Urogenital symptoms presenting in general practice
Urogenital symptoms presenting in general practice |
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Key Words: dysuria; genital discharge; vulval soreness; antibiotics; antifungals
Introduction
Some patients present with urogenital symptoms such as genital discharge, soreness and painful micturition to their general practitioner. When they present for the first time we don't investigate apart from male patients suspected of urinary tract infection. Unless the problem persists we do not perform investigations. This may be because of time constraints, however if there is need to take swabs in female patients they are sent to the practice nurse. In many cases we believe that in women the symptoms are due to thrush, and for men we try to rule out urinary tract infection. This study was done to review the management of urogenital symptoms (men and women) in our practice. There are six doctors in our practice, 2 female and 4 male and generally female patients with urogenital problems tend to see female doctors. The size of our practice is 12,000.
Methods and Patients
Using the practice computer details of all women who were prescribed antifungals and, trimethoprim for urinary tract infection in men were extracted. Thirty-two female notes and 8 male notes were extracted for the period January-April 2000. These were carefully
analysed.
Results
Among the 32 female patients, nine (28%) were below the age of 30 years [figure 1] and for the males, the age ranged between 15-37 years. Symptomatically, 19 females complained of discharge and 13 complained of soreness. There were combinations of symptoms in 5 patients. The diagnosis of candidosis was made from a cervical cytology report of one patient. With regards to predisposing factors, 6 patients (18.75%) had diabetes mellitus and 3 patients (9.4%) had just completed a course of antibiotics. Among the eight men, dysuria and urgency were the complaints. MSU was done for seven of them but only one (14.3%) grew E.coli on culture. His medication was changed to cephalexin. One man who had genital warts was referred to the genitourinary medicine department.
Comments and discussion
Vulvo-vaginal candidosis is an extremely common condition (1). Whenever a woman presents with vulval soreness in our practice, antifungal cream is usually given. However, pessaries are given if discharge is present, and if there is a combination of symptoms, combipack is given. Topical treatment is the usual first line of treatment before we resort to oral antifungals which are more expensive. In this study only 3 patients (9.4%) had high vaginal swabs done of which one was positive for candida. This is less than the 44% frequency of HVS tests reported in a previous report from this area (2). Our usual practise is to start treatment if we clinically suspect a fungal infection, but if the symptoms do not resolve to perform a high vaginal swab.
In the men who complained of dysuria or urgency, Trimethoprim is prescribed for suspected urinary tract infection and a specimen of urine is sent for culture and sensitivity at the same time. However those who present with urethral discharge are referred to the genito-urinary medicine clinic.
Conclusion
Considering that 28% of the patients in this study are below 30 years of age and urinary tract infections are uncommon in males below the age of 30 years, it may be prudent for GPs to be more aware of sexually transmitted infections and refer more patients to the local GUM clinics. This is a sensitive issue because the doctor needs to avoid upsetting doctor/patient relationship in general practice. Some patients may think that the doctor is doubting their character or morality. Sexually transmitted infections are more prevalent than some general practitioners think, as I have found out since I have been working in a genito-urinary medicine clinic. General practitioners should not be afraid to raise the issue of sexually transmitted infections with their patients.
References
* Dr Patel also works as a Clinical Assistant in Genito-urinary Medicine department at Middlesbrough General Hospital
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