Case 8: A Problem at College Sarah, a sophomore college student, had moved into her apartment in September. It was a big change from last year s life in the dormitory and would have been a little lonely if it hadn t been for Steve. She had met Steve in the organic chemistry class, where she had drawn him as a partner in laboratory. Steve was a sharp, handsome chemical engineering major. Within a month they were in love, and on the final weekend in October after the homecoming celebration. Steve stayed at Sara s apartment. On Friday of the next week, Sara was at the student health clinic. She had an extreme amount of vaginal itching, dysuria and a mild headache and felt a little feverish. The physician obseved a mixture of vesicular pusular lesions and shallow coalesced ulcers bilaterally present on the labia. Local edema was extensive. An internal gynecologist examination could not be made because of extreme discomfort as the spectulum was inserted. One of the outer lesions was scraped as gently as possible and a microscopic smear was prepared. Acyclovir ointment was applied. Sara was told she would probably have recurrences of this condition and that she should avoid all sexual contact during the active stage of her disease and for 1 week thereafter. Questions: 1. How could Steve, in the absence of any obvious illness, transmit an STD to Sara? - Asymptomatic viral shedding is the presence of virus in the absence of clinical signs or symptoms. Up to 70% of new infections can be attributed to asymptomatic shedding.[8-10] Asymptomatic shedding occurs in virtually all HSV-2 infected patients, and shedding rates cannot be predicted on the basis of age, sex, or reported history of outbreaks.[7,11] Shedding of virus can occur from multiple genital sites, and 50% of asymptomatic shedding events occur more than 7 days before or after a clinical outbreak. And although viral shedding tends to diminish over the course of infection, the rate of decay is measured in years and the potential of transmission persists. The presence of HSV-2 on the genital mucosal surface, whether associated with clinically recognized outbreaks, subclinical outbreaks, or asymptomatic shedding, can and does lead to the transmission of HSV-2.
The tzanck preparation of papanicolau stain shows cytoloic change in scraping from the base of the vesicle or the mucous membrane.
Recurrences of genital herpetic infections are common and tend to be mild.
5. Drugresistant virus strains may emerge.Acyclovir. Approximately how long will Sara have these lesions? . shorten time to healing. A limited number of vesicles appear and heal in about 10 days.encoded thymidine kinase to the monophosphate. but much of the difference is attributable to less frequent genital lesions because lesions are accompanied by frequent viral shedding. preventing further virus complication.Conclusion: Persons with asymptomatic HSV-2 infection shed virus in the genital tract less frequently than persons with symptomatic infection.
2. Whether a recurrence is symptomatic or asymptomatic. However.
3. The drugs may suppress clinical manifestations.Pain lasts for 4 days and lesion usually heals within 10 days. HSV remains latent in sensory ganglia. The acyclovir triphosphate is efficiently incorporated into viral DNA by the HSV polymerase. The stain can t be differentiated between herpex simples and varicella zoster
. What is the mode of action of Acyclovir? . and reduce recurrences of genital herpes. a person shedding virus can transmit the infection to sexual partners.Herpes Simplex Virus Type 2 Differential Diagnosis: Chancroid/ Syphilis .
4. Acyclovir triphosphate is incorporated into growing chain of viral DNA by viral DNA polymerase and acts as a chain terminator. where it then prevents chain elongation. Acyclovir monophosphate is further converted to the triphosphate by cellular enzymes.T. is monophosphorylated by the HSV thymidine kinase and is then converted to the triphosphate form by cellular kinases. pallidum infection by darkfield examination of ulcer exudate or by a serologic test for syphilis performed at least 7 days after onset of ulcers. Some recurrences are asymptomatic with anogenital shedding lasting less than 24 hours. Which STDs present as vesicular lesions? . Virus is shed for only a few days. Acyclovir is phosphorylated by HSV. a nucleoside analog. What would be seen in the microscopic smear of the lesions? . The triphosphate also inhibit HSV DNA polymerase to a much greater extent than cellular DNA polymerase.
Virus isolation remains the definitive diagnostic approach. Explain this in relationship to protective immunity 10. 7. Virus may be isolated from herpetic lesions and may also be found in throat washings.-
In this process.
Results of the tests take up to 2 weeks. .
One common test is called a Tzanck smear.No. and stool. Many patients with this disease have high specific antibody titers. If stimulated.Inoculation of tissue cultures is used for viral isolation. so characteristic cytopathic effect are observed in 24 . HSV return to the skin along sensory nerve and causes recurrent infection. Describe the basis of latency and recurrences of this disease .
6.Virus isolation is the reliable method in confirmation of the clinical diagnosis. HSV is easy to cultivate. and cytopathic effects usually occur in only 2 3 days.48 hours if adequate specimen is obtained. This test is less accurate than viral cultures. Storage at -20 C in standard freezer compartments results in significant loss of virus. -
. Specimens should be refrigerated after 24 hours after they are inoculated. Virus is rarely obtained from crusted lesion. cerebrospinal fluid. If there is longer delay. Does this disease pass from person to person only by sexual contact? . 9. How can the etiologic agent be isolated between episodes? . the virus migrate to dorsal route ganglion and establish lifelong latency. Vesicular fluid contains higher titer of virus. Typing of HSV isolates may be done using monoclonal antibody or by restriction endonuclease analysis of viral DNA but is only useful for epidemiologic studies. The virus is spread by direct contact with infected secretion. 8. Specimens should be placed in viral transport media and inoculated into tissue culture as soon as possible. both during primary infection and during asymptomatic periods. then specimens and transport media should be frozen at -70 C. as it is difficult to ascertain which type of HSV infection is present. the isolation of HSV is not in itself sufficient evidence to indicate that the virus is the causative agent of a disease under investigation. Lesion are highly infectious to susceptible individual. Therefore. . scraping from lesions are stained and then examined under a microscope. The agent is then identified by Nt test or immunofluorescence staining with specific antiserum. Compare this disease as it present in males and females.After initial replication of the virus on the skin. HSV grows rapidly.