Virogenetic-STD

Heqiubo
Dept. of Dermatology,The first affiliated
hospital of zhengzhou university
Condyloma acuminatum
,
CA
 Etiology
human papilloma virus, HPV
 A large family of double stranded D
NA viruses
 While more than 80 types HPVs have bee
n isolated, there are only 15 types can in
duce CA
 The most common etiologic agents are t
ype6 、 11, and then type16 、 18
 Etiology
human papilloma virus, HPV
•Hpv-6 and Hpv-11 are the most com
mon low-risk genital Hpv types.
•Hpv-16 and Hpv-18 are the most co
mmon high-risk genital Hpv types.
•This is its structure under electron
microscope.
 Etiology

human papilloma virus, HPV

 Human being is the only host
These viruses do not produce acute s
igns or symptoms but induce slow-gr
owing lesions that can remain subclin
ical for long periods of time
 Clinical feature
 Incubation time
 1~6months ， average 3months

 predilection sites
 Genital areas
 male ： balanus 、 urethral orifice
 female ： labia major and minor 、 cervical canal
 Anal areas: anus, perineum
 Other sites ： in mouth 、 breast
 Clinical feature
 Skin lesion
 Early stage
 Small, soft, slight red rough,spiny papules
 Characteristic lesion
 Have verrucous surface
 Papillose, cauliflower like
 slow growing
 Giant CA: very rare
 Symptoms
 70% do not have any symptom
CA on prepuce
CA on coronal sulcus
CA on penile
CA in urethral orifice
verrucous rough,s
piny papules
CA on perianal area

Papillose ca
uliflower lik
e
 CA and malignancy
 cervical infection with high-risk HPVs is th
e main cause of cervical cancer
 Epidemiologic evidence has also linked so
me penile, and anal carcinomas with HPV i
nfection
 The giant condyloma acuminatum, is a lo
w-grade locally invasive squamous cell car
cinoma.
 HPV-16, -18 are so-called high-risk t
ypes
CA with Paget’s disease
 Diagnostic tests

 Acetic-white test
 Smear 5% acetic acid on the skin lesion
 after 3~5min, if the lesion turn white, it
is positive
Acetic-white test positive
 Diagnostic tests
 Histopathology
 papillomatosis
 Large keratinocytes with an eccentric, py
knotic nucleus surrounded by a perinucle
ar halo (koilocytotic cells or koilocytes),
are characteristic of HPV-associated papi
llomas.
 HPV antigen positive
Histopathology

koilocytes
perinuclear h
alo
pyknotic nuc
leus``
 Histopathology

koilocytotic cells

HPV antigen positive cells

 Diagnosis
 History
 Expusure under HPV infect partner
 Indirect contact (very rare)
 Clinical feature
 Papillose, cauliflower like neoplasm on genit
al area, anal area
 Diagnostic tests
 Acetic white test ： positive
 Histopathology ：
 characteristic koilocytotic cells
 HPV antigen positive
pearls liked papuler on
penis

 Because long Prepuce, e

xcretion stimulate
 Diameter 1~2mm papule
 along coronal sulcus

 isolated

 no subjective symptom
famale pudendum notho- co
ndyloma
 medial surface famale labi
um minus
 white/red papuler
 Close-set ， non-fusion
 fish roe form
 No subjective symptom
condyloma lata
secondary syphilid

Applanatia plaque
mi

Microspironema pallidum on
the surface
Syphilis serum reaction posi
tive
 genitals squamous cancer
 Old patient
 not sexual contact (impurity)
 ulcer not concrete
 Histopathology
 Treatment
 Physical therapy
 electrocautery therapy
 Cryotherapy with liquid nitrogen
 laser treatment
 Topical therapy
 25% podophilin, applied weekly and washed o
ff 4~8hs later, 6~12weeks
 5% 5 FU( fliorouracil)cream,applied twice daily
 Systemic therapy
 immun-inhencer: TF(transfer facter),etr
 Prognosis
 Cure rate is very high

 High incidence of recurrence

 Very rarely it becomes carcinoma

Genital herpes
GH
 Genital herpes
Incidence ：
 very high in western country ， and increases
quickly in China

Recurrence rate: very high
 Treatment: no effective way at present
 prognosis ：
 can last lifelong, continuously flare and latent
 Etiology
Herpes Simplex Virus ， HSV the structure under
 DNA viruses Electron microscope
 HSV type-1,type-2
 70-90% of HSV-1 infections occur above the wa
ist. In contrast, 70-90% of HSV-2 infections occ
ur below the waist.
Pathogen of genital herpes
 HSV-2 ： 90% due to
 HSV-1 ： 10%
Pathogenesis
Exposed to active patient
Be infected
Incubation time :3 to 14 days

Primary infection
Latent or dormant state(in some nerve ganglion)
Tired, emotion stress, immunosuppression

Recurrence
(reactivation of this dormant virus, which t
hen travels down the nerve fiber
to establish skin infection)
Clinical feature
 Primary Genital Herpes

Incubation time :3 to 14 days

It is estimated that 95 percent of episodes

of primary genital herpes occur following
sexual exposure to a partner with active
lesions.
 Primary Genital Herpes
 Skin lesions:
 begin with small grouped vesicles
 break and progress to ulcer in 2 to 4 days.
 The first episode of genital herpes usually has
multiple lesions, which are present bilaterally and
coalesce to involve a larger surface
 symptoms:
 Fever, headache
 Local symptom:Pain feeling
 Course: 2 to 3 weeks
 Recurrent Genital Herpes
 Following the primary infection, about
50 percent of men will have a recurrence
in 4 months, whereas 50 percent of women
will not have a recurrence until 8 months
after the initial outbreak
 The severity of symptoms, duration of
symptoms, and duration of viral shedding
are all much shorter in recurrent episodes
than in primary disease.
 Recurrent Genital Herpes
 Skin lesions:
 begins with small grouped vesicles
 break and progress to ulcer in 2 to 4 days.
 time for crusting is 4 to 5 days
 symptoms:
 No or mild
 Local symptom:
 Slight pain, burning, tingling
 Course: 7 to 10 days
 Herpes Simplex Virus Cervicitis

 Herpes simplex virus is a common etiology

of cervical ulcerations

 Shedding of HSV is found in patients both

with and without symptoms
Genital herpes
Erythema on caput penis
Red papules
vesicle
Genital herpes

Cluster
Genital herpes

erosion
 Lab tests
 Viral culture
 Most reliable but difficult to do

 Tzanck Preparation
 Both HSV and varicella zoster virus infecti

on will result in ultinucleated giant cells an

d a positive Tzanck smear.
 Monoclonal Antibodies
 the monoclonal antibodies for HSV-1 and H

SV-2 have proved to be sensitive and speci

fic
 diagnosis
 history
 Exposure to active infected patient
 Clinical feature
 Small vesicles on erythematous base, or erosion
 Pain or itching
 Self limited, but often recur
 Lab test ：
 Viral culture
 Tzanck Preparation
 Monoclonal Antibodies
 Treatment
 Can’t be cured completely

 Treatment guideline:Use anti-virus

agents in time
 Control the symptoms
 Shorten the course
 Control the contagion and recurrence
 Treatment

 Antivirus agents
 topical acyclovir and/or
 systemic acyclovir (oral or intravenou
s)
 Immun-inhencer
 If recurrence rate is very high, can us
e acyclovir continuously, or use immun-in
hencer at the same time