sensitive

• >99% specific

• Strong evidence for Neisseria gonorrhoeae.

Remember:
Gonorrhea = Gram-negative intracellular diplococci

4. Culture

• Culture of urethral discharge can be technically difficult.

• Can be useful when treatment isn't working or drug-resistant gonorrhea is suspected.

• Helps determine which antibiotics will work.

Quick Review

Test	What it tells you
Urinalysis	Pyuria + leukocyte esterase
NAAT/PCR	Highly accurate; detects symptomatic & asymptomatic infection
Gram stain	GN intracellular diplococci → gonorrhea
Culture	Helpful for suspected antibiotic resistance

Urethritis: Treatment

1. Gonococcal Urethritis (GU)

Caused by Neisseria gonorrhoeae.

• Treated with a single dose of an IM antibiotic 💉

2. Non-Gonococcal Urethritis (NGU)

Usually caused by organisms such as Chlamydia trachomatis.

• Treated with oral antibiotics

• Treatment can be:

  • Single dose

  • 7-day course

3. When You're Not Sure

• If chlamydia cannot be excluded → treat for both gonorrhea + chlamydia

• If you cannot distinguish GU from NGU → treat for both

Easy rule:
Can't tell? → Treat both.

4. Partner Treatment

• Notify and treat sexual partners

• Important because it:

  • Prevents reinfection

  • Helps prevent continued spread of the infection

Quick Review

Type	Treatment
GU (gonorrhea)	Single-dose IM antibiotic 💉
NGU	Oral antibiotics
Chlamydia can't be excluded	Treat both
GU vs NGU unclear	Treat both
Sexual partners	Notify + treat

Pelvic Inflammatory Disease (PID)

Definition: PID is a bacterial infection that causes inflammation of the female reproductive organs, including the uterus, fallopian tubes, and ovaries.

1. Causes

• Can occur after an untreated chlamydia and/or gonorrhea infection.

• However, PID does not always follow an STI.

• Often polymicrobial → caused by multiple types of bacteria.

2. Risk Factors

Risk is increased with:

• Young age

• Multiple sexual partners

• Condomless sex

• Previous STIs

• Previous episodes of PID

Easy way to remember:

PID = Pelvic organs become inflamed because of bacterial infection.

Big point:
Chlamydia + Gonorrhea → common causes, but PID can involve multiple bacteria.

Feature	PID
Type	Bacterial infection
Organs affected	Uterus, fallopian tubes, ovaries
Common STI causes	Chlamydia + Gonorrhea
Infection type	Often polymicrobial
Major risk factors	Young age, multiple partners, condomless sex, previous STIs/PID

Pelvic Inflammatory Disease (PID)

1. Clinical Presentation

Common signs and symptoms include:

• Lower abdominal/pelvic pain

  • Often more tender during a pelvic exam

• Vaginal discharge

• Vaginal bleeding

• Fever

• Other signs of systemic inflammation

Easy way to remember:
PID = pelvic pain + discharge/bleeding + fever

2. Diagnosis

• There is no single specific diagnostic test for PID.

• Tests may show:

  • Signs of systemic inflammation

  • Fluid collection in the abdomen/pelvis

Diagnosis is mainly based on the clinical presentation because laboratory tests are not specific.

3. Treatment

• Requires prolonged courses of combined antibiotics

• Antibiotics may be given IV, especially in more severe cases.

• Surgery may be needed if complications occur, such as an abscess.

4. Complications

Untreated or severe PID can cause:

• Sepsis

• Infertility

• Increased risk of ectopic pregnancy

• Chronic pelvic pain

Big Picture

Untreated infection → PID → inflammation → possible permanent reproductive damage

Category	PID
Main symptom	Lower abdominal/pelvic pain
Other symptoms	Discharge, bleeding, fever
Diagnosis	No specific test
Treatment	Prolonged combination antibiotics
Severe cases	IV antibiotics ± surgery
Complications	Sepsis, infertility, ectopic pregnancy, chronic pelvic pain

Genital ulcers

Definition: Genital ulcers are open sores that occur on the skin or mucous membranes of the genital area.

1. What are ulcers?

• Ulcer = open sore on the skin or mucosa.

• Genital ulcers can be caused by different infections, including some STIs.

2. Condom Protection

• Genital ulcers may occur in areas not covered by a condom.

• Therefore, sexual transmission can still occur even when condoms are used.

Easy way to remember:

Genital ulcer = open sore → may be outside the condom-covered area → transmission is still possible.

Important: Condoms reduce the risk of STI transmission but do not provide 100% protection against infections spread by skin-to-skin contact.

Syphilis: Clinical presentation

Definition: Syphilis is a bacterial STI that progresses through different stages if untreated.

1. Primary Syphilis — 2–4 weeks

• The bacteria enters through the skin or mucous membrane.

• Causes an ulcer (open sore) called a chancre.

• Usually occurs on the genitals, but can occur elsewhere.

• The ulcer may heal even without treatment.

2. Secondary Syphilis — 4–8 weeks

• The infection spreads into the bloodstream.

• Causes a rash.

• Other systemic symptoms may occur.

3. Latent Syphilis — Months to years

• The rash disappears.

• The bacteria remains in the body but is dormant.

• The person may have no symptoms.

4. Tertiary Syphilis — Usually years later

• Can cause serious damage to multiple organs.

