Common Genital Symptom Syndromes Flashcards
What are some genital symptoms that people present with?
- Discharge from an orifice
- Pain from somewhere
- Rashes
- Lumps and swellings
- Cuts, sores, ulcers
- Itching
- Change in appearance
- Vague sense of things not being right
What can cause genital symptoms?
- STD
- Other microbial problem
- Non-microbial problem
STD vs Other microbial problem vs Non-microbial problem
STD
- Public and individual health problem.
- Treatable.
- Not always curable
- Micro-organisms involved
Other Microbial Problem .-Individual health problem -Treatable -Usually curable -Micro-organisms involved
Non-Microbial Problem
-Individual health issue
What microbial conditions of the genitals are not regarded as STDs?
- Vulvovaginal candidosis
- Bacterial vaginosis
- Balanoposthitis – anaerobic/candidal
- Tinea cruris
- Erythrasma
- Infected sebaceous glands
- Impetigo
- Cellulitis
- Other
What causes vulvovaginal candidosis?
- 90% Candida albicans
- Can be C. glabrata et al
- Usually acquired from bowel
How does vulvovaginal candidosis present?
If symptomatic presents as thrush
- Itch
- Discharge: classically thick, increased amount (cottage cheese)
Often asymptomatic carriage.
-Pathogenicity is triggered by a change in host environement
Who is at increased risk of vulvovaginal candidosis?
- Diabetes, oral steroids
- Immune suppression incl HIV
- Pregnancy
- Reproductive age group (oestrogen…glycogen = food for yeast)
How is vulvovaginal candidosis diagnosed?
Characteristic history
Examination findings
- Fissuring
- Erythema with satellite lesions
- Characteristic discharge
Investigations
- Gram staining (low sensitivity)
- Culture (low specificity)
How is vulvaginal candidosis treated?
Azole antifungals
- Clotrimazole
- Fluonazole
- Resistant cases= determine species and sensitivities
- Maintain skin and avoid irritants
What is the commonest cause of abnormal vaginal discharge?
Bacterial vaginosis (10-40% of women at any time)
How does bacterial vaginosis present?
-Asymptomatic in 50%
watery -Grey/yellow ‘fishy’ discharge
-May be worse after period / sex
-Sometimes sore/itch from dampness
What is bacterial vaginosis?
An imbalance of bacteria rather than an infection
What is the pathophysiology of bacterial vaginosis?
A biofilm problem
- Increased gardnerella / ureaplasma / mycoplasma /anaerobes
- Reduced lactobacilli
- Sexually transmissibility controversial
- Associated with vitamin D deficiency but just in black women
What possible complications are there from bacterial vaginosis?
- Associated with endometritis if uterine instrumentation / delivery
- Associated with premature labour
- Increases risk of HIV acquisition
How is bacterial vaginosis diagnosed?
-Characteristic history
Examination findings
-Thin, homogenous discharge
-Gram stained smear of vaginal discharge
How is bacterial vaginosis treated?
Metronidazole
- Oral ( avoid ethanol)
- Vaginal gel
Clindamycin
-Vaginal
What is balanitis?
Inflammation of the glans penis
What is posthitis?
Inflammation of the foreskin
How does candida balanitis present?
Blotchy red appearance/ discolouration of the glans penis
How does Zoon’s balanitis (plasma cell balanitis) present?
Chronic inflammation secondary to overgrowth of commensal organisms plus ‘foreskin malfunction’.
What are usually the causative organisms of impetigo?
- Staph aureus
- Strep pyogenes
What is usually the causative agent of erysipelas?
Strep pyogenes
What is tinea cruris?
Dermatophytes infection known as athlete’s groin
What is usually the causative agent of erythrasma?
Corynebacterium minutissimum
What non-microbial symptoms of the genitals may people present with?
- Perceived problems
- Dermatoses
- Structural abnormality (congenital and acquired)
What can be the presenting complaint when a patient has a perception of abnormality but with no clinical findings?
- Vaginal discharge
- Urethral discharge
- Dysuria
- Genital/pelvic discomfort
- Rashes
- Skin lumps
- Penis size, scrotal lumps, labial shape
What questions should be asked if there is a perceived problem but no clinical findings?
- Regretted sexual encounter
- Problems in life
- Co-existing mental illhealth – anxiety
- When did they notice the problem?
- When were things last normal?
How should perceived problems be managed?
- Acknowledge perception
- Ask what they think it is. Allows fears to be dispelled
- Variants of reassurance
- Discuss the limitations of medical approach
What are Fox-Fordyce spots?
Appearance of normal sebaceous glands through stretched skin
What other causes of genital symptoms are there apart from STDs?
- Pain syndromes – the ‘dynias’
- Dermatoses
- Congenital
- Traumatic
- Neoplastic
- Manifestations of systemic disease
- Other
