Common Genital Symptom Syndromes And Their Non STI Causes

Question 1

Genital symptoms – presenting complaints

Answer 1

• 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

Question 2

Vulvovaginal candidosis

Answer 2

• Very common. Usually trivial but can cause misery in a minority. -
• 90% Candida albicans
• Can be C. glabrata et al
• Usually acquired from bowel

Question 3

Vulvovaginal candidosis Presentation

Answer 3

• 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.

Question 4

Vulvovaginal candidosis predisposing factors

Answer 4

• diabetes, oral steroids
• immune suppression incl HIV
• pregnancy
• reproductive age group
• but many cases occur in people with no pre-disposing factors

Question 5

Vulvovaginal candidosis diagnosis

Answer 5

• Characteristic history
• Examination findings
  
  • Fissuring
  • Erythema with satellite lesions
  • Characteristic discharge
• Investigations
  
  • Gram stained preparation
  • culture

Question 6

Vulvovaginal candidosis treatment

Answer 6

• Azole antifungals:
  
  • Clotrimazole 500mg PV once
  • Plus Clotrimazole HC if vulvitis
  • Fluconazole 150mg PO once

Question 7

Bacterial vaginosis presentation

Answer 7

• asymptomatic in 50%
• watery grey/yellow ‘fishy’ discharge
• may be worse after period/sex
• sometimes sore/itch from dampness

Question 8

Bacterial vaginosis causes

Answer 8

• reduction of lactobacillus
• raised pH
• overgrowth of BV associated bacteria

Question 9

Problems associated with bacterial vaginosis

Answer 9

• Associated with endometritis if uterine instrumentation / delivery
• Associated with premature labour
• Increases risk of HIV acquisition

Question 10

Bacterial vaginosis diagnosis

Answer 10

• characteristic history
• examination findings
• thin, homogenous discharge
• pH
• gram stained smear of vaginal discharge

Question 11

Bacterial vaginosis treatment

Answer 11

• Antibiotics
  
  • Metronidazole
    
    • Oral ( avoid ethanol)
    • Vaginal gel
  • Clindamycin
• Vaginal
  
  • Probiotics
  • Vaginal acidification

Question 12

Lines of questioning if nil found on examination or test results

Answer 12

-Regretted sexual encounter -Problems in life -Co-existing mental illhealth – anxiety -When did they notice the problem?

Question 13

Management approach when no clinical findings

Answer 13

-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

Question 14

Balanitis

Answer 14

-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

Question 15

Symtoms if balanitis

Answer 15

-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

Question 16

Causes of balanitis

Answer 16

-poor hygiene -infection - not sexually transmitted -infection - sexually transmitted -allergic reaction and irritants -skin conditions

Question 17

Causes of balanitis - infection not sexually transmitted

Answer 17

-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

Question 18

Treatment for balanitis regardless of cause

Answer 18

-Avoid soaps when inflammation is present. An emollient can be used instead. -Use lukewarm water to clean penis and then dry gently.

Question 19

Cause dependant treatment of balanitis

Answer 19

-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

Question 20

Sexual history

Answer 20

-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

Question 21

Risk assessment for a man

Answer 21

-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

Question 22

Partner notification for STIs

Answer 22

2 ways of doing this: -Patient tells contacts “client referral” -NHS tells contact “provider referral”