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
impetigo - organisms
- features
Staph aureus or Strep pyogenes
- large area of redness, swollen
Erysipelas/cellulitis is caused by
Strep Pyogenes - more severe infeciton
- need antibiotics
- permanent lymph vessel damage
Dermatophyte infection known as?
differential diagnosis?
athletes penis - yeast - scaly patch of skin
- psoriasis
Tinea cruris- known as?
athletes groin
- support around hygeine
- scaly
Erythrasma is?
smoother
- bacterial condition
- darkening of the skin
- antifungal treatment
What can people present with that may result in no diagnosis (8)
- Vaginal discharge
- Urethral discharge
- Dysuria
appearance of skin - Genital/pelvic discomfort
- Rashes
- Skin lumps
- Penis size, scrotal lumps, labial shape : Temporary
More persistent – body dysmorphia
Lines of questioning if nil found on examination or test results
- Regretted sexual encounter
- Problems in life
- Co-existing mental illhealth – anxiety
- When did they notice the problem?
- When were things last normal?
- Family illness
- Friend with an illness
- Media story
symptoms of non - microbial origin - 3 main categories
- Perceived problem only - normal findings
- Dermatoses
- Structural abnormalities : Congenital/ Acquired
Main management approach
- things that may be a deeper cause of symptoms include?
We shouldn’t tell a person that they’re not experiencing a symptom.
- Cancer, infertility, STD.
- reassurance
What can be mistaken for STD’s but they are normal anatomy
- Fox-Fordyce spots - penis
- Vulval papillomatosis - can be mistaken for warts
- Penile pearly papules aka Coronal papillae
- Tyson’s gland - either side of the frenulum
Other causes of genital symptoms
Pain syndromes – the ‘dynias’ Dermatoses Congenital Traumatic Neoplastic Manifestations of systemic disease
Pain syndromes - Vestibulodynia
- Provoked introital tenderness
-
What is Vulvodynia - pain syndromes
Persistent burning or aching
Pain syndromes - Chronic Pelvic Pain Syndrome (2)
Sometimes labelled as prostatitis, but usually no ‘itis’.
Cause unclear buy muscular dysfunction implicated
What is lymphocoele
blocked lymph duct
- can be spontaneous - dry masturbation
secondary to infection
genital cysts
can be internally or externally
Torn frenulum can lead to?
ecchymosis - blood blisters
- secondary infection
Lichen Sclerosus is
autoimmune disease - scarring and thinning of skin
- scarring around the vagina
Lichen planus
another dermatosis - treated with steriods
penile carinoma
can often present with an ulcer with firm base
- poor outcomes
