Term
| _____ people worldwide are infected w/ HIV? |
|
Definition
|
|
Term
| There were _______ new HIV infections were there in 2008? |
|
Definition
|
|
Term
| What is the #1 killer of all causes in Africs? |
|
Definition
|
|
Term
| Globally, ____________ people are projected to die in the next 35 years of AIDS |
|
Definition
|
|
Term
| ____% of people infected with AIDS are undiagnosed? |
|
Definition
|
|
Term
| What race has the highest population of undiagnosed HIV+? |
|
Definition
|
|
Term
| ________% of men with ndiagnosed HIV are MSM |
|
Definition
|
|
Term
| Globally, ____% are undiagnosed and _____% do not know if there partner in infected. |
|
Definition
|
|
Term
| Transmission to the child with current antiretrovirals is _____% each year |
|
Definition
|
|
Term
| _____________ children are born each year to HIV infected women in resource poor settings. |
|
Definition
|
|
Term
| Where in VA are HIV infections the highest? |
|
Definition
|
|
Term
| In 2006, more new AIDS cases among black MSM were diagnosed in the ________ than all other census areas combined. |
|
Definition
|
|
Term
| _____% of those infected with HIV do not know that they are positive. |
|
Definition
|
|
Term
| What percent of those diagnosed with HIV recive no care? |
|
Definition
|
|
Term
| ___% delayed seeking primary care for more than 1 year after learning they were HIV+. |
|
Definition
|
|
Term
|
Definition
| Derived from the chimpanzee SIV as an accidental inoculation during preparation of "bush meat". |
|
|
Term
| How is HIV viral load measured? |
|
Definition
RT-PCR of HIV RNA
lower limit detection: 400 (50 copies/ml)
<400 or <50.ml- undetectable, but not necessarily negative
Load increases again with stoppage of retroviral tx |
|
|
Term
| Guideline: HIV screening is recommended for pts aged ______ in all healthcare settings, unless declined. |
|
Definition
|
|
Term
| Guideline: Persons at high risk for HIV should be screened at least _____________. |
|
Definition
|
|
Term
| Up to ______ of initially positive EIAs may not be confirmed with a western blot. |
|
Definition
|
|
Term
| 4 guidelines for HIV testing |
|
Definition
1. Age 13-64
2. High risk screened annually
3. No separate written consent
4. No required prevention counseling |
|
|
Term
| What is the CDC definition of a western blot positive HIV test? |
|
Definition
| Any 2 bands positive of 3: p24, gp41, or gp120/160-Indeterminate: usually negative |
|
|
Term
| Time from infection to the development of antibodies, usually 1-3mo. |
|
Definition
|
|
Term
| What lab tests should be ordered if you believe a pt is experiencing HIV seroconverting illness? |
|
Definition
PCR- 100% sensitive, almost always >50,000
Ab tests are usually negative |
|
|
Term
| If an ELISA HIV test comes back positive, what's the next testing step? |
|
Definition
| Western blot confirmation |
|
|
Term
| At what CD4 count is a person considered to have AIDS? |
|
Definition
| CD4 count <200 or AIDS defining illness is diagnosed |
|
|
Term
| When the CD4 count is b/w 100-250 what is the most common infectious organism? |
|
Definition
Pneumocystitis jiroveci pneumonia (PCP)
almost all cases CD4 <200 |
|
|
Term
| What are the clinical manifestations of PCP? |
|
Definition
- Fever, non-productive cough
- Dyspnea on exertion
- May be subacute with symptoms for weeks prior to onset |
|
|
Term
| What is necessary to diagnose PCP in an AIDS pt? |
|
Definition
- Inc LDH
-CXR: diffuse, bilateral, interstitial infiltrates
-O2 desaturation with exercise |
|
|
Term
| What are some complications of a pt with a CD4 count of 50-100? |
|
Definition
Cryptococcus meningitis
Esophageal candidiasis |
|
|
Term
| What are some complications of a pt with a CD4 count of <50? |
