Dental Management Chapter 13 Sexually Transmitted Diseases

What are the 3 main bacterial STDs

Chlamydia (Chlamydia trachomatis) Most common

Gonorrhea (Neisseria gonorrhoeae)

Syphilis (Treponema pallidum)

Classification of N. gonorrhoeae

aerobic gram-negative diplococci

N. gonorrhoeae colonizes what type of epithelium

Columnar/Transitional epithelium (Urethra, cervic, rectum, pharynx)

Stratified squamous epithelium (skin, oral mucosa) resistant to it

Clinical of N. gonorrhoeae

Men: Symptomatic (Dysuria, purulent discharge)

Women: Asymptomatic (can cause PID, infertility, ectopic pregnancy)

When is gram stain of N. gonorrhoeae indicated

In purulent discharge

Treatment for N. gonorrhoeae

Ceftriaxone (IM) 500 mg

Gentamycin with azithromycin if not available

Doxycycline if possible chlamydia

Syphilis is caused by _______ _______

Treponema pallidum

How do you diagnose Syphilis

Serologic tests and Microscope

Cannot be cultured and difficult to stain

What is the treatment for syphilis

Penicillin

If allergic: Doxycycline or Tetracycline

What is the Jarisch-Herxheimer reaction

Acute fever, chills within 24 hour of syphilis treatment

Primary vs Secondary Syphilis vs Tertiary

Priamry: Chancre painless

Secondary: mucous patches and lesions

Tertiaary: Gumma

When is syphilis infectious

Primary and Secondary when lesions present (blood, saliva)

Infectiousness reduce rapidly after antibiotic but still infectious wait until lesion absent

Secondary most infectious

What antibody indicates past infection of HSV (Herpes)

IgG

Which HSV is more efficient in reactivating

HSV 2

When is HSV most infectious and least

Vesicle and ulcer highest viral load

Crusting (dry) not very infectious

Herpes Treatment

Acyclovir, Famiciclovir, Valacyclovir (precursor of aycyclovir)

Topical not good

Antiviral in latent HSV

Does not eradicate but reduce duration and severity

What antiviral to give HSV pregnant pt

Famciclovir and Valacyclovir

Acyclovir is category C

Herpetic whitlow/paronychia

HSV infection of finer/nails from contact with oral lesion

Cause of IM (Mono)

Epstein Barr Virus (EBV)

Patients with a history of infectious _______ may be at risk for developing EBV-associated Hodgkin and non-Hodgkin lymphomas.

Mononucleosis

Which HPV are high risk in cancer

16 and 18

16 strongly associated with oropharynx cancer

What is condylomata

Anogenital warts

Treatment of HPV

Direct wart removal (excision and chemical destruction)

HPV vaccine cover how many HPV virus

9 valent

6, 11, 16, 18 the important ones

Prevent oropharyngeal cancer

What age is HPV vaccine given

11-12

Over 27 don’t need cause not effective