Lifecycle EXAM 5

chlamydia, gonorrhea, syphilis, trichomoniasis

Reportable STI’s

herpes (HSV), human papilloma (HPV), hepatitis B (HBV), HIV

Viral STI’s

Herpes 1

typically oral herpes infections

Herpes 2

typically genital herpes infections

Herpes 2 (HSV 2)

 herpes with higher recurrence rate

Herpes 2 (HSV 2)

herpes with more frequent shedding

mostly during active outbreaks, sometimes symptom-free periods (asymptomatic shedding)

When does shedding occur with herpes viruses

antiviral (acyclovir)

Treatment for herpes

Primary herpes

herpes outbreak that may cross midline and spread widely

Yes

Is it necessary to always treat PRIMARY HERPES?

Recurrent herpes

herpes infection that usually does NOT cross midline

16 and 18

HPV types associated with high risk of CANCER

potential for cancer

Why are we concerned about HPV infections

6 and 11

HPV types that cause genital warts and oral papillomas

Vaccination

important prevention method for HPV lesions

Bloodborne pathogens

Why do dentists care about Hepatitis Virus B or C  or HIV?

vaccination, PPE, universal precautions

Management for hepatitis B/C and HIV prevention in dental office

Mild or no symptoms (people spread without knowing they are infected)

Why is chlamydia so common?

chlamydia, gonorrhea, and trichomoniasis

Can lead to pelvic inflammatory disease in women if left untreated

Trachoma (leads to blindness)

result of autoinoculation of chlamydia to eye

chlamydia

Often a coinfection with gonorrhea

treat both (due to coinfection tendency)

What is the treatment plan for patients with EITHER gonorrhea OR chlamydia

gonorrhea

Presents with mucopurulent discharge

gonorrhea

Causes men to have pain with urination and penile discharge which usually leads them to seek treatment

trichomoniasis

STI caused by a parasite

trichomoniasis

Causes impaired sperm motility

metronidazole

Treatment for trichomoniasis

primary (chancre), secondary, latent, tertiary

Stages of syphilius

Primary syphilis

 presents with PAINLESS ulcer, infectious before ulcer appears

Yes

Will the chancre of primary syphilis resolve on it own?

No

Does syphilis go away on its own?

Secondary syphilis

presents with rash, fver, arrthralgia, malaise, lyphadenopathy, and patchy hairloss 2-10 weeks after first presentation

secondary syphilis 

HIGHLY INFECTIOUS rash

syphilis in pregnant woman

causes congenital syphilis and potential miscarriage

Tertiary syphilis

presents with Gummas (nodules with necrosis), aortic aneurysm, and neurosyphilis

testing and treatment before 18th week of pregnancy

Prevention of cogenital syphilis

Hutchinson's triad

dental abnormalities (mulberry molars and hutchinsons incisors), keratitis, deafness

Indicates systemic disease

Why should dentist be aware of Hutchinson's triad?

No, temp determines sex in reptiles

Is sex determined only by chromosomes in all animals?

gonad development

First step of sex differentiation

internal genitalia development

Second step of sex differentiation

external genitalia development

Third step of sex differentiation

SRY gene on Y chromosome

For the TESTES to develop from the multipotent gonadal cells, what must be present?

No SRY gene

For the OVARIES to develop from multipotent gonadal cells, what must be present?

Wolffian ducts

forms male INTERNAL structures

Mullerian ducts

forms female INTERNAL structures

Hormones (TESTOSTERONE)

What determines  INTERNAL reproductive structure development?

male internal structures (epididymes, vas deferens, seminal vesicals)

Develop ONLY under the influence of TESTOSTERONE

Testosterone from fetal testis (leydig cells)

What hormone is necessary for MALE INTERNAL genitalia, and where does it typically come from?

AMH (anti-mullerian hormones) from sertoli cells

What hormone is necessary for the MULLERIAN ducts to REGRESS and where does it come from?

absence of AMH (anti-mullerian hormone)

Allows for development of MULLERIAN derivatives (fallopian tubes, uterus, vagina) in females

DHT (dihydrotestosterone)

 causes formation of male EXTERNAL structures and prostate

5-alpha reductase

converts testosterone to DHT to promote development of male structures

No exposure to testosterone and DHT

What does the development of female external genitalia depend on?

External genitalia

What is sex assigned at birth based on?

No

Is “sex assigned at birth” always the same as the person’s chromosomes, internal organs, and/or external genitalia?

No

Is sex the same as gender?