|
Definition
Mycobacterium-avium complex (MACO
CMV |
|
|
Term
| What are some methods of preventing opportunistic infections in AIDS patents? |
|
Definition
-TMP-SMX if CD4 <200 for PCP
- Azythromycin for MAC |
|
|
Term
| Screening studies for HIV/AIDS pts? |
|
Definition
-RPR (syphilis)- annual
-Pap smear- 6mo
-PPD- annual
-Screen: HCV, HepA-B-C
-Toxoplasma |
|
|
Term
| What are some immunizations the HIV/AIDS patients should receive? |
|
Definition
Pneumovax
HepB
Flu
HepA
NO live virus vaccines |
|
|
Term
| What happened to opportunistic infection rates after HAART was implemented? |
|
Definition
|
|
Term
| What happened to mortality rates of HIV/AIDS after HAART therapy? |
|
Definition
| 94% reduction in mortality |
|
|
Term
| What are the mechanisms of antiretroviral therapy? |
|
Definition
- Reverse transcriptase inhibition
- Protease inhibitor |
|
|
Term
| Rate of transmission with a viral load of <400 ____________. |
|
Definition
|
|
Term
| What is one major contraindications of Efavirenx (Sustiva)? |
|
Definition
| Pregnancy, catD (neural tube defects) |
|
|
Term
| How can a protease inhibitor be boosted? |
|
Definition
Add Ritonavir (CYP 3A4 inhibitor), except nelfinavir
Other PI are CYP 3A4 inhibitors too |
|
|
Term
| What are some side effects of protease inhibitors? |
|
Definition
Atazanavir- inc indirect bilirubin
Kaletra- diarrhea, inc lipids
Ritonavir- drug interactions, inc lipids |
|
|
Term
| What is lipodystrophy in an AIDS pt? |
|
Definition
-Fat depletion- face, butt, arms, legs
-Fat accumulation- visceral fat, buffalo hump, breasts |
|
|
Term
| What is Genotypic Antiretroviral Testing (GART)? |
|
Definition
| Getotpic evaluation of the HIV strain mutations for customized therapy with sensitive drugs. |
|
|
Term
| What are some of the powerful new drugs that came out in 2007? |
|
Definition
Darunavir- most powerful protease inhibitor
Raltegravir- Integrase inhibitor
Maraviroc- CCR5 inhibitor |
|
|
Term
|
Definition
| sensitivity assay for HIV drugs |
|
|
Term
| What are some methods of financial support for HIV drugs? |
|
Definition
<300% poverty limit- VA AIDS Drug Assist Prog (ADAP)
Outpatient HIV related care- Ryan White CARE Act |
|
|
Term
| There is only a _____% risk of HIV infections with each needle stick. |
|
Definition
|
|
Term
| Most occupational infections are from what types of transmission? |
|
Definition
48- percutaneous
41- hollow bore needles (94% seroconverted)
AZT postexposure prophylaxis dec transmission by 79% |
|
|
Term
| What drug should not be used as a prophylactic after HIV exposure? |
|
Definition
|
|
Term
| How long should PEP be continued? |
|
Definition
|
|
Term
| What is the route of transmission of amebiasis? |
|
Definition
-Ingestion of fecally contaminated food or water
-person to person |
|
|
Term
| S/Sx of mild/mod intestinal amebiasis colitis. |
|
Definition
- A few semi-formed stools
- No hematochezia or melena
-Abd cramping, flatulence, fatigue |
|
|
Term
| S/Sx of severe intestinal amebiasis colitis. |
|
Definition
-10-20 liquid stools w/ scant hematochezia & v. little fecal material
- Necrotic tissue in stools
- Fever
- Tender abd exam w/ possible hepatomegaly |
|
|
Term
| Localized ulcerative colonic lesions |
|
Definition
- can be present anywhere in the large bowel
- MC in areas of greatest fecal stasis (transverse colon)
-Stools w/ bloody exudate, mild diarrhea (may be occult) |
|
|
Term
| Localized granulomatous colonic lesions |
|
Definition
-Single or multiple masses of granuation tissue
Pain, obstruction, hemorrhage |
|
|
Term
| Hepatic amebiasis (most common). Cause? Clinical findings? |
|
Definition
- Hepatic abscess Cx of intestinal infx
- Clinical findings: high fever, severe pain, hepatomegaly
