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Signs and symptoms

Chronic mucocutaneous candidiasis

Findings reveal disfiguring lesions of the face, scalp, hands, and nails. Chronic mucocutaneous candidiasis is occasionally associated with oral thrush and vitiligo.

Oropharyngeal candidiasis

Individuals with oropharyngeal candidiasis (OPC) usually have a history of HIV infection, wear dentures, have diabetes mellitus, or have been exposed to broad-spectrum antibiotics or inhaled steroids. Although patients are frequently asymptomatic, when symptoms do occur, they can include the following:

• Sore and painful mouth
• Burning mouth or tongue
• Dysphagia
• Thick, whitish patches on the oral mucosa

Physical examination reveals a diffuse erythema and white patches that appear on the surfaces of the buccal mucosa, throat, tongue, and gums.

The following are the 5 types of OPC:

• Membranous candidiasis - One of the most common types; characterized by creamy-white, curdlike patches on the mucosal surfaces
• Chronic atrophic candidiasis (denture stomatitis) - Also thought to be one of the most common forms of the disease; presenting signs and symptoms include chronic erythema and edema of the portion of the palate that comes into contact with dentures
• Erythematous candidiasis - Associated with an erythematous patch on the hard and soft palates
• Angular cheilitis - Inflammatory reaction characterized by soreness, erythema, and fissuring at the corners of the mouth
• Mixed - A combination of any of the above types is possible

Esophageal candidiasis

Patients with esophageal candidiasis may be asymptomatic or may have 1 or more of the following symptoms:

• Normal oral mucosa (>50% of patients)
• Dysphagia
• Odynophagia
• Retrosternal pain
• Epigastric pain
• Nausea and vomiting

Physical examination almost always reveals oral candidiasis.

Nonesophageal gastrointestinal candidiasis

The following symptoms may be present:

• Epigastric pain
• Nausea and vomiting
• Abdominal pain
• Fever and chills
• Abdominal mass (in some cases)

Genitourinary tract candidiasis

The types of genitourinary tract candidiasis are as follows:

• Vulvovaginal candidiasis (VVC) - Erythematous vagina and labia; a thick, curdlike discharge; and a normal cervix upon speculum examination 
• Candida balanitis - Penile pruritus and whitish patches on the penis
• Candida cystitis - Many patients are asymptomatic, but bladder invasion may result in frequency, urgency, dysuria, hematuria, and suprapubic pain
• Asymptomatic candiduria - Most catheterized patients with persistent candiduria are asymptomatic
• Ascending pyelonephritis - Flank pain, abdominal cramps, nausea, vomiting, fever, chills and hematuria
• Fungal balls - Intermittent urinary tract obstruction with subsequent anuria and ensuing renal insufficiency

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Molluscum contagiosum,

Viral infection treatment

Caring for Molluscum contagiosum

Molluscum contagiosum thrives under warm and damp conditions, so keep the skin clean and dry. Try and avoid sharing the affected person’s towels, clothing, facecloths, bed-linen and toys to avoid spreading the condition.

Those affected should be dissuaded from scratching the bumps and certainly from squeezing them as this can promote spread to other areas of skin not yet affected. In children with the condition, thorough hand-washing should be encouraged to remove the virus from the hands. Affected children do not need to stay away from school (or equally, adults, from work).

For adults, shaving on the affected areas should be avoided. Also, if the ano-genital area is affected, refrain from sexual contact until you have seen a healthcare professional.

An introduction to MolluDab

The most common approach GPs currently take when treating Molluscum contagiosum is to do nothing, as the condition often disappears within 12-18 months of its own accord. However, the condition can take longer to resolve and those affected are often highly embarrassed or self-conscious about their condition. Historically, a number of unsuccessful approaches (owing to the pain and scarring) were used to treat Molluscum contagiosum. With the introduction of MolluDab in England, Wales and Northern Ireland, a highly effective treatment is now available. MolluDab has been successfully used in Germany for several years and is the main product paediatricians most often recommend to treat Molluscum contagiosum. As mentioned, it is now available on prescription in England, Wales and Northern Ireland from your GP, or over the counter to order from your pharmacists, . MolluDab is a topical treatment which helps to kill the virus which causes Molluscum contagiosum and removes the bumps far more quickly than leaving the condition to resolve of its own accord. Furthermore, it does not cause the pain or scarring associated with certain physical removal techniques. 

