Genital symptoms - what could be causing them? Flashcards
Genital symptoms include?
Discharge from an orifice Pain from somewhere Rashes Lumps and swellings Cuts, sores, ulcers Itching Change in appearance Vague sense of things not being right
What could be causing the symptoms? - STD
Public and individual health problem.
Treatable.
Not always curable.
What could be causing the symptoms? - Other microbial probleMS
Individual health problem.
Treatable, if needed.
Usually curable.
What could be causing the symptoms? - NON-MICROBIAL
Individual health issue
What are some Microbial conditions not regarded as STDs (8)
Vulvovaginal candidosis Bacterial vaginosis Balanoposthitis – anaerobic/candidal Tinea cruris Erythrasma Infected sebaceous glands Impetigo Cellulitis
very common condition
Vulvovaginal candidosis
what is Vulvovaginal candidosis caused by?
Candida albicans
Can be C. glabrata et al
How is Vulvovaginal candidosis acquired?
asymptomatic carriage?
if symptomatic - what will they complain of?
bowel
- Changes in host’s environment trigger pathogenicity
If symptomatic: “thrush”
Itch
Discharge – classically thick, ‘cottage cheese’ but often just a report of increased amount.
Vulvovaginal candidosis is more likely to be caused by? (5)
diabetes, oral steroids immune suppression incl HIV pregnancy Reproductive age group ( oestrogen...glycogen = food for yeast) But many cases occur in people with no pre-disposing factors.
how to diagnose Vulvovaginal candidosis
Characteristic history - itching/discharge
Examination findings
Fissuring
Erythema with satellite lesions
Characteristic discharge
investigations
- Gram stained preparation
Low sensitivity – might look at an unrepresentative patch - Culture – eg Sabouraud’s medium
Low specificity – yeast are commensal organisms - PCR - highest sensitivity
candida albicans on a gram stain
egg like blastospores
long hyphey - true hyphe
Treatment of Vulvovaginal candidosis (4)
Other management of candida?
doesn’t need to be treated if its mild
- Azole antifungals:
Clotrimazole 500mg PV once
Plus Clotrimazole HC if vulvitis
Fluconazole 150mg PO once
Maintain skin – avoid irritants, treat dermatitis.
3 possible causes for genital symptoms include
Candida
Bacterial vaginosis
Balanoposthitis
commonest cause of abnormal vaginal discharge?
Bacterial vaginosis
Bacterial vaginosis symptoms (4)
Asymptomatic in 50%
watery grey/yellow ‘fishy’ discharge
may be worse after period / sex
sometimes sore/itch from dampness
BV - biofilm problems (4)
- increased Gardnerella vaginalis, Enterococcus faecalisandActinomyces neuii
- reduced lactobacilli
- Possible sexual transmissibility is a hot topic
- Associated with vitamin D deficiency but significance unclear
BV is a result of
- reduction of lactobacilli - reduction in h202
- raised pH
- overgrowth of BV associate bacteria
BV can be associated with what complications? (3)
- Associated with endometritis if uterine instrumentation / delivery - bacteria up into the uterus
- Associated with premature labour
- Increases risk of HIV acquisition
Examination findings of BV?
Thin, homogenous discharge
pH testing
gram stained smear of vaginal discharge
BV on a gram stain looks like?
very large epothelial cells covered in gram variable organisms - governoralvaginosis
Treatment of BV? oral vs vaginal
AntiB’S
- Metronidazole
- Oral ( avoid ethanol)
- Vaginal gel
- Clindamycin - vaginal
- probiotics
- vaginal acidification - pH - 4.5
male genital symptom conditions - what is balanitis
organism?
rash on the end of the penis - blotchy
- men with a foreskin
Candidal balanitis
zoom’s balanitis features
- initial treatment
inside of foreskin involved - circumcision needed
Chronic inflammation secondary to overgrowth of commensal organisms plus ‘foreskin malfunction’.
mixed antimicrobial steroid cream
