In Clinical Practice

In Clinical Practice

Taking a practical approach to clinical medicine, this series of smaller reference books is designed for the trainee physician, primary care physician, nurse practitioner and other general medical professionals to understand each topic covered. The coverage is comprehensive but concise and is designed to act as a primary reference tool for subjects across the field of medicine.

Christopher Sonnex Sexual Health and Genital Medicine in Clinical Practice Second Edition

Christopher Sonnex Cambridgeshire Community Services Cambridge UK ISSN 2199-6652 ISSN 2199-6660 (electronic) In Clinical Practice ISBN 978-3-319-21637-9 ISBN 978-3-319-21638-6 (ebook) DOI 10.1007/978-3-319-21638-6 Library of Congress Control Number: 2015950748 Springer Cham Heidelberg New York Dordrecht London Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com)

Preface This book is aimed specifically at medical practitioners in primary care who require a quick guide to help diagnose and manage genital problems. As such, this is not a comprehensive text but a prompt to what to do next when faced with a patient presenting with a genital complaint. A list of reference of textbooks and useful websites is provided in the Further Reading section (page 179) and I would recommend perusing these at some time. Just a word of explanation about genitourinary medicine, which is referred to in the text and is familiar to practitioners in the United Kingdom. GU medicine arose as a medical specialty in the mid-1980s replacing the term venereology which seemed an outdated and too restrictive description for the types of problems seen in, the then, socalled VD or special clinics. Although many patients attended these clinics with sexually transmitted infections (STIs), a good number attended with other genital problems. GU medicine clinicians now routinely diagnose and manage genital skin conditions, psychosexual problems, and infections, such as candidiasis and bacterial vaginosis, in addition to sexually acquired infections. The name genitourinary medicine was considered more appropriate and less stigmatizing as it suggests a specialty that deals with a range of medical conditions affecting the urogenital tract. GU medicine has caused some confusion beyond the United Kingdom, but education rather than reverting back to old title of STI clinician is the preferred way forward. The stigma associated with STIs persists and, inevitably, a degree of stigma hangs over the GU medicine clinic, but the message that GU medicine has v

vi Preface a wider sexual health remit is slowly permeating through the medical establishment and into the public psyche. Over the last few years in the United Kingdom, there has been a trend to move away from the name GU medicine toward sexual health. This is by no means favored by all and does lead to a blurring of the remit of the specialty and some loss of identity, as gynecologists and family planning specialists would also, quite rightly, consider their expertise to fall within the umbrella term sexual health. Training will eventually provide expertise in all aspects of sexual health care but for the moment, in the United Kingdom at least, GU medicine has a well-defined training program with the emphasis on genital infection and STI diagnosis and management. This text attempts to cover the range of conditions seen in GU medicine clinics in the United Kingdom, but genital infections and medical problems are pretty similar worldwide and so any practitioner managing genital disease and sexual health problems should find this book of practical value. Cambridge, UK Christopher Sonnex

Acknowledgments A special thank you to my wife, Kay Sonnex, Lead Gynaecology-Oncology Colposcopist at Addenbrooke s Hospital, Cambridge University Hospitals NHS Foundation Trust, for her invaluable input and, in particular, assistance with the revision of Chap. 11. vii

Contents 1 Which Patients to Refer to Genitourinary Medicine or Sexual Health.................... 1 2 Routine Investigations Performed in Genitourinary Medicine.................... 5 3 Taking a Sexual History....................... 11 4 Bacterial Vaginosis........................... 17 5 Candidiasis.................................. 25 6 Other Causes of Vaginal Discharge............. 37 7 A General Approach to the Management of Vaginal Discharge......................... 45 8 Vulval Problems............................. 51 9 Frequency Dysuria Syndrome................. 65 10 Pelvic Pain.................................. 69 11 Cytology and Colposcopy..................... 73 12 Dysuria in Young Men........................ 85 13 Prostatitis, Chronic Pelvic Pain Syndrome, and Hematospermia.......................... 93 ix

x Contents 14 Intra-Scrotal Pain............................ 99 15 Penile Rashes............................... 105 16 Genital Ulceration........................... 115 17 Genital Lumps............................ 127 18 Genital Irritation............................ 143 19 Human Immunodeficiency Virus (HIV) Infection........................ 149 20 Genital Problems in Children.................. 165 21 Painful Sex and Psychosexual Problems......... 171 Further Reading................................. 179 Index........................................... 181