Medical Fun Facts Podcast

MFF0051: Genital infections

Tonight’s episode is dropping on Monday 27 March 2017. Before I start my ramblings on genital infections, I’d like to thank new subscribers to the podcast. I’m very grateful that people take a few minutes out of their busy schedules to listen to this light-hearted show featuring a few facts some of which are fun.

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So, let’s dive into genitals. Diagnosing genital infections has a lot of overlap with sexually transmitted infections. Not all genital infections, however, are transmitted by sexual contact. For example, yeast infections in men and women as well as balanitis in men who have no concept of penis hygiene.

For the life of me, I cannot understand why some men don’t clean themselves properly and don’t clean under their foreskins. Cheesy smegma can’t be something a bloke wants to encourage especially if he wants any sexual action. This point was a special one for Lauren from Mouthy Broadcast.

This explanation won’t be complete but I’ll go through the basics.

In men, it’s pretty simple, you collect a swab specimen from wherever the infection is. If there are herpetic vesicles on the head or shaft of the penis or hidden in pubic hair or around the anus, these days most people would make a diagnosis by PCR. If a bloke has abused his penis and he has what looks like a pyogenic infection, then a swab for microscopy and culture is in order. I remember one bloke who after anal sex with his girlfriend wouldn’t clean himself and he wondered why the shaft of his penis was covered in sores. He hadn’t heard of lubrication either so there were friction abrasions getting infected. When there is a urethral discharge a swab for microscopy and culture should be collected. If an asymptomatic man is just interested in knowing his gonorrhoea and chlamydia status, then a first void urine for PCR is best.

For genital warts, there’s usually no need to try to confirm that the wart is due to a Human Papillomavirus and they tend to be burnt off using cryotherapy. Don’t do this at home with a match head or do it yourself dry ice treatment please.

Yeast infections are usually identified with microscopy and culture from a swab specimen and clinically, because yeast infections, especially candidiasis has a distinctive appearance.

In women, it’s important to appreciate the healthy vagina is a self-cleaning organ that is quite complex in terms of anatomy. The vagina is not a cul-de-sac, there is an external opening at the vulva, and the uterine cervix opens into the vagina. The uterus also has open connections into the peritoneal cavity via the uterine or Fallopian tubes. In addition, the epithelium or skin on the inside changes. The cervix is lined with columnar epithelium which is quite delicate while the remainder of the vagina is lined with stratified squamous epithelium so it’s tough like the skin on the outside except there are no hair follicles.

Certain bacteria have an affinity for columnar epithelium, for example, the bacteria that cause gonorrhoea and chlamydia tend to infect the cervix and urethra rather than the lining of the vagina. This has implications for diagnosis. In women without an obvious discharge and if growing gonococcus is important to get antimicrobial resistance information, then the cervix and urethra should be sampled. In asymptomatic women, first void urine can be used for a PCR diagnosis of gonorrhoea and chlamydia similar to what happens in asymptomatic men.

Vesicular lesions should be swabbed for Herpes Simplex virus PCR and any obvious pyogenic infection on or around the vulva should also be swabbed for microscopy and culture.

Vaginal infections apart from gonorrhoea and chlamydia include trichomoniasis, thrush or candidiasis, and bacterial vaginosis. A swab for microscopy and culture should be collected for these conditions. In trichomoniasis, PCR is now available but the motile parasite, Trichomonas vaginalis can be identified in microscopy of a wet preparation from a swab. Yeast cells from thrush are really easy to see in a Gram’s stain (as well as a wet preparation) while bacterial vaginosis is mostly a clinical and microscopic diagnosis with culture now no longer recommended.

Needless to say, genital health is really important. You need to look at your bits and keep them in good working order. If you have any concerns, see your doctor. Don’t go and see a naturopath or a homeopath or a chiropractor or an acupuncture practitioner or a dry needle practitioner. Herbs, water, genital manipulation and needles whether they be hollow or not will not diagnose or treat your genital infection. Only a fair dinkum proper doctor or trained nurse practitioner can do that. The rest is witchcraft.

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