Non-Sexually Transmitted Infections of the Genital Tract Flashcards
What are the possible causes of genital symptoms?
Perceived problem only - normal findings and sensations
STIs
Microbial problem that is not an STI
Dermatoses
Structural abnormalities - congenital, acquired
What features might cause a perception of abnormality?
Vaginal discharge
Urethral discharge
Dysuria
Genital appearance
What are some non-STI genital symptoms?
Fox-Fordyce spots
Vulval papillomatosis
Penile pearly papules (coronal papillae)
Tyson’s glands
What do organisms only transmitted by non-sexual means cause?
Conditions entirely dependent on host factors, not on the organism
Compared to organisms transmitted exclusively during sexual contact which cause conditions which are entirely predicted by the infecting organism
What are some non-STI microbial problems?
Vulvovaginal candidosis Bacterial vaginosis Balanitis Tinea cruris Erythrasma Infected sebaceous glands
What is the most common causative organism of vulvovaginal candidosis?
90% candida albicans
Can also be due to candida glabrata etc.
How is vulvovaginal candidosis usually acquired?
From the bowels
What are the symptoms of vulvovaginal candidosis?
Often asymptomatic carriage - changes in host’s environment trigger pathogenicity
Thrush - itch, discharge
Discharge classically thick (cottage cheese-like), but often just report of increased amount
When is a diagnosis of vulvovaginal candidosis more likely?
Diabetes Oral steroids Immunosuppression (including HIV) Pregnancy Reproductive age group
(in many cases can occur in women with no predisposing factors)
How is vulvovaginal candidosis diagnosed?
Characteristic history Examination findings Fissuring Erythema with satellite lesions Characteristic discharge
What are the investigations for vulvovaginal candidosis?
Gram stained preparation - low sensitivity, might look at an unrepresentative patch
Culture - low specificity, yeast are often commensal
What is the treatment of vulvovaginal candidosis?
Azole antifungals - clotrimazole 500mg PV once plus clotrimazole HC if vulvitis, fluconazole 150mg PO once
Resistant cases - determine species and sensitivities and treat accordingly
What percentage of women will be affected by bacterial vaginosis at any one time?
10-40%
What is bacterial vaginosis?
Imbalance of bacteria rather than an infection
What are the symptoms of bacterial vaginosis?
Asymptomatic in 50%
Watery grey/yellow fishy smelling discharge
May be worse after period or after sex
Sometimes sore/itch from dampness
What imbalance of bacteria causes bacterial vaginosis?
Increased gardnerella/ureaplasma/mycoplasma/anaerobes, reduced lactobacilli
What is bacterial vaginosis associated with in black women?
Vitamin D deficiency
What are the potential problems associated with bacterial vaginosis?
Usually trivial
Associated with endometritis if uterine instrumentation/delivery
Associated with premature labour
Increases risk of HIV acquisition
How is bacterial vaginosis diagnosed?
Characteristic history
Examination findings - thin, homogenous discharge
Gram stained smear of vaginal discharge
What is the treatment of bacterial vaginosis?
Metronidazole - oral or vaginal gel
Clindamycin - vaginal
What is Zoon’s balanitis?
Chronic inflammation secondary to overgrowth of commensal organisms plus foreskin malfunction
What is the most common causative organism of impetigo?
Staph aureus
What is the most common causative organism of erysipelas?
Group A strep
What is the most common causative organism of dermatophyte infection?
Trichophyton rubrum
What is the most common causative organism of erythrasma?
Corynebacterium minutissimum
What are some other genital symptoms of non-STI infections?
Pain syndromes Dermatoses Congenital Traumatic Neoplastic Manifestations of systemic disease
