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Infection > 9 Sexually transmitted + urinary infections > Flashcards

9 Sexually transmitted + urinary infections Flashcards

1
Q

prevalence of symptomatic UTIs in men and young non-pregnant women

A

<0.1%, 1-3%

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2
Q

incidence of symptomatic UTIs in women increase with..

A

age and if they’re sexually active

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3
Q

what is asymptomatic bacteriuria

A

when there is bacteria in the urine but is causing no symptoms or problems, no adverse outcomes on follow up
100% of long term indwelling catheters

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4
Q

what is the main route of getting a UTI and what other is rare

A

the ascending route= main

haematogenous route= through blood, rare

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5
Q

describe the ascending route

A

intestinal flora comes down lower GI tract and lives on surface of skin
migrates towards gynae and urethra
get vaginal and urethral colonisation of uropathogenic strains of bacteria
gradually bacteria climb up urethra

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6
Q

what increases the chance of vaginal and peri-urethral colonisation (4)

A

diarrhoea
oestrogen deficiency- change in bacterial flora
spermicides- increase bacterial numbers and adherence
antibiotics

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7
Q

urodynamics preventing UTIs

A

urine flushes out bacteria in urethra, problem with structure can cause difficulties

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8
Q

what makes bacteria good at climbing up urethra

A

motile flagellae

adherence

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9
Q

describe how bacteria climbs up urethra through 2 mechanisms of motile flagellae

A

type 1 fimbriae of bacteria bind to mannose-containing epithelial receptors Uroplakin 1 and 2 of urethra (spiderman)
we produce Tamm Horsfall Protein to fool E.coli/bacteria to bind to it instead, and remove in urine
IgA also binds
ALSO
produces P fimbriae which binds to Gal-Gal which are present on surface of urethral epithelial cells (and red blood cells)

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10
Q

name 2 motile flagellae bacteria has

A

type 1 and P

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11
Q

what is a convene

A

like a condom with a tube at the end, urine goes through into a bag, instead of a urinary catheter
risk of UTI

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12
Q

pathogens in UTIs

A 
main= E. Coli
Staphylococcus saprophyticus= 5-15% of sexually active young women
proteus
pseudomonas
klebsiella
enterobacter
enterococcus
staphylococcus aureus- doesn't typically ascend, haematogenous, take another sample and also take blood culture
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13
Q

what’s cystitis

A

pain on passing urine

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14
Q

symptoms of a lower UTI

A 
cystitis
dysuria
frequency
urgency
suprapubic pain
sometimes haematuria (blood in urine) and fever
cloudy smelly urine
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15
Q

what is pyelonephritis

A

upper UTI infection, infection in kidneys

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16
Q

symptoms of pyelonephritis

A

loin pain and tenderness
fever
sometimes nausea and vomiting
+/- lower UTI symptoms

17
Q

other presentations of UTIs

A

children under 2, failure to thrive

older adults, increased confusion

18
Q

how to diagnose a UTI

A

sometimes based on history and examination alone
urinalysis
mid stream urine, start to wee, stop, start and take sample to avoid getting bacteria

19
Q

what to look for in urinalysis for UTI

A

nitrite- formed by the action of bacterial nitrate reductase (NR) in enterobacteriacae
if no bacteria around, this shouldn’t happen, not always positive if bacteria is there since some don’t have NR

leucocyte esterase- chemical conversion of an ester
false negatives- in presence of blood, on antibiotics (nitrofurantoin, rifampicin)
false positives- co-amoxiclav

20
Q

urine microscopy and culture

A

pyuria= white cells in urine
>100 leukocytes/ml is significant
culture if significant
>10^5 organisms/ml= diagnose

21
Q

management of UTI

A

asymptomatic
- culture positive
- repeat urine culture
- always treat in pregnant women, because increased likelihood of early delivery
symptomatic
- be cautious in renally impaired
- empirial treatment or
- treat after urinalysis and send mid stream urine or
- treat after mid stream urine result is available
may need imaging

22
Q

non-specific therapy for UTI

A

fluid re-hydration
urinary pH- low is antibacterial, difficult to keep low
analgesia not recommended but can be helpful for symptoms alleviation

