By Anthony Wisdom
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Additional info for A Colour Atlas of Sexually Transmitted Diseases
Further sources of confusion are lack of specificity in symptoms, the frequent finding that disease may affect several anatomical sites simultaneously, and the terminology used by patients. Paradoxically, it is also quite common for symptoms to be noticed only by their absence after treatment the patient is aware of a change when symptoms, previously ignored, disappear. In this subsection the significance of some of the more frequent symptoms is discussed in more detail. Inevitably there is considerable overlap.
The history is usually diagnostic w^hen the bleeding is caused by trauma. Vulval ulceration, urethral caruncle, acute and acute urinary tract infections may be the cause of the bleeding and with these conditions other symptoms are usually present. Ectopy of the cervix is frequently observed and may cause intermenstrual or postcoital bleeding; other cervical lesions such as ulceration, endometriosis or polyp may cause similar symptoms but are less common. Contraceptive methods must always be considered in any patient with this complaint - oral contraceptive agents and intra-uterine devices are both fairly frequently associated with menstrual irregularity and intermenstrual spotting.
Skin symptoms Most symptoms originating from vulval cutaneous tissues have already the paragraphs referring to discharge and vulval symptomatology but some patients present with symptoms originating on the pubis. The aetiology of this symptom is similar in male and female patients and the reader is referred to page 33. In practice, it is noticeable that females appear much less likely to become anxious about skin symptoms when these are the sole abnormality present; most female patients who mention skin symptoms have other symptoms which are the main reason for attendance.
A Colour Atlas of Sexually Transmitted Diseases by Anthony Wisdom