MiniPBLs Week 8

STIs

MiniPBL 1:
Q.1.
Preparation of a Papanicolaou (Pap) smear A: Obtain cervical scraping from complete
squamocolumnar junction by rotating 360 degrees around the external os. B: Place the material
1 inch from the end of the slide and smear along the slide to obtain a thin preparation. Place a
saline-soaked cotton swab or small endocervical brush into the endocervical canal and rotate
360 degrees. Place this specimen onto the same slide and quickly fix with fixative.
Q.2.

Colposcopy is a procedure that uses an instrument with a magnifying lens and a light, called a
colposcope, to examine the cervix (opening to the uterus) and vagina for abnormalities. The
colposcope magnifies the image many times, thus allowing the physician to see the tissues on
the cervix and vaginal walls more clearly. In some cases, a cervical biopsy, a small sample of
tissue, may be taken for further examination in the lab.

Q.3.

Pap smears should offered to women aged 21 or within 3 years of onset of sexual intercourse,
whichever comes first.

Women under 30, should undergo pap smear y yearly.

Women over 30, with normal pap smear results for 3 consecutive years may undergo pap smear
every 2-3 years.

Q.4.

Human Papilloma virus is a Non-enveloped double stranded DNA virus belonging to the
Papillomaviridae family. It has an icosahedral capsid composed of seventy two capsomeres.
Over 100 genotypes have been sequenced. It has a circular genome of 8000 base pairs divided
into 3 regions: LCR, Early proteins (E1 to E8), Late proteins (L1 L2).

Two types :

1. Cutaneous
a. Types 1 and 2
2. Mucosal
a. High Risk:
i. HPV 16, 18
b. Low Risk:
i. HPV 6, 11, 42
Q.5.
Clinical Manifestations of HPV include:

Anogenital warts, condylomas or verrucae

& carcinoma of the cervix.

Q.6.

HV 16 & 18 are important because they are considered of the high risk HPV types and are
strongly linked to cervical cancer, as HPV is recognized as causal agent for cancer.

Q.7.

ASCUS: atypia of squamous cells of undetermined significance.

LSIL: low grade intraepithelial lesion

HSIL: high grade intraepithelial lesion

MiniPBL 2:

Q.1.

The most likely diagnosis is Syphilis. Others include:

1. lymphgranuloma venereum caused Chlamydia trachomatis serovars L1 L2 L3, &

2. Granuloma inguinale caused by Klebsiella granulomatis.

Q.2.

Direct examination of scrapings of the lesion on Darkfield microscopy, Direct fluorescent

Antibody (DFA-TP), & immunohistochemistry.

Also Screening for serological proof by non-treponemal tests VRDL, or RPR-card, and then
confirming it by FTA-ABS, TP-HA, and MHA which are specific treponemal tests.

Q.3.

3 confirmatory tests may be done: FTA-ABS, TP-HA, and MHA. These are necessary because the
screening test is not specific for syphilis while these are specific to the microorganism. Also,
screening tests detect antibodies to lipids that are released from damaged treponemes & host
cells, these may result from any other infection not necessarily syphilis.

Q.4.
It will heal within 4-8 weeks but the organism will remain in the body, then within 10 weeks
from appearance of chancre, the patient will develop secondary syphilis with macules & papules
all over body which will also heal within a couple of weeks. Then patient will develop early latent
syphilis all that while the patient is highly infectious, after 2 years he’ll develop late latent
infectious where he is no longer infectious however he’ll be at risk of developing tertiary syphilis
with neurosyphilis.

Q.5.

Penicllin G, Those allergic may be gradually desensitized then treated or use doxycycline or
tetracycline instead.