23
Q

antimicrobial chemotherapy- antibiotics for UTI

A

need ability to reach good concentration in urine, more important than in blood
dose modification in renal failure
nitrofurantoin- don’t use for anything else
pivmecillinam- penicillin but can still have if allergic
fosfomycin- one off dissoluble in water then 3 days later
oral cephalosporins- not always brilliant;y absorbed
co-amoxiclav- increasing resistance
(trimethoprim)- traditionally used but too high a resistance, use if sensitive but not empirically
(amoxicillin)- high resistance

if kidney infection
give IV because will be vomiting
tazocin
aminoglycosides (gentamicin)- monitor renal function
quinolones (ciprofloxacin)- oral so may not be helpful if vomiting

24
Q

length of antibiotic treatment in UTIs

A

cystitis= 3 days, better than single dose and as good as 7 days
pyelonephritis= 10-14 days
be wary that some drugs might not get into kidney parenchyma

25
Q

consequences of treatment in UTI

A 
cure= negative culture after 1-2 weeks
persistence= bacteriuria after 48 hours of treatment
relapse= within 1-2 weeks with the same organism
reinfection= different bug whilst on treatment of after finishing
26
Q

what is herpes simplex 2- superficial

A

STI- painful ulcers with local lymphadenopathy (enlarged lymphnodes in groin)
recurrent when run down
confirm diagnosis with PCR- sample from base of ulcer
treat with acyclovir
may need long term suppression
may transmit virus without ulcers

27
Q

what is syphilis

A

primary
often non-painful, might have no idea if in vagina
local lymphadenopathy
may heal spontaneously- latency

secondary
macular, coppery rash, may involve palms and soles
may become latent again

tertiary
serious and diverse complications

diagnose with dark ground microscopy
serology- s and t

28
Q

treatment of syphilis- early, secondary and early latent

A

benzathine penicillin G- single injection
procaine penicillin- injection for 14 days
doxycycline if penicillin allergic for 15 days, not as effective

29
Q

treatment of syphilis- tertiary

A

benzathine 3x weekly
doxycycline for 28 days
in all patients monitor serological response
re-infection possible
want negative VDRL, EIA and TPPA test will stay positive

30
Q

what’s chancroid infection

A

ulcers similar to syphilis but the base is more necrotic with exudate- ooses
usually single lesions
gram negative
treat with azithromycin or ceftriaxone (both single dose)

31
Q

other STI ulcers

A

granuloma inguinale

lymphogranuloma venereum- form of chlamydia

32
Q

what is urethritis/cervicitis

A

urethral/cervical infection with discharge
dysuria/deep dyspareunia (painful sexual intercourse)
swab for gram stain, microscopy and culture
looking for gram negative diplococci (gonorrhoea)
first pass urine testing, self vaginal swab

33
Q

infection in urethritis/cervicitis

A

N. Gonnorrhoeae
chlamydia trachomatis
Herpes simplex

34
Q

gonorrhoea- complications beyond genital tract

A 
conjunctivitis- can pass to baby and it can go blind if not treated
septic arthritis
pharyngeal infection
peri-hepatitis- stranding around liver
disseminated disease
pelvic inflammatory disease
35
Q

chlamydia -complications beyond genital tract

A

conjunctivitis

pelvic inflammatory disease

36
Q

treatment of gonorrhoea and problems

A

penicillin resistance
chromosomal resistance also developed to penicillin to make concentrations difficult so they’re not used
routine use of ciprofloxacin until resistance imported from overseas

traditional treatment- single dose
ceftriaxone IM and azithromycin 1g oral dose

but increasing resistance to both of these XDR, extreme drug resistance

37
Q

traditional treatment for urethritis not from gonorrhoea

A

azithromycin but due to resistance change to 1g plus 2 further doses so they complete the course
make pregnant women and those with persistent symptoms come back to test symptoms

38
Q

empirical treatment of STI coinfections

A

gonorrhoea and chlamydia
chlamydia and mycoplasma genitalium
CRO IM one off dose AND doxycycline for a week

39
Q

what causes genital warts

A 
human papillomavirus
range of size and shape
asymptomatic
treatment= scraping, cryotherapy (freezing), keratolytics, podophyllin, imiquimod
apply to skin

Infection (18 decks)

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