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Lecture 36 February 28th-Male genetalia and reproduction

Lecture 36 February 28th-Male genetalia and reproduction

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1DDX: LECTURE 36 \u2013 FEBRUARY 28TH, 2007
CONDITIONS OF THE MALE GENITALIA AND REPRODUCTIVE SYSTEM
Page 4
BENIGN PROSTATIC HYPERPLASIA
Now seeing more BPH because people are living longer.
Nodular gland is not necessarily cancerous: this happens in any enlarged organ that is encapsulated.
GONORRHEA
\u2022
Sex + opaque urethral discharge. Take history. Swab, stain, culture the discharge.
\u2022
Not limited to men: affects women too.
\u2022
Multiple sex partners: risk factor, but not limited to sexual interaction.
\u2022
Patient will come in because of pain during urination, not because of discharge.
\u2022
May become chronic, pain will lessen over time. These patients may be incubating and spreading the illness without
treating it.
\u2022
Patient will have fever, increased WBC count.
CHLAMYDIA
\u2022
Sticky, watery discharge. Mucousy, clear discharge. Still contains some WBC, but not as much as gonorrhea.
\u2022
Causes trachoma in childbirth: blindness
\u2022
Difficult to urinate in the morning, mucous obstructs urethra.
\u2022
Sore throats may be the result of sexually transmitted disease from oral sex
\u2022
Females may be asymptomatic.
\u2022
Progression: starts as discomfort, this may be ignored, then it moves into chronic case.
\u2022
Associated with infertility in women: fibrosis in fallopian tubes.
HERPES
\u2022
Tends to affect area that it first came in contact with the body.
\u2022
In neonates, causes meningitis, (in everyone?) causes renal complications, septicemia and death. Not just cold
sores.
\u2022
Vesicles. Unique presentation. Tzank smear: almost never required because of presentation. History + fluid filled
vesicles + pain\u2026 not much else it could be.
\u2022
Herpes lives in nerves, expressed in vesicles.
\u2022
Contagious before vesicles burst. May spread to other nerve endings in vicinity during outbreak (autoinfection)
\u2022
The virus does not die. Immune system allows it to continue living.
\u2022
Can lead to erosions, loss of skin. PAIN.
\u2022
Most transmissions occur when there are no visible lesions.
\u2022
Sex education should begin very early!
\u2022
HSV I tends to cause: encephalitis, conjunctivitis, gigivostormatitis tonsillitis labialis, pharyngitis esophagitis, herpes
gladiatorum, tracheobronchitis, genital herpes, herpes whitlow.
\u2022
HSV II tends to cause meningitis, gingivostomatitis tonsillitis labialis, pharyngitis, perianal herpes, genital herpes,
herpes whitlow.
\u2022
PRODOMAL ITCHING AND TINGLING: this is vesicles forming: skin is detaching from dermatome.
\u2022
Not many DDxs, but add chicken pox to list.
\u2022
Primary and secondary lesions are different.
\u2022
Manage through lifestyle, managing stressors
\u2022
Immunocompromised patients: different presentation. More likely to progress from cold sore to more systemic effects.
CONDYLOMA ACUMINATA
\u2022
No erythema, no pain. Flesh-coloured mass.
\u2022
In feet, plantar wart, can be painful as you are walking on it all day.
\u2022
Less well-circumscribed on mucous membranes. Can be tiny patches (in slide at vagina)
\u2022
During pregnancy, immune system is suppressed: condyloma can take over.
\u2022
Molluscum contagiosum: ddx. This is an umbilicated growth. See this in pediatric cases.
DDX LECTURE 36, FEBRUARY 28th, 2007 \u2013 PAGE 1
LYMPHOGRANULOMA VENERIUM
\u2022
Caused by chlamydia. Typically problem in developing countries.
\u2022
Swollen glands, ulceration of skin, lymph nodes. Bilateral or unilateral lymphadenopathy that is painful and that ISN\u2019T
GOING AWAY.
\u2022
Patient may not see vesicles, may not know that they had an infection.
\u2022
Buboes: coalesced lymph nodes that have come together.
SYPHILIS
\u2022
Angry-looking sore. Tends to be large, surrounded by redness. Patient feels nothing: this is pathognomonic. Not
herpes, not acne\u2026 No pain felt because syphilis affects the nerves.
\u2022
Hard, solitary, painless sore. UNMISTAKABLE. Would have painless lymphadenopathy.
\u2022
Rash on palms and soles: look for this.
\u2022
Condyloma lata: can be mistaken for fungal infection: causes hair loss.
\u2022
Tertiary syphilis: Gumma. Immune system is waking up. Covers offending cells with fibrous tissue. Causes lots of
problems throughout the body.
\u2022
Know syphilis well for NPLEX
\u2022
VDRL, RPR; if these don\u2019t come back +, need help of specialist. More specialized tests that we can\u2019t order.
CHANCROID
\u2022
Like painful primary syphilis. If you have a nodule that looks syphilitic, but is PAINFUL, consider chancroid.
\u2022
Much less serious than syphilis.
ERECTILE DYSFUNCTION (ED)
\u2022
May be primary or secondary.
\u2022
Psychogenic probably about 30%. Can\u2019t assume that this is a factor in all cases: look for organic causes too.
General causes of ED: (in order from least common to most common)
\u2022
Endocrine: elevated prolactin, hypothyroidism, Cushing\u2019s syndrome.
\u2022
Neurogenic: Peripheral neuropathy: can be caused by
o
diabetes,
o
kidney function loss: when the kidneys can\u2019t get rid of wastes, the nerves get irritated, causes neuropathy
o
malnourishment.
o
Stroke, spinal cord injuries, MS,
\u2022
Pharmacologic: 25% is related to a drug of some sort (includes natural drugs)
\u2022
Psychogenic: about 30%. Much less common than previously thought: past 10 years the focus has been on this.
Depression, stress (can increase or decrease sexual function), personal beliefs, general anxiety.
\u2022
Vascular: major cause is atherosclerosis.
Evaluation: is it sexual desire (psychogenic), erection, orgasm difficulty (may be psychogenic or functional, more likely to
be psychogenic)?
This page will be sent to us will answers filled out!
\u2022
DDX LECTURE 36, FEBRUARY 28th, 2007 \u2013 PAGE 2

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