Genital Symptoms Flashcards
What are some genital symptoms?
Discharge from an orifice, pain, rashes, lumps/ swellings, cuts/ sores/ ulcers, itching, change in appearance and sense of things not being right
What are the 3 types of problems causing genital symptoms?
Sexually transmitted diseases
Other microbial problem
Non-microbial
What are some microbial condition which are no regarded as STDs in the UK?
Vulvovaginal candidiasis, bacterial vaginosis, balanoposthitis, tinea cruris…
Describe vulvovaginal candidosis
Very common and usually trivial but can cause misery in minority
70% just candidia albicans and 30% other species like C. glabrata
If symptomatic - thrush so itch and discharge (classically thick ‘cottage cheese’)
How is vulvovaginal candidosis acquired?
Usually from bowel
Often asymptomatic carriage - changes in hosts environment trigger pathogenicity
When is vulvovaginal candidosis more likely to happen to a person?
Diabetes, oral steroids, immune suppression (HIV), pregnancy and reproductive age group as oestrogen (glycogen) is food for yeast
How is vulvovaginal candidosis diagnosed?
Characteristic history and examination findings - fissuring, erythema with satellite lesions and discharge
Canestest - vaginal pH
What investigations are used for vulvovaginal candidosis?
Gram stained preparation - low sensitivity
Culture - higher sensitivity but labour intensive, low specificity
PCR - highest sensitivity and lowest specificity
What is the treatment for vulvovaginal candidosis?
Azole antifungals - Clotrimazole or Fluconazole
Maintain skin - avoid irritants and treat dermatitis
What is the commonest cause of abnormal vaginal discharge?
Bacterial vaginosis
What are the symptoms of bacterial vaginosis?
Asymptomatic in 50%
Watery grey/ yellow fishy discharge
May be worse after period/ sex
Sometimes sore/ itch from dampness
What makes bacterial vaginosis hard to treat in some women?
Biofilm problem - increased gardnerlla vaginalis enterococcus faecalis and actinomyces neuii
Reduced lactobacilli
What are the 3 aspects of bacterial vaginosis?
Reduction of lactobacilli and H2O2 production
Overgrowth of BV associated bacteria
Raised pH
What are the problems with bacterial vaginosis?
Usually asymptomatic or very mild symptoms
Associated with endometritis if uterine instrumentation/ delivery, premature labour and HIV acquisition
How is bacterial vaginosis diagnosed?
Characteristic history and exam findings - thin and homogenous discharge
Vaginal swab
pH
Gram stained smear of vaginal discharge
What are some current diagnostic methods for bacterial vaginosis?
Microscopy
Molecular
Metabolome/ proteome
What is the treatment for bacterial vaginosis?
Antibiotics - Metronidazole (oral or vaginal gel) and clindamycin (vaginal)
Probiotics
Vaginal acidification - return it to 4.5
Describe candidal balanitis
Inflammation of the head of penis - blotchy dry spots
Describe Zoon’s balanitis
Plasma cell balanitis
Chronic inflammation secondary to overgrowth of commensal organisms plus foreskin malfunction
What is impetigo caused by?
Staph aureus or strep pyogenes
What is erysipelas caused by?
Strep pyogenes
What is a type of dermatophyte infection?
Trichophyton rubrum
What is tinea cruris?
Athletes groin - maintain dry area around groin
What is erythrasma?
Corynebacterium minutissimum
Darkening of the skin
Respond to mild steroids and anti-fungal cream
What are subcategories of non-microbial problems?
Perceived problem only with normal findings
‘Real’ problems
What are examples of symptoms in perception of abnormality but no abnormal findings?
Vaginal discharge, urethral discharge, dysuria, genital/ pelvic discomfort, rashes, skin lumps and penis size
What are fox-foryce spots?
Sebaceous glands of the skin, that some men can have more prominently
What is vulval papillomatosis?
Soft front like projections from the introitus which can be mistaken for warts
What are penile pearly papules (coronal papillae)?
Small bumps around the corona which are normal features that can be more prominent in others
What are Tyson’s glands?
Small vestibular glands either side of frenulum, usually symmetrical and smooth
What are some pain syndromes?
Vestibulodynia - provoked introital tenderness
Vulvodynia - persistent burning or aching
Chronic pelvic pain syndrome
What is a lymphocele?
Blocked lymph duct causing lesion
Can happen due to increased fraction or secondary to infection
What are ecchymosis?
Blood blisters
What is lichen sclerosis?
Autoimmune disease where there is scarring and thinning of the skin and can close off the urethral meatus
Non-microbial
Treat with steroids
