Genital Symptoms

Question 1

What do genital symptoms include?

Answer 1

• Discharge
• Pain
• Rashes
• Lumps/Swellings
• Cuts, sores, ulcers
• Itching
• Change in appearance
• Sense of things not being right

Question 2

What could be causing genital symptoms (3 categories)?

Answer 2

• STI
• Other microbial problem
• Non-microbial

Question 3

What is vulvovaginal candidosis?

Answer 3

Yeast infection

Question 4

What is the most common causative organism for vulvovaginal candidosis?

Answer 4

Candida albicans (70%)

Question 5

Where is vulvovaginal candidosis usually acquired from?

Answer 5

The bowel

Question 6

What is vulvovaginal candidosis usually called if it is symptomatic, and what are the symptoms?

Answer 6

Thrush

• Itch
• Thick, ‘cottage cheese’ discharge (or can just be increased amount)

Question 7

What makes vulvovaginal candidosis more likely to occur?

Answer 7

• Diabetes, oral steroids
• Immune suppression incl HIV
• Pregnancy
• Reproductive age group (oestrogen…glycogen = food for yeast)

Question 8

How do you diagnose vaginal thrush?

Answer 8

• History
• Vaginal pH (thrush same as normal, bacterial different)
• Examination findings

Question 9

What would be the examination findings of vaginal thrush?

Answer 9

• Fissuring
• Erythema with satellite lesions
• Characteristic discharge

Question 10

How do you treat vaginal thrush?

Answer 10

(If mild it will self correct and woman may not need treatment)

• Azole antifungals (clotrimazole, fluconazole)

Question 11

What is the commonest cause of abnormal vaginal discharge?

Answer 11

Bacterial vaginosis

Question 12

What are the symptoms of bacterial vaginosis?

Answer 12

• Asymptomatic in 50%
• Watery grey/yellow ‘fishy’ discharge
• May be worse after period/sex
• Sometimes sore/itch from dampness

Question 13

What triad of problems causes BV?

Answer 13

• Reduction of lactobacilli (not there to produce H2O2)
• Overgrowth of BV associated bacteria
• Raised pH

Question 14

What are the more significant complications of BV?

Answer 14

• Endometritis if uterine instrumentation/delivery
• Associated with premature labour
• Increases risk of HIV acquisition

Question 15

How is BV diagnosed?

Answer 15

• History
• Thin, homogenous discharge
• pH
• Gram stained smear of vaginal discharge

Question 16

How is BV treated?

Answer 16

• Antibiotics (metrondiazole, clindamycin)
• Probiotics
• Vaginal acidification

Question 17

What are some other microbial causes of genital symptoms?

Answer 17

• Candidal balanitis (inflammation of head of penis)
• Zoon’s balanitis/Plasma cell balanitis (inflammation secondary to overgrowth of organisms and foreskin dysfunction)
• Impetigo (staph aureus/strep pyogenes)
• Erysipelas (infection of upper layers of skin)
• Dermatophyte infection (same organisms as athletes foot)
• Tinea cruris
• Erythrasma

Question 18

Important questions to ask if someone has genital symptoms but there is no abnormal findings?

Answer 18

• Regretted sexual encounter?
• Problems in life
• Co-existing mental illhealth (anxiety)
• When did they notice the problem
• When were things last normal (family illness, friend illness, media story)

Question 19

Give examples of normal physiological changes people might notice

Answer 19

• Fox-fordyce spots
• Vulval papillomatosis
• Penile pearly papules (cornal papillae)
• Tysons glands

Question 20

What could cause genital symptoms (non-microbial)?

Answer 20

• Pain syndromes
• Dermatoses
• Congenital
• Traumatic/Iatrogenic
• Neoplasm
• Muscular
• Manifestations of systemic disease
• Idiopathic