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Reproductive block - Y3 > sexual health genital symptoms > Flashcards

sexual health genital symptoms 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 symptoms

A

STI
other microbial problem
non microbial problem

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3
Q

how do you tell if its an STD or not

A

organism only transmitted by sexual contact

organism only transmitted by non sexual means

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4
Q

what causes the symptoms of a microbial infection

A

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

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5
Q

Microbial conditions not regarded as STDs

A

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

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6
Q

Vulvovaginal candidosis

A

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.

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7
Q

when is vulvulvo candidiasis more likely to happen

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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8
Q

how do you diagnose vulvulvo candidiasis

A

characteristic history

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

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9
Q

what investigations are down for vulvylvo candidiasis

A

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

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

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10
Q

treatment of vulvulvo candidiasis

A

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.

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11
Q

Possible causes of genital symptoms

microbial and other

A

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

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12
Q

what is the cause of thrush in 70% of women

A

Candida albicans

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13
Q

bacterial vaginosis

A

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

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14
Q

symptoms of bacterial vaginosis

A

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

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15
Q

potential causes bacterial vaginosis

A

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

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16
Q

what are three dependent steps in overgrowtth of BV bacteria

A

reduction of lactobacilli
reduction in H2O2 production
raised PH

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17
Q

problems associated with BV

A

Usually asymptomatic or very mild symptoms

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

18
Q

how do we diagnosed BV

A

Characteristic history
Examination findings
Thin, homogenous discharge

alternatively
pH
Gram stained smear of vaginal discharge

19
Q

treatment of BV

A

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

20
Q

candidal balanitis

male

A

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

21
Q

Candidal balanitis

male

A
22
Q

Zoon’s balanitis (aka plasma cell balanitis)

male

A

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

23
Q

Impetigo

male

A

Impetigo
Staph aureus or Strep pyogenes

swab treat abx

24
Q

Erysipelas. Strep Pyogenes

male

A

swab treat abx

25
Q

Dermatophyte infection

A

Eg Trichophyton rubrum

‘athletes penis’ psoriasis differential

26
Q

Tinea cruris

A

Dermatophytes – “athlete’s groin”

27
Q

Erythrasma

A

Corynebacterium minutissimum

28
Q

non microbial origin

do you find clinical findings

A

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

29
Q

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

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

30
Q

management approach for non microbial issues

A

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.”

31
Q

Fox-Fordyce spots

A

sebaceous glands of skin - fingerprints

32
Q

Vulval papillomatosis

A

soft vundal like projections mistaken as warts

33
Q

Penile pearly papules aka Coronal papillae

A
34
Q

Tyson’s glands

A
35
Q

alternative causes of genital symptoms

A

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

36
Q

pain syndromes

A

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

37
Q

Congenital cyst

A
38
Q

Torn frenulum and ecchymosis

A
39
Q

Torn frenulum and secondary infection

A
40
Q

Lichen Sclerosus

A
41
Q

Penile carcinoma

A
42
Q

Lichen planus

A

Reproductive block - Y3 (46 decks)

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