Common Genital Symptoms and Their Non-STI Causes Flashcards
What are the microbial conditions that are not deemed sexually transmitted?
- Vulvovaginal candidosis
- Bacterial vaginosis
- Balanoposthitis – anaerobic/candidal
- Tinea cruris
- Erythrasma
- Infected sebaceous glands
- Impetigo
- Cellulitis
What is the most common causative organism of vulvovaginal candidosis?
Candida albicans (90%)
What condition is caused by symptomatic vulvovaginal candidosis?
Thrush
What are the symptoms of thrush?
Itch
Discharge- usually thick, yellow and “cottage cheese like”
What are the risk factors for thrush?
- Diabetes
- Oral steroids
- Immune suppression
- Pregnancy
- Child-bearing age
How is thrush diagnosed?
Usually on classical history but follow can be present on examination:
-Fissuring
-Erythema with satellite lesions
-Characteristic discharge
Can also investigate:
-Gram stained preparation (low sensitivity- may look at unrepresentative patch)
-Culture (low specificity)
How is thrush treated?
Usually azole antifungals
In cases of resistance species and sensitivities can be determined and appropriate antifungals decided.
First line antifungals: one dose of either PV clotrimazole or PO fluconazole.
Skin should also be maintained by avoiding irritants and treating dermatitis.
What is the commonest cause of an abnormal vaginal discharge?
Bacterial vaginosis
What are the symptoms of bacterial vaginosis?
- Asymptomatic in 50%
- Watery grey/yellow ‘fishy’ discharge
- May be worse after period / sex
- Sometimes sore/itch (from dampness due to discharge, if excessive itch then probably another cause)
What is the pathophysiology of bacterial vaginosis?
Pathologically, bacterial vaginosis is associated with a reduction in lactobacilli and so H2O2 production, causing an overgrowth of BV associated bacteria and an increase in vaginal pH
What are the possible complications of bacterial vaginosis?
- Associated with endometritis if uterine instrumentation / delivery
- Associated with premature labour
- Increases risk of HIV acquisition
How is bacterial vaginosis diagnosed?
Based on a characteristic history and presence of a thin, homogenous discharge on examination
What investigations can be done for bacterial vaginosis?
pH (other causes of raised pH)
Gram stain of the discharge
How is bacterial vaginosis treated?
- Antibiotics (oral or vaginal metronidazole or vaginal clindamycin (can’t use oral clindamycin due to C.diff risk))
- Probiotics
- Vaginal acidification
What is balanitis?
Inflammation of the glans of the penis
