genital symptoms Flashcards
(53 cards)
examples of genital symptoms
discharge pain rashes lumps and swellings cuts, sores, ulcers itching change in appearance something not right
causes of genital symptoms
STI - public and individual health problem, treatable, not always curable
other microbial - individual health problem, treatable if needed, usually curable
non-microbial - individual health issue, huge variety
how to determine what is an STI
spectrum of organisms from only transmitted by sexual contact to only transmitted by non-sexual means
large spectrum and many are both
subjective assessment when determining main transmission mode
in terms of microbial infection what can cause the symptoms
infecting organism itself
host response to organism
again a spectrum, likely a bit of both
examples of microbial conditions not regarded as STDs in UK
vulvovaginal candidosis bacterial vaginosis balanoposthitis - anaerobic/candidal tinea cruris erythrasma infected sebaceous glands impetigo folliculitis cellulitis many more
vulvovaginal candidosis - causative organism
~70% just candida albicans
30% other - e.g. C. glabrata or mixed populations
usually acquired from bowel
symptoms of vulvovaginal candidosis
often asymptomatic carriage - change in host environment triggers pathogenicity
symptomatic = thrush - itch, discharge
describe the discharge in vulvovaginal candidosis
classically thick
cottage cheese
often just a report of increased amount
how common is vulvovaginal candidosis
very common
usually trivial
can cause a misery in minority
who is more likely to get vulvovaginal candidosis
diabetes oral steroids immune suppression incl HIV pregnancy reproductive age group
many cases occur in people w/o predisposing factors
making a diagnosis of vulvovaginal candidosis
characteristic hx
vaginal pH? - normal pH can be found with thrush
examination findings
investigations
examination findings in vulvovaginal candidosis
linear fissuring
erythema with satellite lesions
characteristic discharge
investigations for vulvovaginal candidosis
gram stained preparation
culture
PCR
gram stain for vulvovaginal candidosis
low sensitivity
might look at an unrepresentative patch
culture for vulvovaginal candidosis
e.g. Sabouraud’s medium
higher sensitivity but labour intensive
low specificity to determine cause of symptoms - yeast are commensal organisms so may not be the cause but still present
PCR for vulvovaginal candidosis
highest sensitivity
lowest specificity - even more likely to find ‘innocent bystanders’
treatment for vulvovaginal candidosis
often self corrects if mild
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
how many episodes of thrush p/a is classed as recurrent
4 p/a
what is the commonest cause of abnormal vaginal discharge
bacterial vaginosis
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
what type of problem is bacterial vaginosis
biofilm problem - like dental caries; makes management difficult in some women
imbalance of bacteria
only becomes an issue when symptomatic
increased Gardnerella vaginalis, Enterococcus faecalis and Actinomyces neuii
reduced lactobacilli
cycle in bacterial vaginosis
reduction of lactobacilli, reduction in H2O2 production
raised pH
overgrowth of BV associated bacteria
complications from bacterial vaginosis
usually asymptomatic/very mild symptoms
minority of women:
associated with endometritis if uterine instrumentation/delivery
associated with premature labour
increases risk of HIV acquisition
diagnosis of bacterial vaginosis
characteristic hx
examination findings - thin, homogenous discharge
pH - can be more alkaline than normal
gram stained smear of vaginal discharge
