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
Describe the diagnosis of bacterial vaginosis?
- Characteristic history
- Examination findings
- Thin, homogeneous discharge
- Investigations
- pH
- Gram stained smear of vaginal discharge
What are possible complications of bacterial vaginosis?
- Associated with endometritis if uterine instrumentation/delivery
- Associated with premature labour
- Increases risk of HIV acquisition
What is the treatment of bacterial vaginosis?
- Antibiotics
- Metronidazole
- Clindamycin
- Probiotics
- Vaginal acidification
What is balanitis?
Balanitis = inflammation of the head of the penis
What is postitis?
Postitis = inflammation of the foreskin
What is the aetiology of balanitis and posthitis?
- Usually candida lanitis
What is impetigo?
Is a common and highly contagious skin infection
What is the aetiology of impetigo?
- Usually staph aureus or strep pyogenes
What is erysipelas?
Superficial form of cellulitis
What is the aetiology of erysipelas?
- Usually strep pyogenes
What are examples of yeast (dermatophyte) infections?
- Trichophyton rubrum
- Known as athletes penis
- Treated with antifungal
- Tinea cruris
- Known as athletes groin
- Erythrasma
What is trichophyton rubrum known as?
Athletes penis
What is tinea cruris known as?
Athletes groin
What can non-microbial conditions that cause ‘genital symptoms’ be categorised into?
- Perceived problems only (normal findings)
- No clinical findings
- Only findings are physiological
- ‘Real problems’
- Structural abnormalities
- Dermatoses
What are possible perceived problems?
- Vaginal discharge
- Urethral discharge
- Dysuria
- Genital/pelvic discomfort
- Rashes
- Skin lumps
- Penis size, scrotum lumps, labial shape
What are some examples of things that are normal but can be perceived as an STI?
- Fox-Fordyce spots
- Vulval papillomatosis
- Coronal papillae
- Also known as penile pearly papules
- Tyson’s glands
Describe the management approach to ‘perceived problems’?
Questions to understand why this is occurring:
- Regretted sexual encounter
- Problems in life
- Mental health problems such as anxiety
Management approach:
- Acknowledge their perception
- Ask what they think is going on to rule out worries
- Reassurance
- Provide explanation of symptoms
- Discuss limitations of medical approach
What are some non-microbial causes of genital symptoms?
- Pain syndromes
- Dermatoses
- Congenital
- Traumatic/iatrogenic
- Neoplastic
- Neuromuscular
- Manifestations of systemic disease
- Idiopathic
What are some different pain syndromes that can cause genital symptoms?
- Vestibulodynia
- Provoked introital tenderness
- Vulvodynia
- Persistent burning or aching
- Chronic pelvic pain syndrome
- Cause unclear but muscular dysfunction implicated
What are some causes of non-microbial genital symptoms?
Pain syndromes
Lymphocoele
Congenital cyst
Torn frenulum and ecchymosis
Lichen sclerosus
Lichen planux
Penile carcinoma
What is lymphocoele?
Blocked lymph duct
What is a congenital cyst?
Cyst forms in-utero
Can be left or removed
What is the most common aetiology of torn frenulum and ecchymosis?
Torn during sex
What is lichen sclerosus?
Autoimmune disease causing scarring and thinning of the skin
What kind of condition is lichen planus?
Autoimmune condition
What is penile carcinoma?
Cancer of the penis