MolluDab works on Molluscum contagiosum

MolluDab contains 5% potassium hydroxide and this is dotted on the Molluscum contagiosum bumps twice daily by parents or the patients themselves. It breaks down the skin cells which encase the virus, to enable the immune system to recognise the virus and respond to it. After around 4-6 days treatment, the immune system mounts an ‘inflammatory reaction’ to Molluscum contagiosum. Once this inflammatory response has cleared the virus, the skin can begin healing and the Molluscum contagiosum lesions disappear after 1- 5 weeks.

How to apply MolluDab to Molluscum contagiosum

The video below demonstrates how to apply MolluDab. In addition, the following instructions are a concise guide on how to use MolluDab. For a full version, a patient leaflet is also available. Click hereto download the patient information leaflet.

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Thrush is an infection that is caused by a yeast fungus. It is not a sexually transmitted infection but can sometimes develop after you have had sex

Thrush can develop in the vagina and on the male and female genitals. It is a very common cause of unusual vaginal discharge – three out of four women will have thrush at some point in their lives. Most men will not get thrush.

Bacterial vaginosis is the most common cause of unusual vaginal discharge which develops when the normal environment of the vagina changes. One in three women will get it at some time. It is not a sexually transmitted infection but can develop after you have had sex. Men do not get bacterial vaginosis.

This page gives you information about thrush and bacterial vaginosis, what you can do if you are worried that you might have either or both infections and how to get treatment. 

Thrush

What is thrush?

Thrush is usually caused by the yeast fungus candida albicans. This yeast lives harmlessly on the skin and in the mouth, gut and vagina. Normally it is kept under control. Occasionally, however, conditions change and signs and symptoms can develop. This is commonly known as thrush, thrush infection or candida, and sometimes as monilia. On this page we use the term thrush.

This information tells you about thrush that develops in the vagina and on the male and female genitals.

What causes thrush to develop?

Your chances of developing thrush increase if you:

• are pregnant
• wear tight clothing (such as tight jeans) or synthetic clothing (such as nylon underwear) that prevents ventilation
• are taking antibiotics
• are having chemotherapy
• have uncontrolled diabetes, HIV or other illnesses that affect your immune system
• use products that may cause irritation of the vagina, such as vaginal deodorant or perfumed bubble bath or shower gel.

What are the signs and symptoms of thrush?

Some people will not have any signs or symptoms at all, and may not be aware they have thrush. If you do get symptoms you might notice:

Women

• Itching, soreness and redness around the vagina, vulva (the lips around the opening to the vagina) or anus (the opening to the rectum).
• Unusual, white discharge from the vagina that may be thick and look like cottage cheese. It sometimes smells yeasty.
• Pain when passing urine.
• Pain when having sex.

Men

• Irritation, burning or itching under the foreskin or on the tip of the penis.
• Redness, or red patches, under the foreskin or on the tip of the penis.
• A thin or thicker discharge, like cottage cheese, under the foreskin which sometimes smells yeasty.
• Difficulty in pulling back the foreskin.

How will I know if I have thrush?

If you think that you may have thrush you can speak to your doctor, nurse or pharmacist. Thrush is not a sexually transmitted infection but it is important that you don’t delay seeking advice if you think you may have been at risk of a sexually transmitted infection.

What does the test involve?

Women

A doctor or nurse may:

• look at the vagina and genital area
• use a swab to collect a sample of cells from the vagina, during an internal examination.

You may be asked to use a swab or tampon yourself to get a sample.

Men

A doctor or nurse may:

• look at the penis and genital area
• use a swab to collect a sample of cells from the genital area including under the foreskin.

A swab looks a bit like a cotton bud, but is smaller, soft and rounded. The swab is wiped over the parts of the body that could be affected and easily picks up samples of discharge and cells. It only takes a few seconds and is not usually painful, though it may be uncomfortable for a moment.

Samples taken during the examination are looked at under a microscope to check for thrush. Sometimes the result is available immediately. If the sample is sent to a laboratory for testing, the result is usually available within a week.