-Rare: cerebral infx seen on autopsy, 90% fatal |
|
|
Term
| Amebic skin infections. MC location? |
|
Definition
| - Perianal ulcers (white amoebic mass) |
|
|
Term
| Lab findings for intestinal amebiasis? |
|
Definition
- *Stool specimen (ova & parasites), 3 fresh samples
- Antigen-Ab testing in severe cases
- Abdominal ultrasound or abdominopelvic CT
- Colonoscopy- hard b/c must cleanse colon first |
|
|
Term
|
Definition
- Bottled water (avoid fountains or ice cubes)
- Carbonated drinks
- Avoid fresh fruit
- Pasteurized dairy products
- Avoid street vendors |
|
|
Term
| Treatment of intestinal amebiasis? |
|
Definition
- Hydration & pain control
- Diagnostic testing to R/O complications: abdominopelvic CT, colonoscopy
- Multi-drug tx, 2-4 wks (*metronidazole [Flagyl], paromomycin sulfate) |
|
|
Term
| What is a major problem of underdevelopment in children worldwide? |
|
Definition
|
|
Term
| Clinical findings of hookworm? |
|
Definition
| Erythematous, maculopapular or vesicular, pruritic dermatitis at point of transmission (skin or oral). (severity depends on # of invading larvae) |
|
|
Term
| Clinical findings of hookworm disease? |
|
Definition
- *Pulmonary stage: migration through the lungs on the way to the duodenum and jejunum (Bzzz: pulmonay sx)
- Intestinal attachment s/p 2+ weeks of infx
- Severe infx- anorexia, diarrhea, abd pain, anemia, protein loss (hypoalbuminemia) |
|
|
Term
| Laboratory findings of hookworm disease? |
|
Definition
- Stool specimens (ova & parasites)
- Hypochromic microcytic anemia
- Low serum iron |
|
|
Term
|
Definition
- Anthelmintics- v. effective, may need repeat tx
- Ferrous sulfate if anemia present |
|
|
Term
| What is the most prevalent nematode infection worldwide? Tx? |
|
Definition
Pinworms
Tx: Mebendazole (Vermox), double dose
Observe other family members |
|
|
Term
| Nocturnal perianal pruritis. Test? |
|
Definition
Pinworms
Perianal tape test |
|
|
Term
What is the incubation period for malaria?
How long can untreated infections last? |
|
Definition
Incubation 12-30 days
Untreated: 1-2y + |
|
|
Term
| Episodes of "shaking chills", fever (105-106) |
|
Definition
|
|
Term
|
Definition
| - Giemsa stained thick & thin blood films |
|
|
Term
Prevention of malaria?
Tx of malaria? |
|
Definition
- Prophylaxis, insect repellent, long sleeves, bed nets
Tx: NOT chloroquine or quinine- resistance |
|
|
Term
| Intracellular protozoan found worldwide in humas, snimal and birds. Most common in cats. |
|
Definition
|
|
Term
| Biggest contraindication of toxoplasmosis? Cx? |
|
Definition
Toxoplasmosis
-Spontaneous abortion or stillbirth
-Neuro or ophthalmic complications (retinochoroiditis) |
|
|
Term
| Treatments for toxoplasmosis? |
|
Definition
- Lymphadenopathic- no tx
- Retinochorditis- 4 med therapy |
|
|
Term
| 5 common spirochetal infections |
|
Definition
- Lyme disease
- RMSF
- Euricholosis
- Leptospirosis
- Syphilis |
|
|
Term
| Most common vector-borne disease in the US? |
|
Definition
|
|
Term
| What are the s/sx of each stage of Lyme disease? |
|
Definition
1. Early localized- erythema migrans, flu-like
2. Early disseminated- Bell's palsy, meningitis, 2+ mo
3. Late persistant- Arthritis, 3mo-years |
|
|
Term
| B burgdorferi antigen test |
|
Definition
Lyme disease
- False(-) in 50% of early cases, <30 days |
|
|
Term
|
Definition
|
|
Term
|
Definition
1. *Doxycycline, amoxocillin
2. Doxycycline +/- ceftriaxone IV
3. Ceftriaxone IV |
|
|
Term
| Where are most cases of Rocky Mountain Spotted Fever? |
|
Definition
Eastern 1/3 of US, April-Sept
*Not in Rocky Mountains |
|
|
Term
| Rash that begins as faint macules that progress to macular/papular and then petechial. Peripheral to central. |
|
Definition