47 XXY

 Klinefelter syndrome genotype

Wolffian duct derivatives, male external genitalia, no Mullerian ducts

Typical Presentation of 47 XXY/kleinfelter syndrome person

47 XXY/kleinfelter syndrome

develop as phenotypic males with mostly normal internal and external genitalia, but testicular insufficiency leads to lower testosterone

Testosterone

What hormone do 47 XXY individuals have an insufficiency of compared to a 46 XY person?

5a-reductase deficiency

disrupts step required for normal development of EXTERNAL male genitalia, leading to ambiguous or undervirilized external genitalia in 46 XY (typical)  infant

Third step/external genitalia

Which step in sex development is affected by 5α-reductase deficiency?

46 XY (with nonfunctioning androgen receptors)

What sex chromosomes will individuals with ANDROGEN INSENSITIVITY syndrome have?

external female genitalia, no mullerian or wolfian structures, testes present (due to presence of Y chromosome)

How will individuals with ANDROGEN INSENSITIVITY syndrome appear (phenotype)

Swyer syndrome/ complete gonadal dysgenesis

46 XY, with missing or nonfunctional SRY gene, mullerian structures TESTES DONT DEVELOP

external female, internal female, no testes, but presence of Y chromosome

Presentation of individuals with Swyer syndrome/ complete gonadal dysgenesis

Dysgenesis

defective development (ex: of the gonads)

XY

What sex chromosomes do individuals with Swyer syndrome/ complete gonadal dysgenesis have?

SRY gene

Key factor of gonad formation (testis/ovaries)

AMH

Key factor of internal duct regression

DHT, 5α-reductase, and receptors

Key factors of external duct development

Yes due to presence of Y chromosome/SRY gene

Will testes form in an individual that is XXY?

45 X/Turners syndrome

Presents with typical female genitalia, short stature, webbed neck, low hairline, widely spaced nipples, no menstration

accelerated apoptosis of oocyte and degeneration of ovary

What happens to 45 X gonads?

masculized internal/external genitalia

Outcome of excess androgen exposure to XX embryo/fetus

Maternal ovarian/adrenal tumor, CAH, mullerian agenesis/dysgenesis, synthetic steroids

What are some ways an XX embryo/fetus can have androgen excess exposure?

Congenital adrenal hyperplasia (CAH)

most common form of 46 XX DSD

DSDs (disorders/differences of sexual development)

congenital conditions in which the development of chromosomal, gonadal, or anatomical sex is atypical

Androgen Insensitivity Syndrome (AIS)

XY with female external genitalia, TESTES PRESENT

Swyer Syndrome

XY with streak (nonfunctional) gonads, female phenotype

Congenital Adrenal Hyperplasia (CAH)

XX with virilized (male-like) external genitalia

5α-reductase deficiency

XY with undervirilized (less-male like) external genitalia at birth

Congenital adrenal hyperplasia (CAH)

increased ACTH and androgens (testosterone) as a result of adrenal glands' inability to make enough cortisol

autosomal recessive

Inheritance pattern of Congenital adrenal hyperplasia (CAH)

caues increased androgens (testosterone), promotes male differention of external genitalia

Why does CAH make atypical external genitalia in the XX infant but not in the XY infant?

variation in eruption, micrognathia, high palatal arch, malocclusion

dental abnormalities in TURNER syndrome

taurodontism (enlarged pulp chambers)

dental abnormality frequently seen in patient with Kleinfelters syndrome (47XXY)

prevent uterine cancer and supply hormones

why might a person with Swyer syndrome take birth control?

yes (has uterus)

can a person with swyer syndrome carry a pregnancy?

treponema pallidum

what organism causes syphilis

estrogen therapy

what treatment do patients with turner syndrome require?

klinefelter syndrome/ 47 XXY

male patient presents with low serum testosterone, low muscle tone, abnormal testes, gynecomastia, and osteoporosis, DIAGNOSIS?

cortisol/aldosterone replacement

what treatment is necessary for infants with CONGENITAL ADRENAL HYPERPLASIA to survive?

osteoporosis, diabetes, hypertension, infections

long term risk of corticosteroids (such as treatment for CAH)

cardiologist

a pattient with turners syndrome will need estrogen therapy, what additional specilistt will need to be closely monitoring them?

any stage

at what syphilis stage can syphilis be transfered to a fetus?

can become tertiary syphilis with neuronal complications

latent syphilis is incidious, what can resultt if eft untreated?