enital Disorder

Definition: Balanitis is inflammation of the glans penis. When the foreskin (or prepuce) is also affected, it is termed balanoposthitis.
Etiology: Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection by a wide variety of pathogens, including bacteria, virus, or fungus—each of which require a particular treatment.
Clinical Features: The symptoms of balanitis are limited to the foreskin and head of the penis (in circumcised men, only the head is affected). These include redness, inflammation, pain, discharge, sore or itchy skin, and difficulty retracting the foreskin.
Clinical Approach: Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathologic examination of a biopsy.
Treatment: Since anaerobic conditions are necessary for growth of the offending organisms, simple exposure to air and local cleansing is most often effective. Formerly, this treatment, used with peroxide powder and arsphenamine and, in severe cases, a dorsal slit, was the extent of therapy. With the advent of penicillin and other systemic and local antibiotics, the treatment is specific and effective; however, even now a dorsal slit procedure is sometimes necessary.

Definition: Chancroid is a sexually transmitted disease caused by a bacterial infection that is characterized by painful sores on the genitals.
Etiology: Haemophilus ducreyi is spread from person to person by vaginal, anal, and oral sexual contact. Uncircumcised men are about three times more likely than circumcised men to become infected following exposure to Haemophilus ducreyi. Having unprotected sex, exchanging sex for drugs, and having unprotected sex with a prostitute are other risk factors.
Clinical Features: The first sign of chancroid is a small, red papule that occurs within three to seven days following exposure to the bacteria, but may take up to one month. Usually within one day, the papule becomes an ulcer. The chancroid ulcer is painful, bleeds easily, drains a grey or yellowish pus, and has sharply defined, ragged edges. They can vary in size from an eighth of an inch to two inches in diameter. Men usually have only one ulcer, but women often have four or more.
Clinical Approach: Part of the diagnosis of chancroid involves ruling out genital herpes and syphilis because genital ulcers are also symptoms of these diseases. The appearance of these three diseases can be close enough to be confusing. However, the presence of a pus-filled lump in the groin of a patient with a genital ulcer is highly specific for chancroid.
Treatment: The only treatment for chancroid is antibiotics given either once or for several days. Antibiotics taken by mouth for one to two weeks include erythromycin (E-Mycin, Ery-Tab), amoxicillin plus clavulanic acid (Augmentin), co-trimoxazole (Bactrim, Septra), or ciprofloxacin (Cipro).

Definition: Genital warts, which are also called condylomata acuminata or venereal warts, are growths in the genital area caused by a sexually transmitted papillomavirus. A papillomavirus is a virus that produces papillomas, or benign growths on the skin and mucous membranes.
Etiology: There are about 80 types of human papillomavirus. Genital warts are caused by HPV types 1, 2, 6, 11, 16, and 18. HPV is transmitted by sexual contact. The incubation period varies from one to six months. The symptoms include bleeding, pain, and odor as well as the visible warts.
Clinical Features: Genital warts vary somewhat in appearance. They may be either flat or resemble raspberries or cauliflower in appearance. The warts begin as small red or pink growths and grow as large as four inches across, interfering with intercourse and childbirth. The warts grow in the moist tissues of the genital areas. In women, they occur on the external genitals and on the walls of the vagina and cervix; in men, they develop in the urethra and on the shaft of the penis. The warts then spread to the area behind the genitals surrounding the anus.
Clinical Approach: The diagnosis is usually made by examining scrapings from the warts under a darkfield microscope. If the warts are caused by HPV, they will turn white when a 5% solution of white vinegar is added. If the warts reappear, the doctor may order a biopsy to rule out cancer.
Treatment: Genital warts were treated until recently with applications of podophyllum resin, a corrosive substance that cannot be given to pregnant patients. A milder form of podophyllum, podofilox (Condylox), has been introduced. Women are also treated with 5-fluorouracil cream, bichloroacetic acid, or trichloroacetic acid. All of these substances irritate the skin and require weeks of treatment.
Genital warts can also be treated with injections of interferon. Interferon works best in combination with podofilox applications. 

Definition: Herpes is the name of a group of viruses that cause painful blisters and sores. One kind of herpes, herpes simplex, causes both cold sores around the mouth and genital herpes (herpes around the sexual organs).
Etiology: There are two types of HSV.