| Rocky Mountain Spotted Fever |
|
|
Term
|
Definition
Doxycycline PO or IV
Chloramphenicol |
|
|
Term
| Caused by gram(-) intracellular bacteria found in small ticks. Tx? |
|
Definition
Ehrlichiosis
Tx: Doxycycline |
|
|
Term
| Most common intestinal protozoal infection in the US? |
|
Definition
Giardiases
-Fecal contamination of food/water
-Non-bloody diarrhea |
|
|
Term
| Contamination is via contact with snails in fresh water streams, canals, lakes, and reservoirs. |
|
Definition
Schistosomiasis
-1-2 months post-infection; GI & GU
-25% mortality |
|
|
Term
| Unicellular, reproduce asexually by budding (blastoconidia formation) or fission |
|
Definition
|
|
Term
| Branching, thread-like tubular filaments which grow by apical extension, an area of intense metabolic activity |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| On or under the surface of the medium, provide nutrients |
|
Definition
|
|
Term
| Often contain conidia which are easily airborne, involved in asexual reproduction and dissemination of spores. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Hypersensitivity pneumonitis |
|
|
Term
| Hypersensitivity pneumonitis |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| 3 phases of Amanita mushroom poisioning |
|
Definition
1. 6-24h post-ingestion; profuse, watery diarrhea w/ nausea & vomiting
2. Quiescent
3. 3-6d after ingestion is the onset of hepatic & renal failure w/ a 50-90% mortality |
|
|
Term
| Amanita mushroom exposures: in CA, ____% were unintentional, ___% were children <6yo, only ___% had symptoms |
|
Definition
|
|
Term
| 5 primary sites of fungal infection |
|
Definition
|
|
Term
| Caused by Malassezia furfur, a lipophilic dimorphic yeast. Found in areas rich in sebaceous glands. Presents with hyper- or hypo-pigmented lesions. |
|
Definition
|
|
Term
| "Spaghetti & meatballs" KOH wet prep |
|
Definition
| Pityriasis (Tinea) versicolor |
|
|
Term
|
Definition
Selenium sulfide, 2.5%, 7d
Alt: itraconazole, fluconazole |
|
|
Term
| One of the most common human diseases; 2nd most common skin disease in adults, 3rd in children |
|
Definition
|
|
Term
| How do cutaneous mycoses (dermatophyte) infection differ from superficial mycoses? |
|
Definition
| Invoke an inflammatory response |
|
|
Term
| 3 genera of dermatophytes |
|
Definition
Epidermophyton
Microsporum
Trichophyton |
|
|
Term
| Predominant cause of Tinea capitis? |
|
Definition
|
|
Term
Spores surround the hair shaft due to destruction of the cuticle.
May fluoresce.
Presents as areas of alopecia.
Hairs break off just above the scalp, "gray patches" |
|
Definition
|
|
Term
Spores appear inside the shaft
... |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Typical scalloped, erythematous, scaling border. Does not involve scrotum. |
|
Definition
|
|
Term
| Onchomycosis is more prevalent in ______ and 4x more likely on the _________. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Most common location of onchomycosis infection |
|
Definition
| Distal subungal onchymycosis |
|
|
Term
| Classic nail sign of HIV infection |
|
Definition
Proximal subungual onchymycosis
|
|
|
Term
|
Definition
Sporanox
Itraconazole (Pulse)- 200mg, 2xd for 1 week each month x3m
Terbinafine (Lamasil)- QD for 6-12wks, or 7d every 3mo x12mo |
|
|
Term
| Nodular and ulcerative lesions that develop along the lymphatics that drain the site of inoculation. Often from rotting splinters and rose thorns. |
|
Definition
| Sporotrichosis (Sporothrix schenkki) |
|
|
Term
| Histology: Budding, cigar-shaped yeast in culture at 37C, but at 25C grows as a delicate, branching hyphae w/ conidia at the ends of conidiophores in a rosette pattern. |
|
Definition
|
|
Term
Ohio & Mississippi river valley, VA & MD seaboard.
