Genital Symptoms

Question 1

What are some genital symptoms?

Answer 1

Discharge from an orifice, pain, rashes, lumps/ swellings, cuts/ sores/ ulcers, itching, change in appearance and sense of things not being right

Question 2

What are the 3 types of problems causing genital symptoms?

Answer 2

Sexually transmitted diseases
Other microbial problem
Non-microbial

Question 3

What are some microbial condition which are no regarded as STDs in the UK?

Answer 3

Vulvovaginal candidiasis, bacterial vaginosis, balanoposthitis, tinea cruris…

Question 4

Describe vulvovaginal candidosis

Answer 4

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’)

Question 5

How is vulvovaginal candidosis acquired?

Answer 5

Usually from bowel
Often asymptomatic carriage - changes in hosts environment trigger pathogenicity

Question 6

When is vulvovaginal candidosis more likely to happen to a person?

Answer 6

Diabetes, oral steroids, immune suppression (HIV), pregnancy and reproductive age group as oestrogen (glycogen) is food for yeast

Question 7

How is vulvovaginal candidosis diagnosed?

Answer 7

Characteristic history and examination findings - fissuring, erythema with satellite lesions and discharge
Canestest - vaginal pH

Question 8

What investigations are used for vulvovaginal candidosis?

Answer 8

Gram stained preparation - low sensitivity
Culture - higher sensitivity but labour intensive, low specificity
PCR - highest sensitivity and lowest specificity

Question 9

What is the treatment for vulvovaginal candidosis?

Answer 9

Azole antifungals - Clotrimazole or Fluconazole
Maintain skin - avoid irritants and treat dermatitis

Question 10

What is the commonest cause of abnormal vaginal discharge?

Answer 10

Bacterial vaginosis

Question 11

What are the symptoms of bacterial vaginosis?

Answer 11

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

Question 12

What makes bacterial vaginosis hard to treat in some women?

Answer 12

Biofilm problem - increased gardnerlla vaginalis enterococcus faecalis and actinomyces neuii
Reduced lactobacilli

Question 13

What are the 3 aspects of bacterial vaginosis?

Answer 13

Reduction of lactobacilli and H2O2 production
Overgrowth of BV associated bacteria
Raised pH

Question 14

What are the problems with bacterial vaginosis?

Answer 14

Usually asymptomatic or very mild symptoms
Associated with endometritis if uterine instrumentation/ delivery, premature labour and HIV acquisition

Question 15

How is bacterial vaginosis diagnosed?

Answer 15

Characteristic history and exam findings - thin and homogenous discharge
Vaginal swab
pH
Gram stained smear of vaginal discharge

Question 16

What are some current diagnostic methods for bacterial vaginosis?

Answer 16

Microscopy
Molecular
Metabolome/ proteome

Question 17

What is the treatment for bacterial vaginosis?

Answer 17

Antibiotics - Metronidazole (oral or vaginal gel) and clindamycin (vaginal)
Probiotics
Vaginal acidification - return it to 4.5

Question 18

Describe candidal balanitis

Answer 18

Inflammation of the head of penis - blotchy dry spots

Question 19

Describe Zoon’s balanitis

Answer 19

Plasma cell balanitis
Chronic inflammation secondary to overgrowth of commensal organisms plus foreskin malfunction

Question 20

What is impetigo caused by?

Answer 20

Staph aureus or strep pyogenes

Question 21

What is erysipelas caused by?

Answer 21

Strep pyogenes

Question 22

What is a type of dermatophyte infection?

Answer 22

Trichophyton rubrum

Question 23

What is tinea cruris?

Answer 23

Athletes groin - maintain dry area around groin

Question 24

What is erythrasma?

Answer 24

Corynebacterium minutissimum
Darkening of the skin
Respond to mild steroids and anti-fungal cream

Question 25

What are subcategories of non-microbial problems?

Answer 25

Perceived problem only with normal findings
‘Real’ problems

Question 26

What are examples of symptoms in perception of abnormality but no abnormal findings?

Answer 26

Vaginal discharge, urethral discharge, dysuria, genital/ pelvic discomfort, rashes, skin lumps and penis size

Question 27

What are fox-foryce spots?

Answer 27

Sebaceous glands of the skin, that some men can have more prominently

Question 28

What is vulval papillomatosis?

Answer 28

Soft front like projections from the introitus which can be mistaken for warts

Question 29

What are penile pearly papules (coronal papillae)?

Answer 29

Small bumps around the corona which are normal features that can be more prominent in others

Question 30

What are Tyson’s glands?

Answer 30

Small vestibular glands either side of frenulum, usually symmetrical and smooth

Question 31

What are some pain syndromes?

Answer 31

Vestibulodynia - provoked introital tenderness
Vulvodynia - persistent burning or aching
Chronic pelvic pain syndrome

Question 32

What is a lymphocele?

Answer 32

Blocked lymph duct causing lesion
Can happen due to increased fraction or secondary to infection

Question 33

What are ecchymosis?

Answer 33

Blood blisters

Question 34

What is lichen sclerosis?

Answer 34

Autoimmune disease where there is scarring and thinning of the skin and can close off the urethral meatus
Non-microbial
Treat with steroids