• HSV type 1 causes cold sores (also called fever blisters) on the lips. HSV-1 is generally spread by kissing or by sharing eating utensils (such as spoons or forks) when sores are present. HSV-1 can also cause sores around the genitals.
• HSV type 2 causes sores in the genital area (genital herpes), such as on or around the vagina or penis. HSV-2 also causes the herpes infection seen in babies who are delivered vaginally in women who have genital herpes. HSV-2 is generally spread by sexual contact. HSV-2 can sometimes cause mouth sores.

Clinical Features: Symptoms of herpes outbreaks typically begin with pain, tenderness, or itching in the genital area and may also include fever and headache. Bumps and blisters may appear on the vagina, penis, scrotum, anus, thigh, or buttocks. Blisters soon open to form painful sores that can last up to 3 weeks.
Clinical Approach: Tests for HSV are most often done only for sores in the genital area. In rare cases, the test may be done using other types of samples, such as spinal fluid, blood, urine, or tears. Different types of tests that may be done are:

• Herpes viral culture. Cells or fluid from a fresh sore are collected with a cotton swab and placed in a culture cup. A viral culture is the most specific method of finding a genital herpes infection.
• Herpes virus antigen detection test. Cells from a fresh sore are scraped off and then smeared onto a microscope slide. This test finds markers (called antigens) on the surface of cells infected with the herpes virus. This test may be done with or in place of a viral culture.

Treatment: A herpes infection cannot be cured. Once you become infected with HSV, the virus stays in the body for life. It "hides" in a certain type of nerve cell and causes more outbreaks of sores in some people. Recurring infections can be triggered by stress, fatigue, sunlight, or another infection, such as a cold or flu. Medicine can relieve symptoms and shorten the length of the outbreaks, but medicine cannot cure the infection.

Definition:  Is an inflammatory disease that affects the skin and the oral and genital mucosa.
Etiology: The cause is not known.
Clinical Features: The typical rash of lichen planus is well-described by the "5 P's": well-defined pruritic, planar, purple, polygonal papules. The commonly affected sites are near the wrist and the ankle. The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time. Besides the typical lesions, many morphological varieties of the rash may occur. The presence of cutaneous lesions is not constant and may wax and wane over time. Oral lesions tend to last far longer than cutaneous lichen planus lesions.
Clinical Approach: A preliminary diagnosis may be made on the way your skin or mouth lesions look. A skin lesion biopsy or biopsy of a mouth lesion can confirm the diagnosis.
Treatment: Currently there is no cure but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.
Medicines used to treat lichen planus include:

• Oral and topical steroids.
• Oral retinoids
• immunosuppressant medications
• hydroxychloroquine
• tacrolimus
• dapsone

 Definition: Pearly penile papules are small dome-shaped to filiform skin-colored papules that typically are located on the sulcus or corona of the glans penis. Commonly, lesions are arranged circumferentially in one or several rows and often are assumed wrongly to be transmitted sexually.The appearance of this condition also means it is often mistaken for a sexually transmitted disease.
Etiology: Pearly penile papules are considered a normal variant and harbor no malignant potential. They are not contracted or spread through sexual activity.
Lesions are observed more frequently in uncircumcised males; however, the mechanisms underlying their development remain unknown.
Clinical Features: * On physical examination, pearly penile papules appear as one or several rows of small, flesh-colored, smooth, dome-topped to filiform papules situated circumferentially around the corona or sulcus of the glans penis (Media File 1). Uncommonly, lesions may extend onto the glans penis.
    * Lesions typically are asymptomatic and persist throughout life; however, they gradually may become less noticeable with increased age.
Clinical Approach: Diagnosis made on physical exam. Confirmation of this diagnosis may be obtained by obtaining a biopsy specimen of a lesion for histopathologic analysis.
Treatment: Though there is no risk to your health, you don’t have to live with them. If you are feeling self-conscious or embarrassed by them, carbon dioxide laser ablation can remove or reduce the appearance of the bumps. Before you cringe at the thought of using a laser “down there,” remember that you do not have to do anything at all. Just know that you have an option.