Sexual helf - Genital symptoms

Question 1

What is Vulvovaginal candidosis?

What organism(s) cause it?

How commonly is it symptomatic?

Answer 1

Yeast infection

Caused by Candida albicans (70%)

• Others - C. glabrata, mixture

Very commonly carried asymptomatically, but if symptomatic (Thrush) then severe

Question 2

Where is Vulvovaginal candidosis usually acquired from?

Answer 2

Bowel

Question 3

What are the symptoms of thrush? (V. candidosis)

Answer 3

Itch

Discharge - cottage cheese, may just be described as increased vaginal discharge

Superficial dyspareunia

Question 4

What are risk factors for thrush? (aside from shaggin)

Answer 4

Diabetic

Meds - oral steroids, antibiotics

Immunosuppressed - (thrush often occurs in HIV patients)

Pregnancy

being of Reproductive age

Question 5

What investigations can be done for thrush?

Answer 5

Examination:

• Vulval erythema w/ satellite lesions
• Fissuring
• Characteristic discharge

Can be clinically diagnosed - but if indicated:

• Gram stained preparation (from self-swab)
• Culture (Sabouraud’s medium)
• PCR

Question 6

How is thrush treated?

Answer 6

(Mild thrush often self corrects)

Azole anti-fungals:

• Clotrimazole 500mg PV (once)
  
  • • Clotrimazole HC if vulvitis
• Fluconazole 150mg PO (once)

Other management:

• Maintain skin - avoid irritants, treat dermatitis etc

Question 7

What are the problems caused by Bacterial Vaginosis?

Answer 7

Usually asymptomatic or v mild

But:

• Can cause endometritis if uterine instrumentation / delivery
• Can cause premature labour
• Increases risk of HIV acquisition

Question 8

How is BV diagnosed?

Answer 8

Characteristic history

Examination findings:

• Thin, fishy smelling, homogenous discharge

pH testing >4.5 (BV = more alkaline) - more useful for BV than thrush.

Gram stain of discharge

Question 9

How is Bacterial vaginosis treated?

Answer 9

Antibiotics:

• Metronidazole
  
  • Oral (avoid ethanol)
  • Vaginal gel
• Clindamycin (vaginal)

Probiotics

Vaginal acidification

Question 10

What is Balanitis?

Answer 10

Inflammation of the end of the penis

(think bellanitis)

Fungal - Usually Candida

Question 11

What is Zoon’s balanitis?

Answer 11

Chronic inflammation of the head of the penis (can also involve the foreskin)

Secondary to overgrowth of commensal organisms and malfunction of the foreskin

Question 12

What organisms cause genital impitigo?

Answer 12

Staph aureus

Strep pyogenes

Question 13

What is erysipelas?

What organism causes it?

Why is it important to treat promptly?

Answer 13

Superficial form of cellulitis which can affect the genitals

Strep pyogenes

Risk of permanent lymph vessel damage if not treated quickly

Question 14

What condition is described as athletes penis?

What organism most commonly causes it?

Answer 14

Dermatophyte infections (fungal)

These are caused by the same organisms of athletes foot

Trichophyton rubrum

Question 15

What is the difference between Tinea cruris & erythrasma?

Answer 15

Tinea cruris (athletes groin):

• dermatophyte (fungal) infection of groin which gives scaly AoE with sharp borders

Erythrasma:

• bacterial infection of groin which has a much more gradual border

Question 16

What bacteria often causes erythrasma?

Answer 16

Corynebacterium minitissimum