genital symptoms Flashcards
examples of genital symptoms
discharge pain rashes lumps and swellings cuts, sores, ulcers itching change in appearance something not right
causes of genital symptoms
STI - public and individual health problem, treatable, not always curable
other microbial - individual health problem, treatable if needed, usually curable
non-microbial - individual health issue, huge variety
how to determine what is an STI
spectrum of organisms from only transmitted by sexual contact to only transmitted by non-sexual means
large spectrum and many are both
subjective assessment when determining main transmission mode
in terms of microbial infection what can cause the symptoms
infecting organism itself
host response to organism
again a spectrum, likely a bit of both
examples of microbial conditions not regarded as STDs in UK
vulvovaginal candidosis bacterial vaginosis balanoposthitis - anaerobic/candidal tinea cruris erythrasma infected sebaceous glands impetigo folliculitis cellulitis many more
vulvovaginal candidosis - causative organism
~70% just candida albicans
30% other - e.g. C. glabrata or mixed populations
usually acquired from bowel
symptoms of vulvovaginal candidosis
often asymptomatic carriage - change in host environment triggers pathogenicity
symptomatic = thrush - itch, discharge
describe the discharge in vulvovaginal candidosis
classically thick
cottage cheese
often just a report of increased amount
how common is vulvovaginal candidosis
very common
usually trivial
can cause a misery in minority
who is more likely to get vulvovaginal candidosis
diabetes oral steroids immune suppression incl HIV pregnancy reproductive age group
many cases occur in people w/o predisposing factors
making a diagnosis of vulvovaginal candidosis
characteristic hx
vaginal pH? - normal pH can be found with thrush
examination findings
investigations
examination findings in vulvovaginal candidosis
linear fissuring
erythema with satellite lesions
characteristic discharge
investigations for vulvovaginal candidosis
gram stained preparation
culture
PCR
gram stain for vulvovaginal candidosis
low sensitivity
might look at an unrepresentative patch
culture for vulvovaginal candidosis
e.g. Sabouraud’s medium
higher sensitivity but labour intensive
low specificity to determine cause of symptoms - yeast are commensal organisms so may not be the cause but still present
PCR for vulvovaginal candidosis
highest sensitivity
lowest specificity - even more likely to find ‘innocent bystanders’
treatment for vulvovaginal candidosis
often self corrects if mild
azole antifungals - clotrimazole 500mg PV once (plus clotrimazole HC if vulvitis), fluconazole 150mg PO once
resistant case - determine species and sensitivities and treat accordingly
other management - maintain skin, avoid irritants, treat dermatitis
how many episodes of thrush p/a is classed as recurrent
4 p/a
what is the commonest cause of abnormal vaginal discharge
bacterial vaginosis
10-40% of women at any time
symptoms of bacterial vaginosis
asymptomatic in 50%
watery grey/yellow ‘fishy’ discharge
may be worse after period/sex
sometimes sore/itch from dampness
what type of problem is bacterial vaginosis
biofilm problem - like dental caries; makes management difficult in some women
imbalance of bacteria
only becomes an issue when symptomatic
increased Gardnerella vaginalis, Enterococcus faecalis and Actinomyces neuii
reduced lactobacilli
cycle in bacterial vaginosis
reduction of lactobacilli, reduction in H2O2 production
raised pH
overgrowth of BV associated bacteria
complications from bacterial vaginosis
usually asymptomatic/very mild symptoms
minority of women:
associated with endometritis if uterine instrumentation/delivery
associated with premature labour
increases risk of HIV acquisition
diagnosis of bacterial vaginosis
characteristic hx
examination findings - thin, homogenous discharge
pH - can be more alkaline than normal
gram stained smear of vaginal discharge
bacterial vaginosis treatment
abx:
- metronidazole (oral - avoid ethanol; vaginal gel)
- clindamycin (vaginal)
probiotics - replacement of lactobacilli (vaginal/oral)
vaginal acidification - maintain pH at 4.5 w/ acidifying gel
causative organisms of balanitis and posthitis etc
candidal balanitis
Zoon’s balanitis (aka plasma cell balanitis)
- rash on the end of the penis
- mostly seen in uncircumcised men
causes of Zoon’s balanitis
chronic inflammation 2y to overgrowth of commensal organisms plus ‘foreskin malfunction’
causative organisms of impetigo
staph aureus
strep pyogenes
causative organism of erysipelas
strep pyogenes
causative organism of dermatophyte infection
e.g. tricophyton rubrum
psoriasis as differential dx
causes of tinea cruris
dermatophytes - ‘athlete’s groin’
hygiene - important to maintain dry area to prevent growth of harmful organisms
causative organism of erythrasma
corynebacterium minutissimum
subcategories of non-microbial genital conditions
percieved problem only - normal findings, no clinical findings, only findings are psychological
‘real problems’ - dermatoses, structural abnormalities (congenital, acquired)
examples of perception of abnormality but no clinical findings
vaginal discharge urethral discharge dysuria genital/pelvic discomfort rashes skin lumps penis size, scrotal lumps, labial shape
many problems are temporary, some are more persistent can lead to body dysmorphia
lines of questioning if nil found on examination or tests results
regretted sexual encounter problems in life co-existing mental ill health - anxiety when did they notice the problem when were things last normal - family illness, friend will illness, media story
management approach for perception of abnormality but no clinical findings
acknowledge the perception
what do they think is the cause - allows some conditions to be specifically covered and ruled out e.g. cancer, infertility, STD
variants of reassurance - provide alternative, benign explanation
discuss limitations of medical approach
examples of physiological clinical signs which can be mistaken for STDs
Fox-Fordyce spots
vulval paillomatosis
Coronal papillae
Tyson’s glands
what are Fox-Fordyce spots
sebaceous glands of the skin
more prominent in some men than others
completely normal
what are vulval paillomatosis
soft projections
sometimes mistakenly treated as warts
what are coronal papillae
penile pearly papules
normal features, more prominent in some than others
can be mistaken for warts
what are Tyson’s glands
smooth, small vestigial glands
either side of the frenulum
usually symmetrical
can be mistaken for warts
other causes of genital symptoms i.e. non-microbial but there is something going on
pain syndromes ('dynias')
dermatoses
congenital
traumatic/iatrogenic
neoplastic
neuromuscular
manifestations of systemic disease
idiopathic
etc.examples of pain syndromes
vestibulodynia
vulvodynia
chronic pelvic pain syndrome
what is vestibulodynia
provoked introital tenderness
e.g. during penetrative sex, tampon insertion
what is vulvodynia
persistent burning or aching
what is chronic pelvic pain syndrome
sometimes labelled as prostatitis (but usually no ‘itis)
cause unclear
muscular dysfunction implicated in many cases
what is a lymphocele
blocked lymph duct
becomes engorged with lymph
can occur as a result of increased friction, 2y to infection
can settle spontaneously - avoid friction
what are congenital cysts
form during development in the uterus
can be external or internal
often don’t cause an issue
what is an ecchymosis
blood blister
can occur with torn frenulum - small artery that can bleed a lot
examples of dermatoses
lichen sclerosus
lichen planus
what is lichen sclerosus
AI disease, scarring and thinning of skin
can close off urethral meatus
also affects women, scarring around the vagina can be mistaken for FGM
what is lichen planus
cause isn’t entirely clear - thought to be AI
indications of carcinoma
ulcer with firm base
