Common Genital Symptom Syndromes

Question 1

What are the most common presenting complaints for genital symptoms?

Answer 1

Discharge
Pain
Rashes
Lumps/swellings
Sores/ulcers
Itching
Change in appearance
"things not right"

Question 2

What are the likely causes of genital symptoms?

Answer 2

STD
Other microbial problem
Non-microbial problem

Question 3

Which microbial conditions are not regarded as STDs

Answer 3

Vulvovaginal candidosis
Bacterial vaginosis
Balanoposthitis – anaerobic/candidal
Tinea cruris
Erythrasma 
Infected sebaceous glands
Impetigo
Cellulitis

Question 4

What is the most common pathogen in Vulvovaginal candidosis?

Answer 4

90% Candida albicans

Candida galbrata

Question 5

Where is C. albicans most commonly acquired from?

Answer 5

Bowel

Question 6

What are the symptoms of thrush?

Answer 6

Itch
Discharge (thick, 'cottage cheese')

Question 7

What are the risk factors for C. albicans infection?

Answer 7

Diabetes
Oral steroids
Immunosuppression
Pregnancy
Reproductive age group

Question 8

How is Candidosis diagnosed?

Answer 8

History
Fissuring
Erythema with satellite lesions
Characteristic discharge
Gram staining
Culture

Question 9

How is Candidosis treated?

Answer 9

Azole antifungals
Maintain skin (avoid irritants)

Question 10

Which antifungals are used in Candidosis?

Answer 10

Clotrimazole 500mg PV once

Fluconazole 150mg PO once

Question 11

What is the most common cause of vaginal discharge?

Answer 11

Bacterial Vaginosis

Question 12

What are the symptoms of Bacterial vaginosis?

Answer 12

50% asymptomatic
Watery/yellow fishy discharge
May be worse post-period or sex
Sometimes itch/sore

Question 13

What is the cause of bacteria vaginosis?

Answer 13

IMBALANCE of bacteria

Biofilm

Question 14

What is the bacterial imbalance seen in bacterial vaginosis?

Answer 14

Increased:
 - Gardnerella
 - Ureaplasma
 - Mycoplasma
 - Anaerobes
Reduced:
 - Lactobacilli 
Associated with Vit D deficiency in black women

Question 15

What problems are associated with bacterial vaginosis?

Answer 15

Endometriosis if instrumentation associated
Premature labour
Increased risk of HIV acquision

Question 16

How is Bacterial vaginosis diagnosed?

Answer 16

History
Thin homogenous discharge
Gram staining of vaginal discharge

Question 17

How is bacterial vaginosis treated?

Answer 17

Metronidazole

Clindamycin

Question 18

What is Zoon’s/Plasma cell balanitis?

Answer 18

Chronic inflammation secondary to overgrowth of commensal organisms

Question 19

What are the causative bacteria of impetigo?

Answer 19

Staph aureus

Strep pyogenes

Question 20

What are the causative bacteria of erysipelas?

Answer 20

Strep pyogenes

Question 21

What are the causative bacteria of dermatophyte?

Answer 21

Trichophyton rubrum

Question 22

What should be questioned if nil found on examination/test results?

Answer 22

Regretted sexual encounter
Problems in life
Mental health
When did they notice problem?
When were things last normal?

Question 23

How should you manage a patient if nil found on examination/test results?

Answer 23

Acknowledge the perception
What do they suspect?
Reassure
Discuss limitations of a medical approach