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Reproduction > Genital Symptoms & Conditions > Flashcards

Genital Symptoms & Conditions Flashcards

1
Q

What are some common genital symptoms?

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

STDs are treatable but not always ..?..

A

Curable

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3
Q

Why is there a grey area when it comes to whether its an STD or not?

A

Can think of most organisms as being in that central zone – assessment of where its main transmission mode is, whether it is an STI or not

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4
Q

In a microbial infection, what’s causing the symptom?

A

Could be symptom caused by infecting organism or caused by host response to organism or combination.

Look at how pathogenic the organism itself is or if its something else that has caused the problem

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5
Q

What is the majority of Vulvovaginal candidiasis caused by and where is it acquired from?

A

90% Candida Albicans

Usually acquired from bowel (Could be common commensals in the vagina & in the bowel)

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6
Q

Is Vulvovaginal candidiasis common & how does it present?

A

V common. Usually trivial but can cause misery in a minority.

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

What are the reasons that Vulvovaginal candidiasis is 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 is Vulvovaginal candidiasis diagnosed/examination findings?

A

Characteristic history

Examination findings
* Fissuring
* Erythema with satellite lesions
* Characteristic discharge

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9
Q

What is the Canes test (OTC Test)?

A

pH test kit - misleading as vaginal pH is the same as the vaginal pH of thrush so is not a diagnostic test for thrush

Normally self swab done -stained in clinic & then checked under microscope

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10
Q

If have vaginal pH normal of about 4.5 what can you know?

A

It is probably not bacterial vaginosis

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11
Q

Where else is common for a thrush presentation?

A

May see this in the back of peoples mouths too (e.g overuse of oral or inhaled steroids, undiagnosed HIV etc)

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12
Q

How is Vulvovaginal candidiasis investigated (think actually figuring out what organism is)?

A
  • Gram stained preparation
    – Low sensitivity – might look at an unrepresentative patch
  • Culture – eg Sabouraud’s medium
    – Low specificity – yeast are commensal organisms
    – Higher sensitivity-but labour intensive

PCR-largely used in research setting-as has the lowest specificity (& highest sensitivity)- so even more likely to find ‘innocent bystander’ organisms

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13
Q

How is Vulvovaginal candidiasis treated & how do you manage a resistant case of it?

A
  • Azole antifungals:
  • Clotrimazole 500mg PV once + Clotrimazole HC if vulvitis
  • Fluconazole 150mg PO once
  • Resistant case?
    Determine species and sensitivities and treat accordingly
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14
Q

What is other management for Vulvovaginal candidiasis?

A

Maintain skin-avoid irritants, treat dermatitis

Some women’s skin is particularly prone to thrush symptoms, maybe tendency to atopy

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15
Q

Does Vulvovaginal candidiasis often need to be treated?

A

Often will self correct- so doesn’t need to be treated necessarily

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16
Q

What is classed as recurrent thrush?

A

4 episodes a year

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17
Q

What is the commonest cause of abnormal vaginal discharge?

A

BACTERIAL VAGINOSIS

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18
Q

What are the 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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19
Q

How is bacterial vaginosis caused?

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
20
Q

Does bacterial vaginosis require treatment?

A

Bacterial imbalance – isn’t always symptomatic – often doesn’t need any treatment

21
Q

How are some organisms able to survive the hydrogen peroxide & acid environments which are normally present in the vagina?

A

Certain organisms have an electrostatic attraction to the vaginal wall & create a layer under which they are able to produce chemicals which are able to survive in the environment

In bacterial vaginosis: Cycle of reduction of lactobacilli & reduction in H202 production- Raised pH- Overgrowth of BV associated bacteria

22
Q

What are some of the more harmful things associated with BV

A

*Associated with endometritis if uterine instrumentation / delivery
*Associated with premature labour
*Increases risk of HIV acquisition-through mechanism on the vaginal immune system

23
Q

How is BV diagnosed?

A
  • Characteristic Hx
  • Examination findings= Thin, homogenous discharge
  • pH (can become more alkaline)
  • Gram stained smear of vaginal discharge (self swab typically)
24
Q

How is BV treated?

A

Abx
- Metronidazole (oral (avoid ethanol) or vaginal gel)
- Clindamycin-vaginal

Probiotics

Vaginal acidification-maintain pH of 4.5 by vaginal acidifying gel

25
Q

What type of organisms cause Balanoposthitis?

A

Anaerobic/candidal

26
Q

What organism causes balanitis & posthitis etc & what is it?

A

Candida balantitis

Inflammation of head of penis-blotchy dry spots

27
Q

What is Zoon’s balanitis (aka plasma cell balanitis) and what is the short term treatment for it?

