Genital lumps, ulcers and skin problems

Question 1

Describe pearly penile papules

Answer 1

Benign small pearly bumps on the glans penis

Question 2

Describe Fordyce spots

Answer 2

Benign yellowish spots on the glans or shaft of the penis or the vulva.

Question 3

Describe parafrenular glands

Answer 3

Smooth small bumps either side of the frenulum of the glans penis

Question 4

Describe vestibular papillae

Answer 4

Small frond-like glands present on the vulva

Question 5

What is the cause of genital warts?

Answer 5

HPV types 6 and 11

Question 6

How are anogenital warts managed?

Answer 6

Most resolve spontaneously within 12/12
Otherwise:
Topical imuquimod or podophylootoxin
If persistent:
Cryotherapy
Electrocautery
Excision

Question 7

What is the cause of molluscum contageousum?

Answer 7

Pox virus

Question 8

Describe the classical appearance of molluscum contageosum?

Answer 8

Smooth, stuck on appearance domed papules

Central umbilication

Question 9

How are molluscum contageosum treated?

Answer 9

Most resolve spontaneously within 12/12
Otherwise:
Topical imuquimod or podophylootoxin
If persistent:
Cryotherapy
Electrocautery
Excision

Question 10

What is a lymphocele?

Answer 10

A hard swelling which appears suddently on the shaft of the penis, caused by temporary blockage of the lymphatic channels on the penis

Question 11

What are the common triggers for lymphocele?

Answer 11

Vigorous masturbation or sex

Question 12

How is lymphocele managed?

Answer 12

Nil required, resolves spontaneously

Question 13

What is the cause of anogenital herpes?

Answer 13

HSV2 (most commonly)

Question 14

How might genital herpes present?

Answer 14

Visible ulcerated land painful lesions
Dysuria (irritation from urine on ulcer)
Vaginal or urethral discharge
Fever

Question 15

How is genital herpes diagnosed?

Answer 15

Viral PCR from swab of lesion

Question 16

How is genital herpes managed?

Answer 16

Aciclovir

Question 17

Following aciclovir, can the patient have another activation of herpes?

Answer 17

Yes

Question 18

What is the cause and bacteria responsible for chancres?

Answer 18

Syphilis; treponema pallidum

Question 19

What population is syphilis typically dominant in?

Answer 19

MSM age 25-35

Question 20

Describe how the skin manifestations of syphilis change as the infection progresses

Answer 20

Primary syphilis: single painless chancre which is non-purulent
Secondary syphilis: widespread maculopapular rash

Question 21

How is syphilis diagnosed?

Answer 21

Serology from serum sample

Microscopy of swabs

Question 22

Describe the cardinal feature of primary syphilis?

Answer 22

Single painless chancre

Question 23

Describe the features of secondary syphilis and when they might develop?

Answer 23

Multisystemic presentation, occuring 4-10 weeks after an untreated initial chancre
Widespread maculopapular rash
Hepatitis
Splenomegaly
Renal problems
Menignitis
Neurological involvement

Question 24

What is latent syphilis?

Answer 24

Untreated syphilis lying dormant.
Early syphilis: under 2 years of infection
Late syphilis: more than 2 years of infection

Question 25

What are the features of tertiary syphilis?

Answer 25

Neurosyphilis
Cardiovascular complications
Gumma

Question 26

How is syphilis treated?

Answer 26

Benzathine penicillin 2.5MU IM injection single dose

If the patient if penicillin allergic:
Doxycycline 100mg PO for 14/7

Question 27

What is balanoposthitis?

Answer 27

Inflammation of the glans penis and foreskin

Question 28

What is the most common cause of balanoposthitis?

Answer 28

Candida

Question 29

How might balanoposthitis present?

Answer 29

Local rash
Soreness
Itching 
Odour
Inability to retract the foreskin
Discharge from glans

Question 30

How is balanopasthitis diagnosed?

Answer 30

Swab for candida or bacterial culture

Question 31

How is balanoposthitis managed?

Answer 31

Treating the identified cause
- If candida, PO fluconazole
Advised to avoid soaps and irritants, wear looser underwear and use emollients