sexual health genital symptoms

Question 1

genital symptoms include

Answer 1

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…

Question 2

what could be causing symptoms

Answer 2

STI
other microbial problem
non microbial problem

Question 3

how do you tell if its an STD or not

Answer 3

organism only transmitted by sexual contact

organism only transmitted by non sexual means

Question 4

what causes the symptoms of a microbial infection

Answer 4

symptoms entirely causes by infecting organism
symptoms entirelyly cause by host response to organism

Question 5

Microbial conditions not regarded as STDs

Answer 5

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

Question 6

Vulvovaginal candidosis

Answer 6

V common. Usually trivial but can cause misery in a minority.

90% Candida albicans
Can be C. glabrata et al
Usually acquired from bowel
Often asymptomatic carriage
Changes in host’s environment trigger pathogenicity
If symptomatic: “thrush”
Itch
Discharge – classically thick, ‘cottage cheese’ but often just a report of increased amount.

Question 7

when is vulvulvo candidiasis more likely to happen

Answer 7

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.

Question 8

how do you diagnose vulvulvo candidiasis

Answer 8

characteristic history

examination findings - fissuring, erythema with satellite lesions, characteristic discharge

Question 9

what investigations are down for vulvylvo candidiasis

Answer 9

Gram stained preparation
Low sensitivity – might look at an unrepresentative patch

Culture – eg Sabouraud’s medium
Low specificity – yeast are commensal organisms

Question 10

treatment of vulvulvo candidiasis

Answer 10

Azole antifungals:
Clotrimazole 500mg PV once
Plus Clotrimazole HC if vulvitis
Fluconazole 150mg PO once

Resistant case?
Determine species and sensitivities and treat accordingly

Other management
Maintain skin – avoid irritants, treat dermatitis.

Question 11

Possible causes of genital symptoms

microbial and other

Answer 11

Microbial causes
Candida
Bacterial vaginosis
Balanoposthitis
Other causes
Dermatoses
Trauma
Cancer
Neuromuscular
‘Hypervigilance’
Iatrogenic
Idiopathic

Question 12

what is the cause of thrush in 70% of women

Answer 12

Candida albicans

Question 13

bacterial vaginosis

Answer 13

Commonest cause of abnormal vaginal discharge
10-40% of women at any time.

Question 14

symptoms of bacterial vaginosis

Answer 14

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

Question 15

potential causes bacterial vaginosis

Answer 15

A biofilm problem – like dental caries
increased Gardnerella vaginalis, Enterococcus faecalis and Actinomyces neuii
reduced lactobacilli
Possible sexual transmissibility is a hot topic
Associated with vitamin D deficiency but significance unclear

Question 16

what are three dependent steps in overgrowtth of BV bacteria

Answer 16

reduction of lactobacilli
reduction in H2O2 production
raised PH

Question 17

problems associated with BV

Answer 17

Usually asymptomatic or very mild symptoms

But…
Associated with endometritis if uterine instrumentation / delivery
Associated with premature labour
Increases risk of HIV acquisition

Question 18

how do we diagnosed BV

Answer 18

Characteristic history
Examination findings
Thin, homogenous discharge

alternatively
pH
Gram stained smear of vaginal discharge

Question 19

treatment of BV

Answer 19

Antibiotics
Metronidazole
Oral ( avoid ethanol)
Vaginal gel
Clindamycin
Vaginal
Probiotics
Vaginal acidification

Question 20

candidal balanitis

male

Answer 20

a yeast infection in the penis caused by the fungus Candida albicans

Question 21

Candidal balanitis

male

Question 22

Zoon’s balanitis (aka plasma cell balanitis)

male

Answer 22

Chronic inflammation secondary to overgrowth of commensal organisms plus ‘foreskin malfunction’.

Question 23

Impetigo

male

Answer 23

Impetigo
Staph aureus or Strep pyogenes

swab treat abx

Question 24

Erysipelas. Strep Pyogenes

male

Answer 24

swab treat abx

Question 25

Dermatophyte infection

Answer 25

Eg Trichophyton rubrum 'athletes penis' psoriasis differential

Question 26

Tinea cruris

Answer 26

Dermatophytes – “athlete’s groin”

Question 27

Erythrasma

Answer 27

Corynebacterium minutissimum

Question 28

non microbial origin do you find clinical findings

Answer 28

no Perceived problem only - normal findings. No clinical findings Only findings are physiological ‘Real’ problems: Dermatoses Structural abnormalities Congenital Acquired nail found Vaginal discharge Urethral discharge Dysuria Genital/pelvic discomfort Rashes Skin lumps Penis size, scrotal lumps, labial shape Temporary More persistent – body dysmorphia

Question 29

Lines of questioning if nil found on examination or test results for non microbial issues

Answer 29

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

Question 30

management approach for non microbial issues

Answer 30

Acknowledge the perception. We shouldn’t tell a person that they’re not experiencing a symptom. What do they think might be causing the symptom? – Cancer, infertility, STD. Allows those conditions to be specifically covered and ruled out. “I can say with 100% certainty that it’s not HIV” Variants of reassurance. Provide an alternative, benign explanation for symptoms. Telling someone “It’s nothing to worry about” doesn’t usually help much. Discuss limitations of medical approach. “We’re really here to exclude the bad stuff – cancer, infections, etc. We can’t always explain every symptom.” “In my experience these symptoms usually settle on their own.”

Question 31

Fox-Fordyce spots

Answer 31

sebaceous glands of skin - fingerprints

Question 32

Vulval papillomatosis

Answer 32

soft vundal like projections mistaken as warts

Question 33

Penile pearly papules aka Coronal papillae

Question 34

Tyson’s glands

Question 35

alternative causes of genital symptoms

Answer 35

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

Question 36

pain syndromes

Answer 36

Vestibulodynia Provoked introital tenderness Vulvodynia Persistent burning or aching Chronic Pelvic Pain Syndrome Sometimes labelled as prostatitis, but usually no ‘itis’. Cause unclear buy muscular dysfunction implicated

Question 37

Congenital cyst

Question 38

Torn frenulum and ecchymosis

Question 39

Torn frenulum and secondary infection

Question 40

Lichen Sclerosus

Question 41

Penile carcinoma

Question 42

Lichen planus