Genital Syndromes Flashcards
What are common presenting features of genital pathology?
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 are the causative organisms of vulvovaginal candidiasis?
Candida Albicans
Candida Glabrata
What are the symptoms of vulvovaginal candidiasis?
Vulvar pruritus Dysuria Pain, burning Swelling Redness Soreness Irritation Dyspareunia Usually little or no discharge but if present, appears white and clumpy, curd-like
In what patient groups is vulvovaginal candidiasis more common?
Diabetes Oral steroids Immune suppression incl HIV Pregnancy Reproductive age group-(oestrogen...glycogen = food for yeast) Idiopathic
What investigations should be done for vulvovaginal candidiasis?
Vaginal pH (will be higher than 4) Vaginal Discharge Culture Nucleic Acid Amplification
What is the management of vulvovaginal candidiasis?
Azole antifungals: Clotrimazole 500mg PV once Plus Clotrimazole HC if vulvitis Fluconazole 150mg PO once Patients encouraged to seek treatment from pharmacy if they think they have thrush
What is the underlying cause of bacterial vaginosis?
Imbalance of bacteria in the vagina
Increased gardnerella / ureaplasma / mycoplasma /anaerobes
Reduced lactobacilli
What are the symptoms of bacterial vaginosis?
50% to 75% asymptomatic Fishy odour especially after intercourse Off-white, thin, homogeneous discharge Rarely dysuria and dyspareunia Risk factors including new sexual partner or >3 in past year, douching, cigarette smoking
What are the investigations done in bacterial vaginosis?
KOH test of vaginal discharge-presence of fishy odour when potassium hydroxide (KOH) is added to vaginal discharge
Nucleic Acid Amplification
PCR
Wet mount microscopy
What is the management of bacterial vaginosis?
Metronidazole-oral or vaginal gel
Clindamycin- vaginal
What is Amsel’s Criteria?
At least 3 out of 4 of: thin, homogeneous discharge; vaginal pH >4.5; a positive whiff test or release of amine odour with the addition of base; clue cells on microscopic evaluation of saline wet preparation
What is balanoposthitis?
Balanoposthitis refers to inflammation of the glans penis and prepuce. Cannot occur if the penis is circumcised.
What is the presentation of balanoposthitis?
Multiple sexual partners High-risk sexual behaviours Post-inflammatory hypo- or hyper-pigmentation Pruritus Red scaly patches Erosions Personal/family history of psoriasis Urinary dribbling Hypo-pigmentation Purpura Red plaques Blisters Papules or micro-papules Pustules
What investigations should be done in balanoposthitis?
Virology and Microbiology Swab
PCR
Skin Biopsy
Patch testing to exclude dermatitis
How is balanoposthitis treated?
Treat according to cause
If candida, treat with azoles
If dermatitis, treat with steroids etc
