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1DDX: LECTURE 36 – FEBRUARY 28TH, 2007

CONDITIONS OF THE MALE GENITALIA AND REPRODUCTIVE SYSTEM

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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
• Sex + opaque urethral discharge. Take history. Swab, stain, culture the discharge.
• Not limited to men: affects women too.
• Multiple sex partners: risk factor, but not limited to sexual interaction.
• Patient will come in because of pain during urination, not because of discharge.
• May become chronic, pain will lessen over time. These patients may be incubating and spreading the illness without
treating it.
• Patient will have fever, increased WBC count.

CHLAMYDIA
• Sticky, watery discharge. Mucousy, clear discharge. Still contains some WBC, but not as much as gonorrhea.
• Causes trachoma in childbirth: blindness
• Difficult to urinate in the morning, mucous obstructs urethra.
• Sore throats may be the result of sexually transmitted disease from oral sex
• Females may be asymptomatic.
• Progression: starts as discomfort, this may be ignored, then it moves into chronic case.
• Associated with infertility in women: fibrosis in fallopian tubes.

HERPES
• Tends to affect area that it first came in contact with the body.
• In neonates, causes meningitis, (in everyone?) causes renal complications, septicemia and death. Not just cold
sores.
• Vesicles. Unique presentation. Tzank smear: almost never required because of presentation. History + fluid filled
vesicles + pain… not much else it could be.
• Herpes lives in nerves, expressed in vesicles.
• Contagious before vesicles burst. May spread to other nerve endings in vicinity during outbreak (autoinfection)
• The virus does not die. Immune system allows it to continue living.
• Can lead to erosions, loss of skin. PAIN.
• Most transmissions occur when there are no visible lesions.
• Sex education should begin very early!
• HSV I tends to cause: encephalitis, conjunctivitis, gigivostormatitis tonsillitis labialis, pharyngitis esophagitis, herpes
gladiatorum, tracheobronchitis, genital herpes, herpes whitlow.
• HSV II tends to cause meningitis, gingivostomatitis tonsillitis labialis, pharyngitis, perianal herpes, genital herpes,
herpes whitlow.
• PRODOMAL ITCHING AND TINGLING: this is vesicles forming: skin is detaching from dermatome.
• Not many DDxs, but add chicken pox to list.
• Primary and secondary lesions are different.
• Manage through lifestyle, managing stressors
• Immunocompromised patients: different presentation. More likely to progress from cold sore to more systemic effects.

CONDYLOMA ACUMINATA
• No erythema, no pain. Flesh-coloured mass.
• In feet, plantar wart, can be painful as you are walking on it all day.
• Less well-circumscribed on mucous membranes. Can be tiny patches (in slide at vagina)
• During pregnancy, immune system is suppressed: condyloma can take over.
• Molluscum contagiosum: ddx. This is an umbilicated growth. See this in pediatric cases.

DDX LECTURE 36, FEBRUARY 28th, 2007 – PAGE 1


LYMPHOGRANULOMA VENERIUM
• Caused by chlamydia. Typically problem in developing countries.
• Swollen glands, ulceration of skin, lymph nodes. Bilateral or unilateral lymphadenopathy that is painful and that ISN’T
GOING AWAY.
• Patient may not see vesicles, may not know that they had an infection.
• Buboes: coalesced lymph nodes that have come together.

SYPHILIS
• Angry-looking sore. Tends to be large, surrounded by redness. Patient feels nothing: this is pathognomonic. Not
herpes, not acne… No pain felt because syphilis affects the nerves.
• Hard, solitary, painless sore. UNMISTAKABLE. Would have painless lymphadenopathy.
• Rash on palms and soles: look for this.
• Condyloma lata: can be mistaken for fungal infection: causes hair loss.
• Tertiary syphilis: Gumma. Immune system is waking up. Covers offending cells with fibrous tissue. Causes lots of
problems throughout the body.
• Know syphilis well for NPLEX
• VDRL, RPR; if these don’t come back +, need help of specialist. More specialized tests that we can’t order.

CHANCROID
• Like painful primary syphilis. If you have a nodule that looks syphilitic, but is PAINFUL, consider chancroid.
• Much less serious than syphilis.

ERECTILE DYSFUNCTION (ED)


• May be primary or secondary.
• Psychogenic probably about 30%. Can’t 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)
• Endocrine: elevated prolactin, hypothyroidism, Cushing’s syndrome.
• Neurogenic: Peripheral neuropathy: can be caused by
o diabetes,
o kidney function loss: when the kidneys can’t get rid of wastes, the nerves get irritated, causes neuropathy
o malnourishment.
o Stroke, spinal cord injuries, MS,
• Pharmacologic: 25% is related to a drug of some sort (includes natural drugs)
• 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.
• 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!


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