Sometimes thrush signs will be noticed during a cervical screening test, but you will only need treatment if you have problems with discharge or itching. Routine blood tests do not detect infections such as thrush.

How accurate are the tests?

Tests for thrush are usually very accurate in women. They are less accurate in men, so diagnosis in men is often made by looking at the penis and genital area.

Where can I get a test?

You can have a test as soon as you have signs and symptoms. There are a number of services you can go to. Choose the service you feel most comfortable with.

A test can be done at:

• a genitourinary medicine (GUM) or sexual health clinic
• your general practice
• some contraception clinics and young people’s services.

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What do trichomoniasis symptoms look like?

Like many STIs, there may be no symptoms at all (in half of men and women) – but for those who do develop symptoms, they normally appear within a month of infection.

In women, symptoms include:

• yellow-green vaginal discharge which may have an unpleasant smell
• soreness, swelling and itching in and around the vagina
• pain when passing urine or having sex
• pain in the lower stomach

For men, there may be:

• thin, white discharge from the penis
• pain or a burning sensation when urinating
• soreness, swelling and redness around the head of the penis and foreskin3

You can't diagnose trichomoniasis by looking at pictures because symptoms vary from person to person. See your doctor or healthcare worker if you think you have trichomoniasis.

Can I get tested for trichomoniasis?

You can be tested for trichomoniasis whether you have symptoms or not.

You will need to see your doctor or healthcare worker who will examine your genital area for any visible symptoms and take a swab taken from either the vagina or penis. A urine sample can also be taken from a man.

It takes just a few days for the results to come back. If the doctor strongly suspects you have the infection, treatment may be offered before you get your results.4

You may also be tested for other STIs such as chlamydia and gonorrhoea.

How is trichomoniasis treated?

Trichomoniasis is easily treated. Caught early, it can be cured with antibiotics (usually Metronidazole) either taken twice daily for five to seven days or in a single, larger dose.5

To avoid re-infection, avoid having sex during your treatment. Any recent sexual partners should also be tested and treated.

What happens if I don't get treatment for trichomoniasis?

Complications of trichomoniasis are rare; however, as with other STIs, trichomoniasis increases your chances of getting other STIs, including Hiv. 

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What is syphilis?

Syphilis is a sexually transmitted infection (STI). It can cause serious health problems for women and men if it is not diagnosed and treated.

Syphilis is caused by bacteria that is passed on while having sex.

People can contract syphilis again after it has been cured.

Syphilis can be spread by having sex with an infected person, including oral and anal sex, and sharing sex toys.

In some cases, syphilis can be caught through close contact with the body of a person who has infected syphilis sores.

The syphilis bacterium Treponema pallidumcannot survive for long away from the body, so it can't be caught from using the same toilet, clothing or cutlery or bathroom as an infected person. Syphilis may be spread by injecting drug users sharing needles.

Pregnant women with syphilis can give it to their baby, with the risk of stillbirth.

Despite safer sex campaigns, more than 5,000 people a year are diagnosed with syphilis in England each year. 

Symptoms at each stage of syphilis

Syphilis infection occurs in three stages, each with their own distinct symptoms:

Stage 1: Primary syphilis

The first symptoms of syphilis are a painless but very infectious sore or ulcer known as a chancre, on the genitals or around the mouth. The infection is spread by contact with these sores, which last around two to six weeks. During this stage, a person may also experience swollen lymph glands, including those in the neck, groin or armpits.

Stage 2: Secondary syphilis

The next stage of syphilis symptoms includes a non-itchy skin rash and sore throat lasting a few to several weeks. A person may also feel tired and experience headaches. Other symptoms include fever, weight loss, patches of hair loss and joint pain. The primary and secondary stages are when there is a greater risk of passing the infection to other people.

This is followed by a hidden or latent stage where no symptoms are experienced. This can last for some years.

Stage 3: Tertiary syphilis

This third stage of syphilis is the most dangerous, affecting around a third of people who are not treated for syphilis in the earlier stages. Tertiary syphilis can cause damage to the brain, nerves, eyes, heart, bones, skin or blood vessels. This may lead to serious or even life-threatening conditions including stroke, heart disease, dementia, loss of co-ordination, numbness, paralysis or becoming blind or deaf.

