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Year 3: Reproduction > Genital symptoms - what could be causing them? > Flashcards

Genital symptoms - what could be causing them? Flashcards

1
Q

Genital symptoms include?

A 
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
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2
Q

What could be causing the symptoms? - STD

A

Public and individual health problem.
Treatable.
Not always curable.

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3
Q

What could be causing the symptoms? - Other microbial probleMS

A

Individual health problem.
Treatable, if needed.
Usually curable.

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4
Q

What could be causing the symptoms? - NON-MICROBIAL

A

Individual health issue

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5
Q

What are some Microbial conditions not regarded as STDs (8)

A 
Vulvovaginal candidosis
Bacterial vaginosis
Balanoposthitis – anaerobic/candidal
Tinea cruris
Erythrasma 
Infected sebaceous glands
Impetigo
Cellulitis
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6
Q

very common condition

A

Vulvovaginal candidosis

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7
Q

what is Vulvovaginal candidosis caused by?

A

Candida albicans

Can be C. glabrata et al

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8
Q

How is Vulvovaginal candidosis acquired?
asymptomatic carriage?

if symptomatic - what will they complain of?

A

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.

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9
Q

Vulvovaginal candidosis is more likely to be caused by? (5)

A 
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.
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10
Q

how to diagnose Vulvovaginal candidosis

A

Characteristic history - itching/discharge

Examination findings
Fissuring
Erythema with satellite lesions
Characteristic discharge

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11
Q

investigations

A
  • 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
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12
Q

candida albicans on a gram stain

A

egg like blastospores

long hyphey - true hyphe

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13
Q

Treatment of Vulvovaginal candidosis (4)

Other management of candida?

A

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.

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14
Q

3 possible causes for genital symptoms include

A

Candida
Bacterial vaginosis
Balanoposthitis

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15
Q

commonest cause of abnormal vaginal discharge?

A

Bacterial vaginosis

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16
Q

Bacterial vaginosis symptoms (4)

A

Asymptomatic in 50%
watery grey/yellow ‘fishy’ discharge
may be worse after period / sex
sometimes sore/itch from dampness

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17
Q

BV - biofilm problems (4)

A
  • increased Gardnerella vaginalis, Enterococcus faecalisandActinomyces neuii
  • reduced lactobacilli
  • Possible sexual transmissibility is a hot topic
  • Associated with vitamin D deficiency but significance unclear
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18
Q

BV is a result of

A
  • reduction of lactobacilli - reduction in h202
  • raised pH
  • overgrowth of BV associate bacteria
19
Q

BV can be associated with what complications? (3)

A
  • Associated with endometritis if uterine instrumentation / delivery - bacteria up into the uterus
  • Associated with premature labour
  • Increases risk of HIV acquisition
20
Q

Examination findings of BV?

A

Thin, homogenous discharge
pH testing
gram stained smear of vaginal discharge

21
Q

BV on a gram stain looks like?

A

very large epothelial cells covered in gram variable organisms - governoralvaginosis

22
Q

Treatment of BV? oral vs vaginal

A

AntiB’S

  • Metronidazole
  • Oral ( avoid ethanol)
  • Vaginal gel
  • Clindamycin - vaginal
  • probiotics
  • vaginal acidification - pH - 4.5
23
Q

male genital symptom conditions - what is balanitis

organism?

A

rash on the end of the penis - blotchy
- men with a foreskin

Candidal balanitis

24
Q

zoom’s balanitis features

- initial treatment

A

inside of foreskin involved - circumcision needed
Chronic inflammation secondary to overgrowth of commensal organisms plus ‘foreskin malfunction’.

mixed antimicrobial steroid cream

25
Q

impetigo - organisms

- features

A

Staph aureus or Strep pyogenes

- large area of redness, swollen

26
Q

Erysipelas/cellulitis is caused by

A

Strep Pyogenes - more severe infeciton

  • need antibiotics
  • permanent lymph vessel damage
27
Q

Dermatophyte infection known as?

differential diagnosis?

A

athletes penis - yeast - scaly patch of skin

- psoriasis

28
Q

Tinea cruris- known as?

A

athletes groin

  • support around hygeine
  • scaly
29
Q

Erythrasma is?

A

smoother

  • bacterial condition
  • darkening of the skin
  • antifungal treatment
30
Q

What can people present with that may result in no diagnosis (8)

A
  • 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
31
Q

Lines of questioning if nil found on examination or test results

A
  • 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
32
Q

symptoms of non - microbial origin - 3 main categories

A
  • Perceived problem only - normal findings
  • Dermatoses
  • Structural abnormalities : Congenital/ Acquired
33
Q

Main management approach

- things that may be a deeper cause of symptoms include?

A

We shouldn’t tell a person that they’re not experiencing a symptom.

  • Cancer, infertility, STD.
  • reassurance
34
Q

What can be mistaken for STD’s but they are normal anatomy

A
  • 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
35
Q

Other causes of genital symptoms

A 
Pain syndromes – the ‘dynias’
Dermatoses
Congenital
Traumatic 
Neoplastic
Manifestations of systemic disease
36
Q

Pain syndromes - Vestibulodynia

A
  • Provoked introital tenderness

-

37
Q

What is Vulvodynia - pain syndromes

A

Persistent burning or aching

38
Q

Pain syndromes - Chronic Pelvic Pain Syndrome (2)

A

Sometimes labelled as prostatitis, but usually no ‘itis’.

Cause unclear buy muscular dysfunction implicated

39
Q

What is lymphocoele

A

blocked lymph duct
- can be spontaneous - dry masturbation
secondary to infection

40
Q

genital cysts

A

can be internally or externally

41
Q

Torn frenulum can lead to?

A

ecchymosis - blood blisters

- secondary infection

42
Q

Lichen Sclerosus is

A

autoimmune disease - scarring and thinning of skin

- scarring around the vagina

43
Q

Lichen planus

A

another dermatosis - treated with steriods

44
Q

penile carinoma

A

can often present with an ulcer with firm base

- poor outcomes

Year 3: Reproduction (40 decks)

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