A

-Chronic inflam secondary to overgrowth of commensal organisms plus ‘foreskin’ malfunction

-Short term treatment=mixed antimicrobial steroid preparation – improve symptoms

28
Q

What organisms cause impetigo and how is it treated?

A
  • Staph aureus or Strep pyogens
  • Can be mistaken for Herpes
  • Swab & treat with Abx
29
Q

What condition is caused by strep pyogenes and if its not treated properly can get permanent lymph vessel damage?

A

Erysipelas

30
Q

What does a dermatophyte infection present with & how is it treated?

A
  • E.g. Trichophyton rubrum
  • Scaly patch of skin
  • Antifungal steroid preparation
31
Q

What is Tinea cruris & how is it managed?

A

-Dermatophytes- ‘athletes’s’ groin
-Hygiene- keep dry area around groin

32
Q

What is erythrasma, what’s it caused by & how is it managed?

A

-Corynebacterium minutissimum
-Smooth edge-bacterial condition
-Mild steroid & antifungal preparation interestingly works surprisingly well

33
Q

What are some possible microbial causes of genital symptoms?

A
  • Candida
  • Bacterial vaginosis
  • Balanoposthitis
34
Q

What are some possible other causes of genital symptoms?

A
  • Pain syndromes – the ‘dynias’
  • Dermatoses
  • Trauma
  • Cancer/Neoplastic
  • Neuromuscular
  • ‘Hypervigilance’
  • Iatrogenic
  • Congenital
  • Idiopathic
  • Manifestations of systemic disease
35
Q

What are some symptoms of non microbial origin?

A

Perceived problem only - normal findings.
- No clinical findings
- Only findings are physiological

‘Real’ problems:
*Dermatoses
*Structural abnormalities
- Congenital
- Acquired

36
Q

What kind of things can be perceived as an abnormality when there is actually nil to find?

A
  • Vaginal discharge
  • Urethral discharge
  • Dysuria
  • Genital/pelvic discomfort
  • Rashes
  • Skin lumps
  • Change in appearance of skin
  • Penis size, scrotal lumps, labial shape
  • Temporary
  • More persistent – body dysmorphia
37
Q

What are some physiological clinical findings can be mistaken for STDs but are just normal parts of anatomy?

A
  • Fox Fordyce spots=sebaceous glands of the skin that some men have more prominently than others (‘Normal as fingerprints’)
  • Vulval papillomatosis=Projections that can sometimes be mistaken for warts
  • Penile pearly papules aka Coronal papillae
  • Tyson’s glands=Vestigial glands either side of the frenulum
38
Q

What is vestibulodynia & what is Vulvodynia (pain syndromes)?

A

Vestibulodynia=Provoked introital tenderness

Vulvodynia=Persistent burning or aching

39
Q

What is the cause of chronic pelvic pain syndrome and what is it?

A
  • Sometimes labelled as prostatitis, but usually no ‘itis’.
  • Cause unclear but muscular dysfunction implicated

Chronic-persistent aching of the genitals even though there is nothing to actually find in the genitals

(Sometimes gets attributed to prostatitis but is more likely to be a sort of neuromuscular dysfunction problem, causing chronic pelvic pain syndrome, and vulvodynia.)

40
Q

What is a lymphocele & how does it resolve?

A

oBlocked lymph duct-increased friction or secondary to an infection

oSettles down spontaneously given a few days of avoiding friction

41
Q

Are congenital cysts always removed?

A

Can be left as are or if they are large & causing a problem they can be removed

42
Q

Describe a torn frenulum & ecchymosis?

A

oEcchymosis=blood blisters under the skin
oLittle artery in the frenulum which can bleed a lot
oCan get a torn frenulum & then a secondary infection

43
Q

What is lichen sclerosis and how is it treated?

A

o Autoimmune disease that causes thinning & scarring of the skin & can totally close off the urethral meatus
o Affects women as well & sometimes it can cause scarring around the vagina

Steroid treatment

44
Q

For what condition is the cause not entirely clear but is thought to be another autoimmune condition and is treated with steroid treatment like lichen sclerosis?

A

Lichen Planus

45
Q

What should you be wary of in terms of ulcers that would make you think penile carcinoma?

A

Ulcer with a very firm base to it

46
Q

Do STDs just cause genital symptoms?

A

NO

A lot of things can cause genital symptoms – not just STDs. And the other side is that…Correctly categorising the cause of genital symptoms is the most important step. A precise diagnosis is important but a secondary concern for many patients.

Reproduction (17 decks)

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