Genital Symptoms Flashcards
What are examples of genital symptoms?
- Discharge from an orifice
- Pain
- Rashes
- Lumps and swellings
- Cuts, sores, ulcers
- Itching
- Change in appearance
What are the different categories of causes for genital symptoms?
- STD
- Other microbial problem not regarded as STD
- Non-microbial
What are some examples of microbial infections not regarded as STIs in the UK?
- Vulvovaginal candidosis
- Bacterial vaginosis
- Balanoposthitis – anaerobic/candida
- Impetigo
- Erisipelas
- Dermatophyte infections
What is the aetiology of vulvovaginal candidosis?
- 70% candida albicans
- 30% other species such as C. Glabrate
What are risk factors for vulvovaginal candidosis?
- Diabetes
- Oral steroids
- Immune suppression
- Pregnancy
- Reproductive age group
Describe the epidemiology of vulvovaginal candidosis (common/rare)?
Very common
What is the presentation of vulvovaginal candidosis?
- Often asymptomatic
- If symptomatic
- Thrush
- Itch
- Discharge – classically thick, ‘cottage cheese’
- Thrush
What is the discharge due to vulvovaginal candidosis usually decribed as?
- Discharge – classically thick, ‘cottage cheese’
How is vulvovaginal candidosis diagnosed (including investigations)?
- Characteristic history
- Vaginal pH
- Examination findings
- Fissuring
- Erythema with satellite lesions
- Characteristic discharge
- Investigations
- Gram stained
- Low sensitivity
- Culture
- Higher sensitivity, low specificity
- PCR
- Highest sensitivity, lowest specificity
- Gram stained
What are some possible examination findings for vulvovaginal candidosis?
- Fissuring
- Erythema with satellite lesions
- Characteristic discharge
Which of gram staining, culture and PCR has greatest sensitivity and specificity?
- Gram stained
- Low sensitivity
- Culture
- Higher sensitivity, low specificity
- PCR
- Highest sensitivity, lowest specificity
What is the treatment for vulvovaginal candidosis?
- Often does not require any
- Azole antifungals
- Clotrimazole 500mg PV once
- Fluconazole 150mg PO once
- If resistant case
- Determine species and sensitivities and treat accordingly
- Other management
- Maintain skin – avoid irritants, treat dermatitis
What does BV stand for?
Bacterial vaginosis
What is the aetiology of bacterial vaginosis?
- Increased gardnerella vaginalis, enterococcus faecalis and actinomyces neuii
- Reduced lactobacalli
Describe the epidemiology of bacterial vaginosis (common/rare)?
- Commonest cause of vaginal discharge
Describe the pathophysiology of bacterial vaginosis?
What is the presentation of bacterial vaginosis?
- Asymptomatic in 50%
- Watery grey/yellow ‘fishy’ discharge
- May be worse after period/sex
- Sometimes sore/itch from dampness