Genital symptoms [non STI] Flashcards
What are the common presenting complaints in terms of genital symptoms?
- Discharge from an oriface - either there is increased discharge, or from where there shouldnt be discharge. .
- Pain from somewhere
- Rashes - spots, redness
- Lumps and swellings - on or in sub cut tissues.
- Cuts, sores, ulcers - “ulcers”
- Itching
- Change in appearance
- “sense of something not being right”
What are the potential causes of genital symptoms?
What are the aspects of each of the potential causative groups?
Micro-organisms involved
- STD
- Public and individual health problem
- Treatable
- Not always curable
- Other microbial problem
- Individual health problem
- Treatable
- Usually curable
Non-microbial
- Individual health issue
What microbial conditions of the genitals are not regarded as STDs?
- These are all casued by microbes.
- Vulvovaginal candidosis
- Bacterial vaginosis
- Balanoposthitis - anaerobic/candidal
- Tinea cruris
- Erythrasma
- Infected sebaceous glands
- Impetigo
- Cellulitis
(skin issues are very common problems - skin and microbial issues can affect the genitals just as easily as anywhere else in the body).
Outline Vulvovaginal candidosis.
Very common. Usually trivial but can become a problem.
- 90% caused by Candida albicans, some can be caused by C. glabrata.
- Usually the pathogens will be acquired from the bowel.
- Often carriage is assymptomatic
- But changes in the host’s envirnoment trigger pathogenicity.
- If symptoms present - described as “Thrush”
- __Itch
- Discharge - classically thick, ‘cottage cheese’ but often just a report of increased amount.
When is Vulvovaginal Candidosis more likley to happen?
- diabetes, oral steroids
- immune suppression incl HIV
- pregnancy
- Reproductive age group
- ( oestrogen…glycogen = food for yeast)
- But many cases occur in women with no pre-disposing factors.
What are some of the examination findings that may be seen in vulvovaginal candidosis?
- Fissuring
- Erythema with satellite lesions (red spots away from the central red area)
- Characteristic discharge - cottage cheese
What investigations can be done is suspected Vulvovaginal Candidosis?
- Gram stained preparation
- Low sensitivity - might look at an unrepresentative patch of vaginal and be falsely negative.
- Culture - eg Sabourauud’s medium
- Low specificity - yeast are often commensal
What is the treatment of choice in Vulvovaginal Candidosis?
Azole antifungals
- Clotrimazole 500mg PV once
- Plus Clotrimazole HC if vulvitis
- Fluconazole 150mg PO once
If a resistant case - Determine species and sensitivites and treat accordingly.
Other managment
- maintain skin - avoid irritants, treat dermatitis.
What is Bacterial Vaginosis?
Symptoms?
Cause?
Commonest cause of abnormal vaginal discharge
- 10-40% of women at any time.
Symptoms:
- Asymptomatic in 50%
- watery grey/yellow ‘fishy’ discharge
- may be worse after period / sex
- sometimes sore/itch from dampness
- Imbalance of bacteria rather than infection.
- A biofilm problem – like dental caries
- increased gardnerella / ureaplasma / mycoplasma /anaerobes
- reduced lactobacilli
- Sexually transmissibility controversial
- Associated with vitamin D deficiency but just in black women
What are the problems that bacterial vaginosis can cause?
- Usually the problems are quite trivial.
- Some more important:
- Associated with endometritis if uterine instrumentation/delivery
- Associated with premature labour
- Increases risk of HIV acquisition
How is bacterial vaginosis usually diagnosed?
- Usually can be diagnosed through the characteristic history upon presentation. - If the symptoms described are typical then usually there are no investigations required.
- Examination findings
- Thin, homogenous discharge
- If investigations are required - gram stained smear of vaginal discharge will do.
What are the treatments for Bacterial Vaginosis?
Often this settles on its own.
Pharmacological Treatments include.
- Metronidazole
- Oral (avoid alcohol consumption)
- Vaginal gel
- Clindamycin
- Vaginal
What is Balanitis and Postitis?
Balanitis - inflammation of the glans penis.
Postitis - inflammation of the foreskin.
What is Zoon’s Balanitis?
AKA Plasma Cell Balanitis
- Chronic inflammation to overgrowth of commensal organisms plus “foreskin malfunction”.
What are the causative organisms behind impetigo?
What causes erisipelas?
Why is this disease relevant in terms of the genitals?
Staph aureus
Staph pyogenes
Strep pyogenes
Any skin condition can also affect the genitals, not always an STD.
What causes “athletes groin”?
Dermatophytes causing tinea cruris.
What are some of the potential causes of non microbial symptoms in the genitals?
- Percieved problem only.
- Normal findings, sensations
- “Real” problems:
- Dermatoses
- Structural abnormalities
- Congenital
- Acquired
What are some of the symtoms that can be explained under “perception of abnormality, but nil to find”?
- Vaginal discharge
- Urethral Discharge
- Dysuria
- Genital/Pelvic Discomfort
- Rashes
- Skin Lumps
- Penis size, scrotal lumps, labial shape
- Temporary
- Permanent - body dysmorphia
What are some lines of questioning that should be followed up on if symptoms are thought to be due to patients perception (nil to find)?
- Regretted sexual encounter
- Problems in life
- Co-existing mental ill health - anxiety
- When did they notice the problem?
- When were things last normal?
- Family illness
- Friend with an illness
- Media story
What is the management approach to “nil to find” symptoms?
- Acknowledge the perception - Don’t tell the person there is no symptom.
- What do they think may be causing the symptom?
- Cancer, infertility, HIV - try to outline these and reassure.
- Variants of reassurance
- Provide an alternative, benign explanation of symptoms.
- Do tell tehm not to worry - doesnt help.
- Discuss limitations of medical approach.
- “here to exclude the bad stuff” - can’t find route of every symptom.
What are some common benign presentations around the genitals that may bring people to the Dr?
- Fox-Fordyce spots - normal sebaceous glands visible in the skin.
- Vulval papillomatosis - cutaneous condition of the vulva, characterized by pink, asymptomatic, fine projections of the vestibular epithelium or labia minora.
- Penile peraly papules - small dome-shaped to filiform skin-colored papules that typically are located on the sulcus or corona of the glans penis.
- Tyson’s Glands - sebaceous glands
What are some non infective but not “perception” issues of the gentials?
- Pain syndromes – the ‘dynias’
- Dermatoses - lichen sclerosis
- Congenital - e.g. congenital cyst of the labia
- Traumatic - such as rupture etc., torn frenulum etc.
- Neoplastic
- Manifestations of systemic disease
