Genitourinary medicine

Dr Philip Marazzi outlines some common genitourinary presentations.

Molluscum contagiosum
Molluscum contagiosum is an infection we are used to seeing in children, commonly infecting the skin of toddlers and primary school-age patients. More rarely, it affects the genitalia as shown here. It is a viral infection caused by four types of pox virux. Penile wart

This penile wart was caused by HPV, another common viral infection that can be sexually transmitted. The importance of this infection in the aetiology of cervical cancer may soon lead to widespread vaccination with, hopefully, significant reductions in infection rates and cervical cancer incidence.

Acute epididymo-orchitis


This 50-year-old man presented with acute pain and swelling of his testis. There was no specific causative organism isolated on swabs although a variety of pathogens may be responsible. These include viruses, gonorrhoea, chlamydia, pseudomonas and coliforms. He was treated empirically with a four-week course of ciprofloxacin. His signs and symptoms did improve and he had no subsequent problems. The scrotal telangestasias seen are not significant and had been present for years.

Gonorrhoea


This 60-year-old man had suspected gonorrhoea and was referred to a GUM clinic for confirmation of the diagnosis, exclusion of any other possible STIs and treatment. Contact tracing is also an important aspect undertaken to limit the spread of the infection.

Candida


This man developed a sore foreskin with these splits in the skin. A swab was taken which grew Candida albicans. A topical antifungal was used and the skin healed.

Herpes simplex


This young woman presented with these painful ulcers. A viral swab confirmed the presence of herpes simplex type 2 virus. She was referred to the GUM clinic. She was not in a stable relationship and needed checking for other possible infections.

Penile cyst


This man developed a benign cystic lesion on the side of his penis. The main problem was that it caused considerable discomfort during intercourse. He was referred to a urologist for excision.

Chlamydia


Chlamydia is probably the most widely diagnosed STI with more than 120,000 cases diagnosed annually. It often affects young people and may be asymptomatic. Its ability to cause tubal damage and subsequent infertility is perhaps the best known complication. As the causative organism is bacterial, antibiotics are usually effective, most often doxycycline or azithromycin. Screening and treating will hopefully see a reduction in cases and complications over the next few years.

  • Contributed by Dr Philip Marazzi, a GP in East Horsley, Surrey

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