What causes genital inflammation?

Causes of Genital Inflammation

Genital inflammation is primarily caused by sexually transmitted infections (STIs), bacterial vaginosis, and other infectious agents, which require prompt diagnosis and treatment to prevent serious complications including infertility and increased HIV acquisition risk.

Common Infectious Causes of Genital Inflammation

Sexually Transmitted Infections

• Chlamydia trachomatis - Often asymptomatic but a major cause of genital inflammation 1
• Neisseria gonorrhoeae - Can cause significant inflammation in both men and women 2
• Trichomonas vaginalis - Causes 2-5% of urethritis cases in men and vaginal inflammation in women 2
• Mycoplasma genitalium - Though one study found it wasn't associated with increased inflammation in young women 3
• Human Papillomavirus (HPV) - Can cause genital warts and inflammation 2

Non-STI Infectious Causes

• Bacterial vaginosis - Disruption of normal vaginal flora leading to inflammation 2, 4
• Candida species (Vulvovaginal candidiasis) - Causes pruritus, discharge, and inflammation 2
• Enteric bacteria (e.g., E. coli) - Particularly in men who are insertive partners during anal intercourse 2
• Fungi and mycobacteria - More common causes of inflammation in immunosuppressed patients 2

Clinical Manifestations of Genital Inflammation

In Women

• Vaginal discharge
• Pruritus and vaginal soreness
• Vulvar burning
• Dyspareunia (painful intercourse)
• External dysuria 2

In Men

• Urethral discharge (mucoid or purulent)
• Burning during urination
• Testicular pain and tenderness (in epididymitis)
• Hydrocele and palpable swelling of the epididymis 2

Diagnostic Approach

For Men with Suspected Urethritis/Epididymitis

1. Gram-stained smear of urethral exudate (≥5 polymorphonuclear leukocytes per oil immersion field indicates inflammation)
2. Culture or nucleic acid amplification test for N. gonorrhoeae and C. trachomatis
3. Examination of first-void urine for leukocytes
4. Syphilis serology and HIV testing 2

For Women with Suspected Genital Inflammation

1. Evaluation for vulvovaginal candidiasis (white discharge, pruritus, erythema)
2. Testing for bacterial vaginosis
3. Screening for STIs, particularly chlamydia and gonorrhea
4. Assessment for pelvic inflammatory disease if upper tract symptoms present 2

Treatment Considerations

For STI-Related Inflammation

• For chlamydial infections: Doxycycline 100 mg orally twice daily for 7 days (preferred) or azithromycin 1 g orally in a single dose 1
• For gonococcal infections: Ceftriaxone 250 mg IM in a single dose plus doxycycline 2
• For epididymitis: Treatment depends on likely cause:
  • If likely STI-related: Ceftriaxone 250 mg IM plus doxycycline 100 mg orally twice daily for 10 days
  • If likely enteric organisms: Ofloxacin 300 mg orally twice daily for 10 days 2

For Non-STI Inflammation

• For vulvovaginal candidiasis: Short-course topical azoles for uncomplicated cases; 7-day topical therapy for pregnant women 2
• For bacterial vaginosis: Appropriate antibiotic therapy based on clinical presentation

Partner Management

• Sex partners should be evaluated and treated if they had sexual contact with the infected individual during the 60 days preceding symptom onset 1
• Patients should abstain from sexual activity until they and their partners complete treatment and are asymptomatic 1

Complications and Prevention

Complications of Untreated Genital Inflammation

• Pelvic inflammatory disease
• Tubal scarring
• Infertility
• Ectopic pregnancy
• Increased risk of HIV acquisition (3-fold higher risk with genital inflammation) 4, 5

Prevention Strategies

• Regular STI screening for at-risk populations
• Consistent and correct condom use
• Prompt treatment of infections
• Partner notification and treatment 1

Special Considerations

HIV-Infected Patients

• Patients with HIV and uncomplicated epididymitis should receive the same treatment regimen as HIV-negative patients
• However, fungi and mycobacteria are more likely causes of epididymitis in immunosuppressed patients 2

Pregnancy

• Pregnant women with suspected PID should be hospitalized and treated with parenteral antibiotics due to high risk for maternal morbidity and fetal complications 2
• Only 7-day topical azole therapies are recommended for vulvovaginal candidiasis during pregnancy 2

Genital inflammation is a significant health concern that increases the risk of HIV acquisition and can lead to serious reproductive health complications if not properly diagnosed and treated. Prompt identification and management of the underlying cause is essential for preventing long-term sequelae.