Common Genital Syndromes and their Non-STI Causes Flashcards
presenting complaints: genitals
- Discharge from an orifice
- Pain
- Rashes
- Lumps and swelling
- Cuts sores and ulcers
- Itching
- Change in appearance
- Vague symptoms
DDx genital symptoms
• STD o Public and individual health problem o Treatable o Not always curable • Other microbial problem o Individual health o Treatable o Usually curable • Non-microbial o Individual • Perceived problem only o Normal findings, sensations • Dermatoses • Structural abnormalities o Congenital o Acquired
Non-STD microbial conditions
- Vulvovaginal candidosis
- Bacterial vaginosis
- Balanitis
- Tinea cruris
- Erythrasma
- Infected sebaceous glands
- Impetigo
- Cellulitis
vulvovaginal candidosis: organism
candida albicans
vulvovaginal candidosis: source
bowel
vulvovaginal candidosis: symptoms
itch
thick “cottage chees” discharge
vulvovaginal candidosis: risk factors
diabetes oral steroids immune suppression regnancy reproductive age group
vulvovaginal candidosis: examination findings
fissuring
erythema with satellite lesions
characteristic dischage
vulvovaginal candidosis: investigations
Gram stained preparation
o Low sensitivity – might look at an unrepresentative patch
• Culture – eg Sabouraud’s medium
o Low specificity – yeast is often commensal
vulvovaginal candidosis: treatment
Azole antifungals o Clotrimazole 500mg PV once § Plus, clotrimazole HC if vulvitis o Fluconazole 150mg PO once • Resistance – species and sensitivities
bacterial vaginosis: symptoms
asymptomatic
watery grey/yell “fishy” discharge
bacterial vaginosis: cause
imbalance of bacteria - biofilm
• Increased Gardnerella/ureaplasma/mycoplasma/anaerobes
• Reduced lactobacilli
• Sexual transmissibility controversial
• Associated with Vit D deficiency, in black women
bacterial vaginosis: may be associated with
endometritis if instrumental/delivery, premature labour
bacterial vaginosis: increases risk of what acquisition?
HIV
bacterial vaginosis: diagnosis
exam is rare, usually Hx alone
discharge is thin
homogenous discharge
gram stained smear
bacterial vaginosis: treatment
Treat with metronidazole oral (avoid ethanol) or vaginal gel. Clindamycin can be used vaginally. Can just leave and it will sort itself out.
name tyoes ofbalanitis and prosthitis
candidal balanitis zoon's balanitis impetigo erysipelas dermatophyte infection tinea cruris erythrasma
what causes Zoon’s balanitis
plasma cell balanitis
chronic inflammation secondary to overgrowth of commensal organisms plus “foreskin malfunciton”
what bacteria causes impetigo in the penis?
staph aureus
strep pyogenes
what organism causes erysipelas of the penis?
group A strrp
organism causing dermatophyte infections of the penis
trichophyton rubrum
what organism cases erythrasma of the male genitalis
corynebacterium miniutissium
what things related to genitals may people think they have wrong but are fine
• Vaginal discharge • Urethral discharge • Dysuria • Genital/pelvic discomfort • Rashes • Skin lumps • Penis size. Scrotal lumps, labial shape o Temporary o More persistent – body dysmorphia
lines of question if nothing to find on examination or tests (genitals)
- Regretted sexual encounter
- Problems in life
- Co-existing mental ill health – anxiety
- When did they notice the problem?
- When were things last normal?
other causes of genital symptoms
lyphocele congenital cyst traumatic ruptured artery in frenulum torn frenulum and infection luchen sclerosis lichen planus
• Pain syndromes – the dynias • Dermatoses • Congenital • Traumatic • Neoplastic • Manifestations of systemic disease • Fox-Fordyce spots o Glands o Normal • Vulval papillomatosis o Normal o Frong like appearance o Worried about HPV • Penile pearly papules – aka Coronal papillae o Normal bumps around • Tyson’s glands o Sebaceous glands around frenulum