Grows in soil enriched by fecal material of birds, esp starlings.
|
|
Definition
|
|
Term
|
Definition
-Inhalation leading to calcified granulomas in the liver & spleen
-500,000 infx each year, 95% asymptomatic |
|
|
Term
| Chronic pulmonary histoplasmosis |
|
Definition
-Older WM w/ chronic pulmonary disease
- Resembles TB
-Upper lobe infiltrates on CXR |
|
|
Term
| Acute disseminated histoplasmosis |
|
Definition
|
|
Term
| Chronic disseminated histoplasmosis |
|
Definition
|
|
Term
| Chronic disseminated histoplasmosis- diagnosis |
|
Definition
|
|
Term
| The one fungal infection where a blood culture is helpful. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Epidemiology of blastomycosis |
|
Definition
-Ohio & Mississippi river, Missouri & Arkansas valley
-MC: Kentucky, Arkansas, Mississippi, NC, TN, LA |
|
|
Term
| Clinical presentation of blastomycosis |
|
Definition
|
|
Term
| Most blastomycosis diagnoses are made by identification of... |
|
Definition
|
|
Term
|
Definition
|
|
Term
| There are _______________ new cases of coccidiomycosis each year. |
|
Definition
|
|
Term
| This phase of coccidiomycosis infection grows in soil & lab media, is highly infectious, and the lab has to be warned about a potential isolate. |
|
Definition
|
|
Term
| This phase of coccidiomycosis infection is the parasitic phase in humans, but non-infectious. |
|
Definition
|
|
Term
| What is the portal of entry of coccidiomycosis? |
|
Definition
-Inhalation of arthrospores in dust (lung)
-Infective dose: 10 arthrospores
-Esp in S. CA, San Joaquin Valley, NM, TX, & AZ |
|
|
Term
| Coccidiomycosis primary infection |
|
Definition
|
|
Term
| Clinical presentation of coccidiomycosis infection |
|
Definition
| Primary infection assoc w/ a hypersensitivity reaction such as erythema nodosum or "Valley Fever" |
|
|
Term
| Etiology of disseminated cocci infection |
|
Definition
-African Americans, Filipinos, pregnant, immunosuppression, AIDS
-Clues: Rising eosiniphilia, persistant symptoms, negative skin tests |
|
|
Term
| Tx for disseminated cocci infection |
|
Definition
-Amphotericin B for life-threatening
-Fluconazole- moderate & meningitis |
|
|
Term
| What are some risk factors for opportunistic fungal infections? |
|
Definition
Underlying host defects: neutropenia, T-cell dysfunction, Diabetes
Immunosuppression: Cytoxic chemo, high-dose corticosteroids, bone marrow/organ transplantation. (Outcomes are more related to the degree of immunosuppression rather than the particular fungus) |
|
|
Term
| Erythematous, macerated skin w/ vesiculopustular satellite lesions. Tx? |
|
Definition
Candidiasis
Tx: Dry skin, -azole creams |
|
|
Term
| ____% of women have suffered at least one episode of vulvovaginitis. Predisposition? |
|
Definition
75%
Predisposition: Abx, steroids, BCP, pregnancy, diabetes |
|
|
Term
| Epidemiology of oral thrush/candidiasis |
|
Definition
| Neonates, abx use, denture wearers, inhaled corticosteroids, HIV/AIDS |
|
|
Term
| Chronic mucocutaneous candidiasis |
|
Definition
-Severe, chronic, cutaneous & mucosal infx
-Narrow & specific problem w/ cell-mediated immunity against Candida
-Almost never develop systemic or disseminated disease |
|
|
Term
| ___% of autopsy proven cases of disseminated Candidiasis have negative blood cultures. |
|
Definition
|
|
Term
|
Definition
-KOH prep
-Growth on lab media (non-specific)
-C. albicans identified by germ tube test; hyphal outgrowths (germ tubes) |
|
|
Term
|
Definition
Fluconazole- C. albicans, tropicalis, parapsilosis
Caspofugin or Mycafungin- C. glabrata |
|
|
Term
| Most common cause of fungal meningitis and meningitis in AIDS patients? |
|
Definition
|
|
Term
| Diagnosis of cryptococcus |
|
Definition