• Possible complications include:

  • Neurological problems

  • Psychiatric problems

  • Cardiovascular problems

  • Orthopedic/bone problems

Easy way to remember:

Primary → Secondary → Latent → Tertiary

Sore → Rash → Silent → Organ damage

Stage	Timing	Main feature
Primary	2–4 weeks	Ulcer/chancre
Secondary	4–8 weeks	Rash
Latent	Months–years	No symptoms
Tertiary	Usually years	Organ damage

Syphilis: Diagnosis and Treatment

1. Diagnosis — Immunological Tests

There are 2 main types of blood tests:

Nontreponemal tests: VDRL or RPR

• Lower specificity → can have false positives.

• Results can be quantified (measured by a titer).

• Useful for checking response to treatment.

• If the titer decreases after treatment → treatment is working.

Treponemal test: FTA-Abs

• Higher specificity → more specific for syphilis.

• Usually remains positive after infection.

• Does not tell you how active the disease is.

Easy way to remember:

• RPR/VDRL = Response → useful for monitoring treatment.

• FTA-Abs = Fingerprint → more specific for syphilis.

2. Treatment

• Penicillin is the main treatment.

• Can be given:

  • IM injection

  • IV infusion

• The treatment depends on the stage of disease.

• More advanced disease → longer antibiotic treatment.

3. Prevention

• No vaccine is available.

• Condom use can reduce transmission.

• Frequent STI testing helps detect infections early.

• DoxyPEP may be used for some people at increased risk to help prevent certain bacterial STIs.

Quick Review

Test/Approach	Main purpose
VDRL/RPR	Lower specificity; monitor treatment response
FTA-Abs	Higher specificity; confirms exposure/infection
Penicillin	Main treatment
Vaccine	None
Condoms + testing	Prevention
DoxyPEP	Prevention for certain high-risk individuals

Genital herpes

Definition: Genital herpes is a lifelong viral STI caused mainly by HSV-2, but it can also be caused by HSV-1.

1. Cause

• Most cases → HSV-2

• Sometimes → HSV-1 (the virus commonly associated with cold sores)

• Infection is lifelong.

• Recurrences are common because the virus remains in the body.

2. Ulcers

Genital herpes ulcers are typically:

• Shallow

• Multiple

• Clustered together

• Painful

Easy way to remember:
Herpes = painful, shallow, clustered sores

3. Diagnosis

If ulcers are present:

• NAAT/PCR from the wound → helpful for detecting HSV.

If there are no ulcers:

• Serology (blood test) can detect HSV-2 antibodies.

• Positive antibodies mean the person has been infected at some point.

• It does not necessarily mean there is an active infection right now.

Test results should always be interpreted together with the clinical presentation.

4. Treatment

• Genital herpes is treated with antiviral medications.

• Antivirals help control symptoms and outbreaks, but they do not eliminate the lifelong infection.

Quick Review

Feature	Genital Herpes
Main cause	HSV-2
Sometimes	HSV-1
Ulcers	Shallow, multiple, clustered, painful
Infection	Lifelong
Recurrence	Common
Ulcers present	NAAT/PCR of wound
No ulcers	Serology
Treatment	Antivirals
Cure	No cure

Genital ulcers: Comparative

This is a high-yield distinction for genital ulcers:

Feature	Syphilis	Herpes (HSV-2)
Number	Few	Multiple
Appearance	Larger ulcers	Small, clustered ulcers
Border	Clear/sharp border	Clean base with redness around ulcers
Pain	Usually not painful	Painful/tender
Lymph nodes	Enlarged, usually not painful	Enlarged and tender/painful

Easy way to remember:

Syphilis = Single-ish + Silent
→ Few, larger, painless ulcer

Herpes = Hurt + Huddled
→ Multiple, small, clustered, painful ulcers

Exam clue:
Painless genital ulcer → think syphilis
Painful clustered genital ulcers → think HSV-2

Doxy PEP

Definition: DoxyPEP = taking doxycycline after condomless sex to help prevent certain bacterial STIs.

What can it reduce?

Studies have shown that DoxyPEP can reduce the incidence of:

• Gonorrhea

• Chlamydia

• Syphilis

Who?

Your lecture specifically states benefits among:

• Cisgender men who have sex with men

• Transgender women who have sex with men

Easy way to remember:

DoxyPEP = Doxycycline AFTER sex → prevents some bacterial STIs

Important: DoxyPEP is for prevention, not treatment of an existing STI, and it does not prevent viral STIs like herpes or HIV.

Anogenital warts (HPV)

Definition: Anogenital warts are raised, cauliflower-like skin lesions caused by human papillomavirus (HPV).

1. Warts

• Can occur in the:

  • Genital area

  • Anal area

  • Perineal area

• Warts themselves are usually not dangerous.

• They can be removed:

  • Chemically

  • Surgically

2. HPV & Cancer

Some types of HPV are high-risk/carcinogenic and can cause:

• Cervical cancer

• Rectal/anal cancer

• Throat cancer

Not all HPV types cause cancer. Some mainly cause warts, while others are associated with cancer.

3. Prevention & Screening

• HPV vaccines include protection against the most important cancer-causing HPV types.

• Regular Pap smears help detect abnormal cervical cells/lesions early.

Easy way to remember:

HPV = Warts + Cancer risk

Low-risk HPV → warts
High-risk HPV → cancer risk
Vaccine + Pap screening → prevention/early detection

Feature	Anogenital Warts (HPV)
Appearance	Raised, cauliflower-like
Location	Genital, anal, perineal
Cause	HPV
Warts dangerous?	Usually
Treatment	Chemical or surgical removal
Cancer risk	Some HPV types → cervical, anal/rectal, throat cancer
Prevention	HPV vaccine
Screening	Regular Pap smear