Two major viral sexually transmitted diseases (STD), genital herpes and genital warts, dramatically increased in frequency during the sexual revolution of the 1960s and 1970s. The painful itchy lesions of genital herpes (Fig 20-6) and the accompanying local and systemic symptoms were described in Chapter 20. Dozens of recurrences, mainly attributable to HSV-2 but increasingly to HSV-1 also, may dominate the life of the hapless carrier. Genital warts, caused most commonly by the human papillomaviruses HPV-6 and HPV-11, can take the form of prolific excrescences on the external genitalia, perineum, vaginal introitus, penis, or anus (known as condyloma accuminatum (Fig. 18-3), or the form of a less conspicuous flat lesion on the cervix (condyloma planum); they are discussed in Chapter 18. Certain oncogenic HPV types, particularly types 16 and 18, produce cervical dysplasia which may progress over the course of many years to invasive cancer; the same HPV types are also eti-ologically associated with carcinomas of the male or female external genitalia and anus (see Chapter 11). Adenovirus type 37 is not uncommonly associated with cervicitis and urethritis. Molluscum conlagiosum is also occasionally transmitted as an STD
Several other very important human pathogens are shed in semen and in female genital secretions and are transmitted by sexual intercourse but cause no disease in the genital tract itself. Foremost among these, ol course, are the human immunodeficiency viruses HIV-1 and H1V-2, but the list also includes the human T-cell lymphotropic viruses HTLV-1 and HTLV-2, hepatitis B and C viruses, and the herpesviruses, cytomegalovirus, and (probably) Fpstein-Barr virus. Many more viruses are regularly conveyed between male homosexuals, depending largely on their particular sexual activities and number of partners. These include enteric viruses such as hepatitis A as well as those just listed.
Viral Diseaes of the Genitourinary Tract"
Genital herpes Genital warts Genital carcinomas Cervicitis
Herpes simplex viruses (HSV-2 > H5V-1) Human papillomaviruses 6, 11, and others Human papillomaviruses 16, 18, and others Adenovirus 37
Molluscum contagiosum virus
Acute hemorrhagic cystitis
Herpes simplex virus, adenovirus 37 Adenovirus 11 Hepatitis B virus Cytomegalovirus
Hantaan virus Enteroviruses?
" Many other important human pathogens causing major diseases not involving the genital or urinary tract clinically are nevertheless transmitted sexually. These include HIV-1 and -2, HTLV-1 and -2, hepatitis B and C viruses, cytomegalovirus, and probably Epstein-Barr virus
Viruses rarely infect the urinary tract (Table 36-6). Urethritis can complicate infections with HSV. Acute hemorrhagic cystitis, an unusual disease of young boys, has been associated principally with adenoviruses 11 and (rarely) 21. Glomerulonephritis is sometimes observed as a manifestation of immune complex disease in chronic hepatitis B infections (see Chapter 22). It is safe to predict that future research may reveal that some cases of "idiopathic" glomerulonephritis are also caused by chronic persistent infections with other viruses yet to be identified (see Chapter 10). Cytomegalovirus persists asymp-tomatically in renal tubules (Fig. 20-8), from which cytomegalic cells as well as virus are shed into the urine. When primary infection or reactivation of CMV occurs during renal transplantation, rejection of (he graft may be accelerated (see Chapter 20). The human polyomaviruses BK and JC (Chapter 18) also persist in the urinary tract and are reactivated by immunosuppression for renal transplantation, but they do not appear to play a role in rejection of the graft.
Clearly there is profound malfunction of the kidneys in hemorrhagic fever with renal syndrome, caused by the bunyavirus Hantaan virus. The clinical developments were described in Chapter 33, but the pathology is still unclear. Hemolytic-uremic syndrome is characterized by acute microangiopathic hemolytic anemia, intravascular coagulopathy, and impaired renal function; various enteroviruses have been isolated from family clusters of cases (see Chapter 23).
It is not generally appreciated how frequently viruses can involve the eyes (Table 36-7). Conjunctivitis is a transient feature of a number of common childhood exanthemata such as measles (Fig. 36-5C), rubella, and certain
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