People with syphilis are around three to five times more likely to be infected with HIV, which can enter the body through any syphilis sores that start to bleed during sex

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Chancroid 

What is chancroid?

Chancroid is a highly contagious yet curable sexually transmitted disease (STD) caused by the bacteria Haemophilus ducreyi [hum-AH-fill-us DOO-cray]. Chancroid causes ulcers, usually of the genitals. Swollen, painful lymph glands, or inguinal buboes [in-GWEEN-al BEW-boes], in the groin area are often associated with chancroid. Left untreated, chancroid may facilitate the transmission of HIV.

How common is it?

The prevalence of chancroid has declined in the United States. When infection does occur, it is usually associated with sporadic outbreaks. Worldwide, chancroid appears to have declined as well, although infection might still occur in some regions of Africa and the Caribbean. Chancroid, as well as genital herpes and syphilis, is a risk factor in the transmission of HIV infection.

A definitive diagnosis of chancroid requires the identification of H. ducreyi on special culture media that is not widely available from commercial sources; even when these media are used, sensitivity is less than 80 percent. No FDA-cleared PCR test for H. ducreyi is available in the United States, but such testing can be performed by clinical laboratories that have developed their own PCR test and have conducted a CLIA verification study.

The combination of a painful genital ulcer and tender suppurative inguinal adenopathy suggests the diagnosis of chancroid. A probable diagnosis of chancroid, for both clinical and surveillance purposes, can be made if all of the following criteria are met: 1) the patient has one or more painful genital ulcers; 2) the patient has no evidence of T. pallidum infection by darkfield examination of ulcer exudate or by a serologic test for syphilis performed at least seven days after onset of ulcers; 3) the clinical presentation, appearance of genital ulcers and, if present, regional lymphadenopathy are typical for chancroid; and 4) a test for HSV performed on the ulcer exudate is negative.

How do people get chancroid?

Chancroid is transmitted in two ways:

• sexual transmission through skin-to-skin contact with open sore(s).
• non-sexual transmission when pus-like fluid from the ulcer is moved to other parts of the body or to another person.

A person is considered to be infectious when ulcers are present. There has been no reported disease in infants born to women with active chancroid at time of delivery.

What are the signs or symptoms of chancroid?

• Symptoms usually occur within four days to ten days from exposure. They rarely develop earlier than three days or later than ten days.
• The ulcer begins as a tender, elevated bump, or papule, that becomes a pus-filled, open sore with eroded or ragged edges.
• The ulcer is soft to the touch (unlike a syphilis chancre that is hard or rubbery). The term soft chancre is frequently used to describe the chancroid sore.
• The ulcers can be very painful in men but women are often unaware of them.
• Because chancroid is often asymptomatic in women, they may be unaware of the lesion(s).
• Painful lymph glands may occur in the groin, usually only on one side; however, they can occur on both sides.

How is chancroid diagnosed?

Diagnosis is made by isolating the bacteria Hemophilus ducreyi in a culture from a genital ulcer. The chancre is often confused with syphilis, herpes or lymphogranuloma venereum; therefore, it is important that your health care provider rule these diseases out.
A Gram stain to identify H. ducreyi is possible but can be misleading because of other organisms found in most genital ulcers.

What is the treatment for chancroid?

Successful treatment for chancroid cures the infection, resolves the clinical symptoms, and prevents transmission to others. In advanced cases, scarring can result, despite successful therapy.
Antibiotics used to treat chancroid include; Azithromycin 11 g orally, Ceftriaxone 250 mg intramuscularly (IM), Ciprofloxacin 500 mg orally or Erythromycin 500 mg orally.
Ciprofloxacin is contraindicated for pregnent and lactating women.
Azithomycin and ceftriaxone offer the advantage of single-dose therapy. Worldwide, several isolates with intermediate resistance to either ciprofloxacin or erythromycin have been reported. However, because cultures are not routinely performed, data are limited regarding the current prevalence of antimicrobial resistance.

