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 Vulvovaginal Candidiasis?
90% of cases are due to Candida Albicans
Candida GLABRATA also common
Usually acquired from bowel
Its common to asymptomatically carry Candida albicans, what’s it commonly called when it becomes symptomatic?
Thrush
How does a case of Vulvovaginal Candidiasis present if symptomatic?
With itching and a thick “cottage cheese” type discharge
Risk factors for candidiasis?
- Diabetes
- Oral steroids
- Immunosuppression (incl. HIV)
- Pregnancy
- Reproductive age group
So how do we diagnose a case of Candidiasis?
- The classic h/o itching and cottage cheese discharge
- Examination looking for:
- Fissuring
- Erythema with satellite lesions
- Discharge - can also gram stain and culture
How do we treat Vulvovaginal candidiasis?
With Azole antifungals:
- Either Clotrimazole PV
- Fluconazole PO
If they’re resistant:
- Do cultures (determine species) 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?
- Asymptomatic
- 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
- Examination
- Thin homogenous discharge (smell)
- Ph > 4.5
- Gram stained smear of discharge
How do we treat bacterial vaginosis?
- Antibiotics
- Metronidazole (either oral or vaginal gel)
- Clindamycin (Vaginal)
- Probiotics
- Vaginal acidification ⇒ maintain pH < 4.5
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 (Zoon’s Balantitis)?
Chronic inflammation of the head of the penis due to overgrowth of commensal microbes.
Also leads to foreskin malfunction.
What microbial problem might be refer to as athletes groin?
Tinea Cruris
It’s the same dermatophyte which 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?
Similar to Tinea Cruris its a dark area spreading out from the groin.
Caused by Corynebacterium Minutissimum.
List some non-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 don’t worry”
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 because the glands of that area are very big
What are common symptoms of a Non-STI genital symptom?
- Discharge from an orifice
- Pain from somewhere
- Rashes
- Lumps and swellings
- Cuts, sores, ulcers
- Itching
- Change in appearance
- Vague sense of things not being right…
What is this?
Candida Balantitis
What is this?
Zoon’s Balantis
What are candida Balantitis and Zoon’s Balantis due to?
Commensal pathogens
In the case of Zoon’s balantis due to choronic inflammation and/or foreskin malfunction
What can a staph pyogens infection lead to?
Impetigo
Erysipelas
What can Dermatophyte infection lead to?
Tinea cruris
What is erythrasma?
Bacterial skin rash in groin area which is similar to tinea cruris.
Treatment of tinea cruris and erythrasma?
Steroids + bacterial/fungal treatment
What is this?
Erythrasma
what is this?
Tinea cruris
Name three pain syndromes and explain them
- Vestibulodynia - Provoked introital tenderness
- Vulvodynia - Persistent burning or aching
- Chronic Pelvic Pain Syndrome
- Sometimes labelled as prostatitis, but usually no ‘itis’.
- Cause unclear buy muscular dysfunction implicated
What are some examples of pain syndromes?
-Vestibulodynia
Provoked introital tenderness
-Vulvodynia
Persistent burning or aching
-Chronic Pelvic Pain Syndrome
Sometimes labelled as prostatitis, but usually no ‘itis’.
Cause unclear buy muscular dysfunction implicated
Describe the pathogenesis of bacterial vaginosis
Overgrowth of predominantly anaerobic organisms (such as Gardnerella vaginalis, Enterococcus faecalis and Actinomyces neuii) and a loss of lactobacilli.
The vagina loses its normal acidity, and vaginal pH increases to greater than 4.5.
- Reduction of lactobacili and H2O2 production
- Overgrowth of BV associated bacteria
- Raised pH
(cycle)
What are possible complications of bacterial vaginosis?
Usually asymptomative or very mild symtoms
Occasionally:
- Assc. with endometritis if uterine instrumentation / delivery
- Assc. with premature labour
- Increases risk of HIV acquisition
