Common genital symptoms

Question 1

Presenting complaints

Answer 1

itch - rash - lumps - discharge - change in appearance - feeling that something is not right - pain - cuts, sores, ulcers

Question 2

are STD’s treatable and curable?

Answer 2

treatable, not always curable

Question 3

Are other microbial problems treatable and curable?

Answer 3

treatable and usually curable

Question 4

List some microbial conditions not regarded as STD’s

Answer 4

vulvovaginal candidosis, bacterial vaginosis
tinea cruris, erythrasma, impetigo, cellulitis
balanoposthitis
infected sebaceous glands

Question 5

Organism in vulvovaginal candidosis and where it is usually obtained from

Answer 5

candida albicans

bowel

Question 6

What is symptomatic vulvovaginal candidosis?

Answer 6

thrush

Question 7

Symptoms of thrush

Answer 7

itch and discharge

cottage cheese, thick, more amounts

Question 8

When is there an increased risk of thrush

Answer 8

pregnancy
diabetes and oral steroids
immunosuppression
reproductive age group

Question 9

Examination of thrush

Answer 9

fissuring, erythema with satellite lesions, characteristic discharge

Question 10

Investigations of thrush

Answer 10

gram stained prep - low sensitivity as unrepresentative patch
culture - low specificity as yeast often commensal

Question 11

Treatment of thrush

Answer 11

azole antifungals - clotrimazole 500mg PV once, fluconazole 150mg PO once
maintain skin - treat dermatitis

Question 12

What is the most common cause of abnormal vaginal discharge and what % of women have this at any time?

Answer 12

bacterial vaginosis

10-40%

Question 13

Symptoms of bacterial vaginosis

Answer 13

Watery grey/yellow fishy discharge maybe worse after period or sex
sore/itch
asymptomatic

Question 14

Is bacterial vaginosis an infection?

Answer 14

no - more so an imbalance

Question 15

Aetiology of bacterial vaginosis

Answer 15

biofilm problem - increased mycoplasma/anaerobes
reduced lactobacilli
sexual transmissibility??
vit D deficiency in black women

Question 16

What is bacterial vaginosis associated with?

Answer 16

endometritis if uterine instrumentation/delivery
premature labour
increased risk of HIV acquisition

Question 17

Diagnosis of bacterial vaginosis

Answer 17

history and on exam - thin, homogenous discharge

gram stained smear of vaginal discharge

Question 18

Treatment of bacterial vaginosis

Answer 18

metronidazole - oral

clindamycin - vaginal

Question 19

What is zoon’s balanitis?

Answer 19

chronic inflammation secondary to commensal overgrowth and foreskin dysfunction

Question 20

Causative organism of impetigo

Answer 20

staph aureus and strep pyogenes

Question 21

Causative organism of erysipelas

Answer 21

strep pyogenes

Question 22

Examples of non microbial symptoms

Answer 22

fox-Fordyce spots
vulval papillomatosis
vaginal discharge, dysuria, pelvic discomfort, rashes

Question 23

Lines of questioning of non microbial symptoms

Answer 23

regretted sexual encounter
co-existing mental health
when were things last normal

Question 24

Management approach of non microbial symptoms

Answer 24

acknowledge the perception
what do they think is causing this?
variants of reassurance
discuss limitations of medical approach

Question 25

Other causes of genital symptoms

Answer 25

pain syndromes
dermatoses 
congenital 
traumatic 
neoplastic 
manifestation of systemic disease