-Serologic test of antigen by latex agglutination- highly sensitive (97-99%)
-India ink preparation- 50% sensitive |
|
|
Term
|
Definition
Amphotericin B + 5-fluorocystine- severe meningitis or dissemination
-Fluconazole for mild disease & relapse prevention in AIDS |
|
|
Term
| Episodic asthma, expectoration of brown mucus plugs & pulmonary infiltrates. Tx? |
|
Definition
Allergic bronchopulmonay aspergillosis
Tx: Corticosteroids |
|
|
Term
| Saprophytic colonization of old cavities; a mass of intertwined hyphae |
|
Definition
|
|
Term
| Invasive Asperigillosis infection |
|
Definition
|
|
Term
| Diagnosis of Aspergillosis |
|
Definition
|
|
Term
|
Definition
| Voriconazole, not amphotericin B |
|
|
Term
| Risk factors for Zygomycosis (Mucormycosis) |
|
Definition
| Metabolic acidosis, hyperglycemia, deferozamine therapy, long-term voriconazole prophylaxis, corticosteroid use, leukopenia |
|
|
Term
| Rhinocerebral Zygomycosis |
|
Definition
|
|
Term
| Angioinvasive fungus which results in tissue infarction, necrosis and hemorrhage. |
|
Definition
|
|
Term
|
Definition
-No serologic or skin-test
-Histologic examination of biopsy: broad, irregular, non-septae hyphae w/ wide-angle branching, "ribbon-like" |
|
|
Term
|
Definition
-Correction of underlying metabolic activity
-Amphotericin B, high dose
-Posaconazole
-Surgical debridement |
|
|
Term
|
Definition
-Abelcet (ABLC)
-AMBd
-Ambisome |
|
|
Term
| Herpesvirus that affects the mouth & oral cavity, but becoming more common in the genital region |
|
Definition
|
|
Term
| Herpesvirus which is the most common cause of genital ulcers and multiple, painful, grouped lesions. |
|
Definition
|
|
Term
| 5 types of HSV-1,2 infections |
|
Definition
-Mucocutaneous (oral & genital)
-Ocular: dendritic ulcers
-Neonatal & congenital: during delivery
-Herpes encephalitis: spinal fluid evaluation
-Disseminated infection: immunocompromised |
|
|
Term
| Tx for HSV1,2 infections? |
|
Definition
| Acyclovir, Penciclovir, Amantadine |
|
|
Term
| Maculopapular rash developing into vesicles & pustules in a unilateral dermatomal distribution. |
|
Definition
| HHV3: Herpes zoster, Shingles |
|
|
Term
| Pruritic rash that begins on the face, scalp and trunk, then moves to the extremities. Papules change to vesicular lesions, rupture, then ulcerate/crust. |
|
Definition
|
|
Term
Posterior cervical chain lymphadenopathy, exudative pharyngitis and/or tonsillitis, soft palate petechiae and sometimes a maculopapular rash.
Tx? |
|
Definition
HHV4: EBV, Mononucleosis
Tx: symptomatic |
|
|
Term
| What are 2 complications of HH4/EBV/mono? |
|
Definition
-Bacterial (strep) pharyngitis
-Splenic rupture secondary to trauma |
|
|
Term
|
Definition
-Prenatal: jaundice, hepatosplenomegaly, thrombocytopenia, neuro defects
-Acute acquired: sex, breast milk, droplet, blood xfusion
-Immunocompromised: Retinitis, GI, pulmonary, neurologic |
|
|
Term
| Viral encephalitis transmitted through infected saliva during an animal bite or through an open wound. |
|
Definition
|
|
Term
| Most common carriers of rabies? |
|
Definition
| Raccoons, skunks, bats, foxes, dogs, and cats. |
|
|
Term
| Early & late signs of rabies infection. |
|
Definition
Early: fever, malaise, nausea, vomiting
Late: alternating delerium/calmness, painful swallowing, seizures, thick saliva, coma, death.
-30-70,000 deaths/year |
|
|
Term
|
Definition
-Clean wound and flush with rabies immunoglobulin
-Human diploid cell rabies vaccine injection days 0,3,7,14,28
|
|
|
Term
| One of the most common causes of sexually transmitted infection. |
|
Definition
|
|
Term
| Soft, moist, flesh-colored warts that appear in the genital area within several weeks after transmission of the infection. |
|
Definition
|
|
