Common genital syndromes (non-STI)

Question 1

Genital symptoms can be largely split into three categories:

Answer 1

• STIs
• Non-STI MIcrobial problems
• Non-microbial problems

Question 2

What are the major Microbial problems (not STIs)

Answer 2

Vulvovaginal Candidiasis
Bacterial Vaginosis
Balanoposthitis & balanitis
Tinea Cruris
Erythrasma

Other things that affect skin elsewhere can also affect skin around the genitals e.g. Staph aureus impetigo or Cellulitis

Question 3

What causes Candidiasis?

Answer 3

90% of cases are Due to Candida Albicans

Question 4

Its common to asymptomatically carry Candida albicans, whats it commonly called when it becomes symptomatic?

Answer 4

Thrush

Question 5

How does a case of Vulvovaginal Candidiasis present?

Answer 5

With itching and a thick “cottage cheese” type discharge

Question 6

Risk factors for candidiasis?

Answer 6

Diabetes
Oral Steroids
Immunosuppression
Pregnancy
Simply being in the reproductive age group

Question 7

So how do we diagnose a case of Candidiasis?

Answer 7

The classic h/o itching and cottage cheese discharge
Do an exam looking for fissuring, erythema with satellite lesions and discharge

Can also gram stain and culture

Question 8

How do we treat Vulvovaginal candidiasis?

Answer 8

With Azoles:
- Either Clotrimazole PV or Fluconazole PO
If they’re resistant do cultures & sensitivity tests

Also avoid irritants and treat dermatitis to protect the skin

Question 9

Bacterial Vaginosis is the other major microbial problem women face, how common is it?

Answer 9

The commonest cause of abnormal discharge. It affects anything from 10-40% of women at once

Question 10

How does Bacterial Vaginosis present?

Answer 10

Watery Grey or yellow “fishy smelling” discharge
Look for complaints of the smell worsening after sex

May be soreness/itching but more due to dampness than directly the microbes

Question 11

What organism causes bacterial vaginosis?

Answer 11

Various bacteria, they’re not pathogens. Rather an imbalance of commensal bacteria

Question 12

How do you diagnose Bacterial Vaginosis?

Answer 12

history
Exam - Thin homogenous discharge (smell)
Gram Staining

Question 13

How do we treat bacterial vaginosis?

Answer 13

Metronidazole (either oral or vaginal gel)

Clindamycin (Vaginal)

Question 14

What is balanoposthitis?

Answer 14

Inflammation of the head of penis (Balantitis) and Shaft (Posthitis)

Common forms are Candida infection and Plasma Cell Balantitis

Question 15

What is Plasma Cell Balantitis?

Answer 15

Aka zoons balanitis
Chronic inflammation of the head of the penis due to overgrowth of commensal microbes. Also leads to foreskin dysfunction

Question 16

What microbial problem might be refer to as athletes groin?

Answer 16

Tinea Cruris, its the same dermatophyte as causes atheletes foot and is often related

Question 17

How does Tinea Cruris look?

Answer 17

A red area that spreads out from the groin, often with a flaky edge.

Question 18

What is Erythrasma?

Answer 18

Simila to Tinea Cruris its a dark area spreading out from the groin.

Caused by Corynebacterium Minutissimum

Question 19

List some none-microbial causes of genital symptoms?

Answer 19

• Dermatoses
• Structural Abnormalities e.g. a cyst
• Pain syndromes
• Trauma
• Neoplastic
• Systemic Diseases
• Perceived problems

Question 20

What are some common traumatic injuries to the genitals?

Answer 20

Torn Frenulum or ruptured vessels in the penis

Question 21

What systemic diseases commonly affect the genitals?

Answer 21

Some autoimmune conditions can cause Lichen Sclerosis & Lichen Planus, itchy white patches on the skin around the genitals.
In lichen sclerosis they commonly appear around the opening to the vagina, anus and penis and can obstruct the openings

Question 22

Many people present with a complaint but on history and exam they actually have no pathology, what might be the reason for this?

Answer 22

• Regretted sexual encounters including assault
• Other problems in life
• Mental health including anxiety
• Media story, family member or friend recently diagnosed

Question 23

How do we manage a perceived problem?

Answer 23

Acknowledge it, they must know your not dismissing them
Properly test for anything they’re worried about e.g. HIV or cancer or they won’t stop worrying
Provide a benign explanation where possible instead of just saying “its normal dwai”

Question 24

What are some benign things that can result in people coming to the doctor?

Answer 24

• Fox-Fordyce spots
• Vulval Papillomatosis
• Coronal Papillae (pearly papules on the penis)
• Tyson’s Glands

Question 25

What are Fox-Fordyce spots?

Answer 25

Visible sebaceous glands under the skin of the penis/scrotum

They’re totally normal, its just cos the glands of that area are very big