Sexual Health Genital Symptoms

Question 1

Give some examples of genital symptoms.

Answer 1

Discharge from orifice
Pain
Rashes
Lumps/swellings
Cuts, sores, ulcers
Itching
Change in appearance

Question 2

Vulvovaginal candidosis?

Answer 2

Yeast inflammatory infection of the vagina and vulva, very common

Question 3

What is the causative organism of the majority of vulvovaginal candidosis?

Answer 3

Candida albicans

-> about 70%, other 30% caused by Candida glabrata or mixed populations

Question 4

Where are the organisms causing vulvovaginal candidosis, like Candida albicans, usually acquired from?

Answer 4

Bowel

Question 5

Vulvovaginal canidiosis can be asymptomatic. However, if symptomatic, which name is commonly given to the condition?

Answer 5

Thrush

Question 6

What are the symptoms of thrush/vulvovaginal candidosis?

Answer 6

Itch
Discharge- typically described a being like cottage cheese

Question 7

Which women are more likely to experience candiasis?

Answer 7

It they are:
-diabetic, on oral steroids
-immune suppression including HIV
-pregnant
-are in the reproductive age group

->being of reproductive age is due to the production of oestrogen , which is a glycogen and therefore a food supply for yeast

Question 8

Diagnosis of thrush/vulvovaginal candidiasis?

Answer 8

Usually based on the characteristic history

->can sometimes use vaginal pH and examination findings (fissuring, erythema with satellite lesions, characteristic discharge)

Question 9

Investigations used in thrush/vulvovaginal candidiasis?

Answer 9

Gram stained prep
Culture
PCR?

Question 10

Treatment of thrush/vulvovaginal candidiasis?

Answer 10

Doesn’t always need treating
Azole antifulngals- clotrimazole, fluconazole

Question 11

Treatment of resistant thrush/vulvovaginal candidiasis?

Answer 11

Determine the species and the sensitivities and treat accordingly

Question 12

What is the commonest cause of abnormal vaginal discharge?

Answer 12

Bacterial vaginosis

Question 13

Symptoms of bacterial vaginosis?

Answer 13

Asymptomatic in 50%
Watery grey/yellow ‘fishy’ discharge
May be worse after periods/sex
Sometimes sore/itch from dampness

->as said, not all women have a problem with it. All to do with an imbalance of bacteria in the vagina

Question 14

Bacterial vaginosis can be a problem because it’s a biofilm problem, like dental caries. What does this mean?

Answer 14

Bacteria create a layer under which they are able produce chemicals which are able to survive the hydrogen peroxide/acid environment which is normally present in the vagina

Question 15

What are the three issues which contribute to bacterial vaginosis?

Answer 15

Reduction of lactobacilli which reduces the hydrogen peroxide production
Raised pH
Overgrowth of the bacterial vaginosis associated bacteria

Question 16

Bacterial vaginosis is usually asymptomatic and doesn’t cause problems. However, what are some of the problems it can cause in some women?

Answer 16

Associated with endometritis if uterine instrumentation/delivery
Associated with premature labour
Increases risks of HIV acquisition

Question 17

Diagnosis of bacterial vaginosis?

Answer 17

Characteristic history
Examination findings- thin, homogenous discharge
Gram stained smear of vaginal discharge

Question 18

Treatment of bacterial vaginosis?

Answer 18

Antibiotics
Probiotics
Vaginal acidification

->vaginal acidification is to tackle one of the problems mentioned previously about raised pH of the vagina being a contributing factor to bacterial vaginosis

Question 19

Which antibiotics may be used in the treatment of bacterial vaginosis?

Answer 19

Metronidazole- oral (avoid alcohol), vaginal gel
Clindamycin- vaginal

Question 20

Balanitis?

Answer 20

One of the commonest conditions seen in men, rash at the end of the penis

Question 21

Which procedure means men will be very unlikely to get balanitis?

Answer 21

Circumcision

Question 22

Might be worth watching parts of this on 2x speed to see pictures of some other kinds of conditions which can affect the genitals

Answer 22

There wasn’t much to write notes on but the pictures and descriptions may be of use…idk

Question 23

Sometimes patient’s may present with ‘changes’ to their genitals which they haven’t noticed before, often after having sex with someone new, and are worried it’s an STI etc.

It’s important to know what’s normal so we don’t give the wrong diagnosis.

Might also be worth looking over this part of the PowerPoint again.

Here are a list of some things which people may present with which are normal:

Answer 23

-Fox-Fordyce spots on penis (sebaceous glands of the skin)
-Vulval papillomatosis (sometimes mistaken for warts)
-Penile pearly papules aka Coronal paillae
-Tyson’s glands

Question 24

What is vestibulodynia?

Answer 24

A pain syndrome.
Pain is felt around the introitus during penetrative sex or tampon insertion

Question 25

Vulvodynia?

Answer 25

Another type of pain syndrome
Causes persistent burning or aching

Question 26

Chronic pelvic pain syndrome?

Answer 26

Usually in men, persistent aching of the genitals even if there is nothing to find in the genitals

Question 27

Lymphocele?

Answer 27

Blocked lymph duct, causing the lymph vessel to become enlarged.

Question 28

What can cause a lymphocele?

Answer 28

Increased friction
Sometimes can occur secondary to infection

->e.g. dry masturbating

Question 29

Treatment of lymphocele?

Answer 29

Often settles spontaneously