sexual health genital symptoms Flashcards
genital symptoms include
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 could be causing symptoms
STI
other microbial problem
non microbial problem
how do you tell if its an STD or not
organism only transmitted by sexual contact
organism only transmitted by non sexual means
what causes the symptoms of a microbial infection
symptoms entirely causes by infecting organism
symptoms entirelyly cause by host response to organism
Microbial conditions not regarded as STDs
Vulvovaginal candidosis
Bacterial vaginosis
Balanoposthitis – anaerobic/candidal
Tinea cruris
Erythrasma
Infected sebaceous glands
Impetigo
Cellulitis
Vulvovaginal candidosis
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.
when is vulvulvo candidiasis more likely to happen
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.
how do you diagnose vulvulvo candidiasis
characteristic history
examination findings - fissuring, erythema with satellite lesions, characteristic discharge
what investigations are down for vulvylvo candidiasis
Gram stained preparation
Low sensitivity – might look at an unrepresentative patch
Culture – eg Sabouraud’s medium
Low specificity – yeast are commensal organisms
treatment of vulvulvo candidiasis
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.
Possible causes of genital symptoms
microbial and other
Microbial causes
Candida
Bacterial vaginosis
Balanoposthitis
Other causes
Dermatoses
Trauma
Cancer
Neuromuscular
‘Hypervigilance’
Iatrogenic
Idiopathic
what is the cause of thrush in 70% of women
Candida albicans
bacterial vaginosis
Commonest cause of abnormal vaginal discharge
10-40% of women at any time.
symptoms of bacterial vaginosis
Asymptomatic in 50%
watery grey/yellow ‘fishy’ discharge
may be worse after period / sex
sometimes sore/itch from dampness
potential causes bacterial vaginosis
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
what are three dependent steps in overgrowtth of BV bacteria
reduction of lactobacilli
reduction in H2O2 production
raised PH
problems associated with BV
Usually asymptomatic or very mild symptoms
But…
Associated with endometritis if uterine instrumentation / delivery
Associated with premature labour
Increases risk of HIV acquisition
how do we diagnosed BV
Characteristic history
Examination findings
Thin, homogenous discharge
alternatively
pH
Gram stained smear of vaginal discharge
treatment of BV
Antibiotics
Metronidazole
Oral ( avoid ethanol)
Vaginal gel
Clindamycin
Vaginal
Probiotics
Vaginal acidification
candidal balanitis
male
a yeast infection in the penis caused by the fungus Candida albicans
Candidal balanitis
male
Zoon’s balanitis (aka plasma cell balanitis)
male
Chronic inflammation secondary to overgrowth of commensal organisms plus ‘foreskin malfunction’.
Impetigo
male
Impetigo
Staph aureus or Strep pyogenes
swab treat abx
Erysipelas. Strep Pyogenes
male
swab treat abx
Dermatophyte infection
Eg Trichophyton rubrum
‘athletes penis’ psoriasis differential
Tinea cruris
Dermatophytes – “athlete’s groin”
Erythrasma
Corynebacterium minutissimum
non microbial origin
do you find clinical findings
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
Lines of questioning if nil found on examination or test results for non microbial issues
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
management approach for non microbial issues
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.”
Fox-Fordyce spots
sebaceous glands of skin - fingerprints
Vulval papillomatosis
soft vundal like projections mistaken as warts
Penile pearly papules aka Coronal papillae
Tyson’s glands
alternative causes of genital symptoms
Pain syndromes – the ‘dynias’
Dermatoses
Congenital
Traumatic
Neoplastic
Manifestations of systemic disease
pain syndromes
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
Congenital cyst
Torn frenulum and ecchymosis
Torn frenulum and secondary infection
Lichen Sclerosus
Penile carcinoma
Lichen planus
