STI infections of the genital tract – Genital symptoms Flashcards
what are some genital symptoms?
- Discharge
- Pain
- Rashes
- Lumps and swellings
- Cuts, sores, ulcers
- Itching
- Change in appearance
- Vague sense of things not being right
what could be causing the symptoms?
- STD – public and individual health, treatable, not always curable
- Other microbial problem – individual health problem, treatable if needed, usually curable
- Non-microbial – individual health issue, huge variety
what is it that is actually causing the symptoms?
Its somewhere on the continuum and not just at either 2 ends
what is Vulvovaginal candidosis?
- Vulvovaginal candidiasis refers to vaginal and vulval symptoms caused by a yeast, most often Candida albicans. It affects 75% of women on at least one occasion over a lifetime
- Very common
- 70% just candida albicans but 30% there is other species involved
- Usually acquired from bowel
- More likely to happen if – diabetes, oral steroids, immune suppression incl HIV, pregnancy, reproductive age group (as more glycogen around which is food for yeast) – many cases happen in people with no pre-disposing factors
what are the symptoms of vulvovaginal candidosis?
Often asymptomatic carriage – changes in hosts environment trigger pathogenicity
If symptomatic = thrush – itch and discharge
how is the diagnosis of vulvovaginal candidosis made?
characteristic history (itching and discharge)
vaginal pH?
examination findings e.g. fissuring
erythema with satellite lesions
characteristic discharge
what investigations are done for vulvovaginal candidosis?
gram stained preparation – low sensitivity
culture - high sensitivity but labour intensive but low specificity to determine cause of symptoms as yeast are commensal organisms
PCR – highest sensitivity but lowest specificity as even more likely to find innocent bystanders
what is the treatment of vulvovaginal candidosis?
not all need treated and if mild will self correct
azole antifungals
if resistant case then determine species and sensitivities and treat accordingly
other management includes maintain skin and avoid irritants and treat dermatitis
what is Bacterial vaginosis?
Bacterial vaginosis (BV) is a common cause of unusual vaginal discharge. BV is not a sexually transmitted infection (STI), but it can increase your risk of getting an STI such as chlamydia
- Commonest cause of vaginal discharge
- Imbalance of bacteria, not a infection
- A biofilm – increased number of organisms, reduced lactobacilli, possible sexual transmissibility , associated with vitamin D deficiency but significance unclear
what are the symptoms of bacterial vaginosis?
- Symptoms – asymptomatic 50% of time, discharge, worse after period/sex, sometimes sore/itch from dampness
- Usually asymptomatic or very mild symptoms but there is more serious problems – endometritis if uterine instrumentation/delivery, premature labour, increased risk of HIV acquisition
what causes bacterial vaginosis?
Result of interplay of 3 problems
Any one of these happen then the other 2 kick in
how is the diagnosis of bacterial vaginosis made?
characteristic history
examination findings (thing, homogenous discharge)
pH (more useful in this than thrush as doesn’t change in thrush but in this it can get alkaline)
gram stain smear of vaginal discharge
what is the treatment of bacterial vaginosis?
antibiotics (metronidazole – oral and vaginal gel, clindamycin – vaginal)
probiotics
vaginal acidification
what are some other microbial causes of genital symptoms?
Candidal balanitis – inflammation of head of penis
Zoons balanitis – chronic inflammation secondary to overgrowth of commensal organisms plus foreskin malfunction
Impetigo (not just genitals) – staph aureus or step pyogenes
Erysipelas – step pyogenes
Dermatophyte infection (yeast) – differential diagnosis may be psoriasis
Tinea cruris – dermatophytes – athletes groin
Erythrasma – bacteril condition
Other conditions – Non-microbial:
what other subcategories are there?
- Perceived problem only – normal findings, no clinical findings, only findings are physiological
- Real problems – dermatoses, structural abnormalities (congenital or acquired)
whata re examples of Perception of abnormality but nil abnormal to find?
- Vaginal discharge
- Urethral discharge
- Dysuria
- Genital/pelvic discomfort
- Rashes
- Skin lumps
- Penis size, scrotal lumps, labial shape (temporary, more persistent – body dysmorphia)
whata re somelLines of questions you can use if nil found on examination or test results?
- Regretted sexual encounter?
- Problems in life
- Co-existing mental illhealth – axiety
- When did they notice the problem?
- When were things last normal?
what is the management approach of a percieved abnormality?
- Acknowledge the perception – don’t say they arnt experiencing symptoms
- What do you think may be causing the symptoms – cancer, infertility, STD – cover these conditions and rule them out
- Variants of reassurance
- Discuss limitations of medical approach
what are some other causes of genital symptoms?
- Pain syndromes
- Dermatoses
- Congenital
- Traumatic/iatrogenic
- Neoplastic
- Neuromuscular
- Manifestations of systemic disease
- Idiopathic
what pain syndromes can cause symptoms?
- Vestibulodynia – provoked introital tenderness
- Vulvodynia – persistent burning or aching
- Chronic pelvis pain syndrome – sometimes labelled as prostatitis but usually no it is, cause unclear but muscular dysfunction implicated in many cases
what are some non-microbial problems that you may encounter?
- Lymphocoele – blocked lymph duct
- Congenital cyst
- Torn frenulum and ecchymosis, secondary infection
- Lichen sclerosus – autoimmune disease
- Lichen planus – autoimmune
- Penile carcinoma
Summary:
- A lot of things can cause genital symptoms – not just ____
- Correctly _________ the _____ of genital symptoms is the most important step – which bucket?
STDs
categorising
cause
