Genital Disorders (Non-STI)

Question 1

Genital symptoms can be largely split into three categories [3]

Answer 1

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

Question 2

What are the major microbial problems (not STIs) [5]

Answer 2

Vulvovaginal Candidiasis

Bacterial Vaginosis

Balanoposthitis

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

How does a case of Vulvovaginal Candidiasis present?

Answer 4

With itching and a thick “cottage cheese” type discharge

Question 5

Presentation [2]

Risk factors for candidiasis [5]

Answer 5

Itching, thick cottage cheese discharge

Diabetes

Oral Steroids, Immunosuppression

Pregnancy

Simply being in the reproductive age group

Question 6

What to look for in examination of a patient with candidiasis [4]

Answer 6

Examination

• Fissuring

Erythema

Satellite lesions

Discharge

Question 7

Vulvovaginal candidiasis

Treatment: First line [2] + 2 additional advice If resistant…

Answer 7

First line treatment is eiither

Clotrimazole PV or Fluconazole PO

Also avoid irritants and treat dermatitis to protect the skin

If they’re resistant do cultures and sensitivity tests

Question 8

How does Bacterial Vaginosis present? [3]

Causative organism

Answer 8

Watery grey or yellow “fishy smelling” discharge

C/o smell worsening after sex

Various bacteria, they’re not pathogens.

Rather an imbalance of commensal bacteria

Question 9

Diagnosis BV [3] Tx BV [2]

Answer 9

History Exam - thin homogenous discharge

Gram staining

Metronidazole (either oral or vaginal gel) Clindamycin (Vaginal)

Question 10

What is balanoposthitis? 2 common forms

Answer 10

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

Common forms are Candida infection and Plasma Cell Balantitis

Question 11

What is Plasma Cell Balantitis? [4]

Answer 11

Chronic inflammation of the head of the penis due to overgrowth of commensal microbes. Associated with foreskin dysfunction

Question 12

Athlete’s groin is also known as… Presentation [3]

Answer 12

Tinea cruris

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

Question 13

What is Erythrasma? Causative organism

Answer 13

Simila to Tinea Cruris its a dark area spreading out from the groin. Caused by Corynebacterium Minutissimum

Question 14

List some none-microbial causes of genital symptoms? [7]

Answer 14

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

Question 15

What are some common traumatic injuries to the genitals? [2]

Answer 15

Torn Frenulum or ruptured vessels in the penis

Question 16

Many people present with a complaint but on history and exam they actually have no pathology, what might be the reason for this? [4]

Answer 16

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

Question 17

How do we manage a perceived problem eg vulval dysmorphic issues? [3]

Answer 17

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 dw”

Question 18

What are some benign things that can result in people coming to the doctor? [4]

Answer 18

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

Question 19

What are Fox-Fordyce spots? [2]

Answer 19

Visible sebaceous glands under the skin of the penis/scrotum

Cause: glands of that area are very big

Question 20

Genital warts

What is the medical name?

Ax [2]

Appearance [3]

Mx [2]

Prognosis

Answer 20

aka condylomata acuminata

Ax: HPV 6, 11

Appearance:

• Small 2-5mm
• Fleshy protruberances, slight pigmentation
• Bleed, itch

Management:

• Topical podophyllum or cryotherapy
• Imiquimod

Prognosis:

• Tend to be resistant to treatment, recurrence common

Question 21

Molluscum contagiosum

Site [4] Ax [2]

Self care advice [4]

Treatment [3]

Answer 21

Site: Anogenital lesions, pubis, thighs, lower abdomen

Ax: sexual contact, molluscum contagiosum virus

Self care advice:

• Reassure self limiting, spontaneous resolution 18m
• Contagious lesions, avoid sharing towels, clothing, baths
• Avoid scratch
• Exclusion from school, gym or swimming not necessary

Treatment:

• Symptomatic: 1% hydrocortisone, fusidic acid 2%
• Simple trauma: squeezing or piercing lesions may be tried following bath
• Cryotherapy

Question 22

Thrush symptoms in men [4]

Answer 22

Irritation, burning, redness around head of penis and sub-preputial area

White discharge like cottage cheese

Unpleasant smell

Difficulty retracting foreskin

Question 23

Anaerobic balanoposthitis

Ax [2]

RF [2]

Routes of transmission [2]

Symptoms [4]

Complication

Answer 23

Ax: infection of glans penis and prepuse by anaerobic Gram-negative microbes

Risk factors:

• Tight foreskin
• Sub-optimal hygienic practices

Routes of transmission:

• Contact with infected mucosal surfaces eg sex
• Contamination by colonised saliva

Symptoms:

• Intense inflammation, edema of prepuce
• Superficial ulcers on glans penis
• Foul smelling subpreputial discharge
• Bilateral inguinal lymphadenopathy

Complications: necrosis, tissue damage