Common Genital Symptom Syndromes And Their Non STI Causes Flashcards
Genital symptoms – presenting complaints
- 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
Vulvovaginal candidosis
- Very common. Usually trivial but can cause misery in a minority. -
- 90% Candida albicans
- Can be C. glabrata et al
- Usually acquired from bowel
Vulvovaginal candidosis Presentation
- Often asymptomatic carriage
- Changes in host’s environment trigger pathogenicity
- If symptomatic: “thrush”
- Itch
- Discharge - classically thick, ‘cottage cheese’ but often just a report of increased amount.
Vulvovaginal candidosis predisposing factors
- diabetes, oral steroids
- immune suppression incl HIV
- pregnancy
- reproductive age group
- but many cases occur in people with no pre-disposing factors
Vulvovaginal candidosis diagnosis
- Characteristic history
- Examination findings
- Fissuring
- Erythema with satellite lesions
- Characteristic discharge
- Investigations
- Gram stained preparation
- culture
Vulvovaginal candidosis treatment
- Azole antifungals:
- Clotrimazole 500mg PV once
- Plus Clotrimazole HC if vulvitis
- Fluconazole 150mg PO once
Bacterial vaginosis presentation
- asymptomatic in 50%
- watery grey/yellow ‘fishy’ discharge
- may be worse after period/sex
- sometimes sore/itch from dampness
Bacterial vaginosis causes
- reduction of lactobacillus
- raised pH
- overgrowth of BV associated bacteria
Problems associated with bacterial vaginosis
- Associated with endometritis if uterine instrumentation / delivery
- Associated with premature labour
- Increases risk of HIV acquisition
Bacterial vaginosis diagnosis
- characteristic history
- examination findings
- thin, homogenous discharge
- pH
- gram stained smear of vaginal discharge
Bacterial vaginosis treatment
- Antibiotics
- Metronidazole
- Oral ( avoid ethanol)
- Vaginal gel
- Clindamycin
- Metronidazole
- Vaginal
- Probiotics
- Vaginal acidification
Lines of questioning if nil found on examination or test results
-Regretted sexual encounter -Problems in life -Co-existing mental illhealth – anxiety -When did they notice the problem?
Management approach when no clinical findings
-Acknowledge the perception. We shouldn’t tell a person that they’re not experiencing a symptom. -What do they think might be causing the symptom? – Cancer, infertility, STD. -Allows those conditions to be specifically covered and ruled out. -Variants of reassurance -Provide an alternative, benign explanation for symptoms. -Discuss limitations of medical approach
Balanitis
-balanitis is an inflammation of the glans. Often the foreskin is also inflamed. -it occurs far more often in men and boys who haven’t been circumcised
Symtoms if balanitis
-redness, irritation and soreness of the glans of the penis -a thick clumpy discharge which comes from under the foreskin -pain or discomfort when passing urine -unretractable foreskin
Causes of balanitis
-poor hygiene -infection - not sexually transmitted -infection - sexually transmitted -allergic reaction and irritants -skin conditions
Causes of balanitis - infection not sexually transmitted
-common cause of infection is with a yeast called candida -infection more likely to develop if! -Already have some inflammation of the penis due to an allergy or irritant -Have diabetes -Have a phimosis
Treatment for balanitis regardless of cause
-Avoid soaps when inflammation is present. An emollient can be used instead. -Use lukewarm water to clean penis and then dry gently.
Cause dependant treatment of balanitis
-balanitis caused by Candida -anti-yeast cream or a course of anti-yeast tablets -balanitis caused by bacteria (including certain STIs) -antibiotics -balanitis caused by allergies or irritants -a mild steroid cream to reduce inflammation
Sexual history
-When did you last have sexual contact? -Casual contact vs ‘regular’ partner? -How long were you going out with them for? -Were they male or female? -Asking about nature of sex act sometimes useful -anxiety about a specific incident -If it’s going to alter where you swab from -Did you use condoms? -Other contraception used -Nationality of contact
Risk assessment for a man
-Have you ever had sexual contact with a man? -Have you ever injected drugs? -Sexual contact with -anyone who’s injected drugs? -someone from outside the UK? (clarify) -Medical treatment outside UK? (clarify) -Involvement with sex industry
Partner notification for STIs
2 ways of doing this: -Patient tells contacts “client referral” -NHS tells contact “provider referral”