Follow-up

Patients should be re-examined three days to seven days after initiation of therapy. If treatment is successful, ulcers usually improve symptomatically within three days and objectively within seven days after therapy. If no clinical improvement is evident, the clinician must consider whether 1) the diagnosis is correct, 2) the patient is coinfected with another STD, 3) the patient is infected with HIV, 4) the treatment was not used as instructed, or 5) the H. ducreyi strain causing the infection is resistant to the prescribed antimicrobial. The time required for complete healing depends on the size of the ulcer; large ulcers might require greater than two weeks. In addition, healing is slower for some uncircumcised men who have ulcers under the foreskin. Clinical resolution of fluctuant lymphadenopathy is slower than that of ulcers and might require needle aspiration or incision and drainage, despite otherwise successful therapy. Although needle aspiration of buboes is a simpler procedure, incision and drainage might be preferred because of reduced need for subsequent drainage procedures.

Other Management Considerations

Men who are uncircumcised and patients with HIV infection do not respond as well to treatment as persons who are circumcised or HIV-negative. Patients should be tested for HIV infection at the time chancroid is diagnosed. If the initial test results were negative, a serologic test for syphilis and HIV infection should be performed three months after the diagnosis of chancroid.

Special Considerations

Pregnancy

Ciprofloxacin is contraindicated during pregnancy and lactation. No adverse effects of chancroid on pregnancy outcome have been reported.

How can chancroid be prevented?

• Abstinence (not having sex)
• Mutual monogamy [having sex with only one uninfected partner]
• Latex condoms for vaginal, oral and anal sex. Using latex condoms may protect the penis or vagina from infection, but does not protect other areas such as the scrotum or anal area. Chancroid lesions can occur in genital areas that are covered or protected by a latex condom, but may occur in areas that are not covered or protected by a condom. Latex condoms, when used consistently and correctly, can reduce the risk of chancroid, genital herpes, syphilis, and genital warts, only when the infected areas are covered or protected by the condom.

If you do get chancroid, avoid contact with the infected area to prevent chance of spreading the infection to other parts of the body.

Why worry?

Chancroid has been well established as a cofactor for HIV transmission. Moreover, persons with HIV may experience slower healing of chancroid, even with treatment, and may need to take medications for a longer period of time. Complications from chancroid include:

• In 50 percent of cases, the lymph node glands in the groin become infected within five to eight days of appearance of initial sores.
• Glands on one side become enlarged, hard, painful and fuse together to form a bubo (BEW-bo), an inflammation and swelling of one or more lymph nodes with overlying red skin. Surgical drainage of the bubo may be necessary to relieve pain.
• Ruptured buboes are susceptible to secondary bacterial infections.
• In uncircumcised males, new scar tissue may result in phimosis [constriction so the foreskin cannot be retracted over the head of the penis]. Circumcision may be required to correct this.

What should I tell my partner?

You should talk to your partner as soon as you learn you have chancroid. Telling a partner can be hard, but it's important that you talk to your partner as soon as possible so she or he can get treatment.

How do I address the subject with my health care provider?

If you have a genital ulcer or painful, swollen lymph nodes, you need to talk to your doctor about whether or not you should be tested. However, it's important to remember that some people, usually women, are asymptomatic. If you are having unprotected sex or discover that your partner is having unprotected sex with another person, you may want to ask your doctor about being tested for STDs.
 

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Pubic lice symptoms

Usually, the symptoms of pubic lice start about 5 days after you get them. Some people never have symptoms, or they think the symptoms are caused by something else (like a rash).

The most common symptom of pubic lice is intense itching in your pubic area. The itching and irritation is caused by your body’s reaction to the crabs’ bites.  

Pubic lice symptoms include:

• Lots of itching in your genital area.
• Super small bugs in your pubic hair. You can usually see pubic lice by looking closely, or you may need to use a magnifying glass. Pubic lice are tan or whitish-gray, and they look like tiny crabs. They get darker when they’re full of blood.
• Crab eggs (called nits) on the bottom part of your pubic hairs. Nits are really small and can be hard to see. They’re oval and yellow, white, or pearly. Nits usually come in clumps.
• Dark or bluish spots on the skin where pubic lice are living. These spots come from the crabs’ bites.
• Feeling feverish, run-down, or irritable.

Crabs usually hang out in your pubic hair around your genitals, which is why it’s easy to get them from sex. But crabs can sometimes end up in other kinds of coarse hair, like your eyelashes, eyebrows, chest hair, armpits, beard, or mustache. It’s really, really rare to get pubic lice in the hair on top of your head.