Genital Disorders (Non-STI) Flashcards
Genital symptoms can be largely split into three categories:
- STIs - Non-STI MIcrobial problems - Non-microbial problems
What are the major Microbial problems (not STIs)
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
What causes Candidiasis?
-90% of cases are Due to Candida Albicans -Candida GLABRATA also common
Its common to asymptomatically carry Candida albicans, whats it commonly called when it becomes symptomatic?
Thrush
How does a case of Vulvovaginal Candidiasis present?
With itching and a thick “cottage cheese” type discharge
Risk factors for candidiasis?
Diabetes
Oral Steroids
Immunosuppression
Pregnancy
Simply being in the reproductive age group
So how do we diagnose a case of Candidiasis?
-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
How do we treat Vulvovaginal candidiasis?
With Azole antifungals: - Either Clotrimazole PV or -Fluconazole PO If they’re resistant do cultures and sensitivity tests Also avoid irritants and treat dermatitis to protect the skin
Bacterial Vaginosis is the other major microbial problem women face, how common is it?
The commonest cause of abnormal discharge. It affects anything from 10-40% of women at once
How does Bacterial Vaginosis present?
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
How do you diagnose Bacterial Vaginosis?
history Exam - Thin homogenous discharge (smell) Ph>4.5 Gram Staining
How do we treat bacterial vaginosis?
Antibiotics: Metronidazole (either oral or vaginal gel) Clindamycin (Vaginal) Probiotics Vaginal acidification
What is balanoposthitis?
Inflammation of the head of penis (Balantitis) and Shaft (Posthitis) Common forms are Candida infection and Plasma Cell Balantitis
What is Plasma Cell Balantitis?
Chronic inflammation of the head of the penis due to overgrowth of commensal microbes. Also leads to foreskin dysfunction
What microbial problem might be refer to as athletes groin?
Tinea Cruris, its the same dermatophyte as causes atheletes foot and is often related
How does Tinea Cruris look?
A red area that spreads out from the groin, often with a flaky edge.
What is Erythrasma?
Simila to Tinea Cruris its a dark area spreading out from the groin. Caused by Corynebacterium Minutissimum
List some none-microbial causes of genital symptoms?
- Dermatoses - Structural Abnormalities e.g. a cyst - Pain syndromes - Trauma - Neoplastic - Systemic Diseases - Perceived problems
What are some common traumatic injuries to the genitals?
Torn Frenulum or ruptured vessels in the penis
What systemic diseases commonly affect the genitals?
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
Many people present with a complaint but on history and exam they actually have no pathology, what might be the reason for this?
- Regretted sexual encounters including assault - Other problems in life - Mental health including anxiety - Media story, family member or friend recently diagnosed
How do we manage a perceived problem?
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”
What are some benign things that can result in people coming to the doctor?
- Fox-Fordyce spots - Vulval Papillomatosis - Coronal Papillae (pearly papules on the penis) - Tyson’s Glands
What are Fox-Fordyce spots?
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
