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Medical Microbiology > Bacterial sexually transmitted & urinary tract infections > Flashcards

Bacterial sexually transmitted & urinary tract infections Flashcards

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1
Q

What are the 2 types of UTIs?

A

Complicated
Uncomplicated

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2
Q

Describe uncomplicated UTI

A

Non-pregnant women
No known relevant anatomical/functional abnormalities in urinary tract
Acute, sporadic, recurrent cystitis (inflammation of the bladder)

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3
Q

Describe complicated UTI

A

Congenital abnormality - obstruction, neurological dysfunction
Acquired abnormality - obstruction, neurological dysfunction
Catheter if symptomatic
Young male patient - men do not get UTIs unless there is an underlying reason
Pregnancy
Repeated upper urinary tract infection
Recurrent infections may be common

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4
Q

Why is the incidence of UTIs higher in females?

A

Shorter urethra so bacteria can ascend through the ureters faster

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5
Q

What is the source of organisms causing UTIs?

A

Bacterial flora of the large bowel
Uropathogenic properties

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6
Q

What is vesico-ureteric reflux?

A

Abnormal flow of urine back up the ureters to the kidneys
Can lead to upper urinary tract infection (pyelonephritis)

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7
Q

What is pyelopnephritis?

A

Bacterial infection causing inflammation of kidneys
Occurs as consequence of ascending UTI which spreads from bladder to kidneys

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8
Q

What is the main cause of complicated and uncomplicated UTIs?

A

UPEC (uropathogenic Escherichia coli)

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9
Q

What is asymptomatic bacteriuria?

A

Presence of bacteria in a urine sample of an individual that shows no signs or symptoms of a UTI

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10
Q

Why is asymptomatic bacteriuria important?

A

Rarely causes serious problems unless there is presence of urinary reflux or stasis, in which case cystitis or pyelonephritis may develop

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11
Q

What are risk factors of getting asymptomatic bacteriuria?

A

Female sex
Sexual activity
Diabetes particularly women
Age
Institutionalisation
Presence of catheter

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12
Q

Describe urethral syndrome

A

UTI symptoms but no evidence of infection
Occurs in women ages 30-50
Unknown cause of infection with unusual organisms
Variety of non-antibiotic treatments

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13
Q

What is cystitis?

A

Superficial inflammation of urethra and bladder
More frequent in women

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14
Q

What can cystitis lead to?

A

Upper tract infection

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15
Q

What are symptoms of cystitis?

A

Frequency
Dysuria - pain when passing urine
Haematuria - blood in urine
Urgency
Suprapubic discomfort
Polyuria

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16
Q

What is pyelonephritis?

A

Upper UTI
Direct invasion of renal tissue

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17
Q

What are signs and symptoms of pyelonephritis?

A

Back pain
Fever
Rigors
Renal angle tenderness
May have cystitis
May develop bloodstream infection/sepsis

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18
Q

What can develop from bacteraemia?

A

Renal abscess - blood borne spread e.g Staphylococcus aureus

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19
Q

How are UTIs diagnosed?

A

Urinary dipsticks

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20
Q

What do urinary dipsticks look for?

A

Nitrite detection - bacteria convert nitrate to nitrite
RBCs
WBCs
Protein

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21
Q

What is another quick test that can be done to check for a UTI?

A

Check if urine is turbid (cloudy) - indicates discharge of blood/pus due to UTI OR increased WBCs in urine due to UTI

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22
Q

How is microscopy used to look for UTIs?

A

Presence of WBCs, RBCs, bacteria, casts

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23
Q

How are cultures used to look for UTIs?

A

Quantification of bacteria on selective/differential media
Can see lower counts in early stages of UTI

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24
Q

How is sensitivity used for UTI testing?

A

Check what antibiotics the organisms are sensitive/susceptible to

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25
Q

What factors determine management of UTIs?

A

Age
Sex
Pregnancy
Catheter
Or any other complications

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26
Q

What are symptomatic treatments of UTIs?

A

Hydration
Analgesia
Alkalisation of urine - potassium citrate; relieves symptoms
Can be combined with antibiotics unless mild infection in adult female where antibiotics may be delayed

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27
Q

What is antibiotic-prophylaxis?

A

Antibiotics given to prevent infection
Recommended in children with recurrent infection
Used in some adults with recurrent infection
No help in preventing catheter related infections
Use if instrumentation of infected urine to prevent bacteraemia

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28
Q

What are non-antibiotic treatments for UTIs?

A

Oestrogen suppositories for post-menopausal women
L-Mannose
Cranberry juice/capsules - polyphenols/proanthocyanidins inhibit adhesion of type-1 pili & reduce inflammation

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29
Q

What types of STIs are there?

A

Bacterial
Viral
Parasitic
Infestations

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30
Q

What are STI syndromes?

A

Genital discharge
Genital ulcer disease
Genital and pelvic pain
Dermatoses

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31
Q

What increases the risk of HIV?

A

Herpes
Syphilis

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32
Q

What are long-term consequences of STIs?

A

Infertility
Ectopic pregnancy
Mother to child (MTC) transmission

33
Q

Describe AMR gonorrhoea

A

High fluoroquinolone resistance
Increasing azithromycin resistance
Emerging resistance of extended-spectrum cephalosporins

34
Q

What are the 4 curable STIs?

A

Chlamydia
Gonorrhoea
Trichomoniasis
Syphilis

35
Q

What causes genital ulcer disease?

A

Syphilis
Herpes
Chancroid
Lymphogranuloma venereum (LGV)
Granuloma inguinale (Donovanosis)
Bacterial infection e.g Staphylococcus infection

36
Q

What is the bacterium causing syphilis?

A

Treponema pallidum

37
Q

What is early syphilis?

A

First 2 years of infection
High replication rate of T.pallidum
Relapsing early disease and infectious

38
Q

What is late syphilis?

A

After 2 years of infection
Low replication rate of T.pallidum
Late disease over decade
Non-infectious
Remains in the body and can reactivate over decades and cause various diseases

39
Q

What is the timeline of syphilis infection including symptoms?

A

Primary syphilis - incubation 9-90 days, chancres
Secondary syphilis - up to 2 years, skin and systemic features
Tertiary syphilis - over 10 years later, neuro, cardiac and skin

40
Q

What are condylomata lata?

A

One of the cutaneous signs of secondary syphilis
Wart-like lesions on genitals
Most infectious skin lesions in syphilis

41
Q

How is syphilis diagnosed?

A

Dark ground microscopy from early lesions
- scrub lesion with n.saline, scrape tissue fluid from ulcer base, with cover slip
- under microscope look for corkscrew motility, slinky motility, bendy motility
Alternative = PCR based tests

42
Q

What is another way of diagnosing syphilis?

A

Serological tests on blood

43
Q

Describe gonorrhoea

A

Gram negative intracellular diplocccus
Genital discharge syndrome
50% of men are asymptomatic
Less than 5% of females are asymptomatic
50% have concurrent other STIs e.g. Chlamydia

44
Q

What can gonorrhoea cause?

A

Ophthalmia neonatorum
Keratitis and rapid corneal scarring
Pelvic inflammatory disease
Ectopic pregnancy
Infertility
Congenital disease
Adult gonococcal conjunctivits
Disseminated gonococcal infection

45
Q

What increases with gonorrhoea infection?

A

Risks of HIV transmission
Antimicrobial resistance

46
Q

What are mechanisms of Neisseria gonorrhoeae resistance to antimicrobials?

A

Chromosomal mediated
Plasmid mediated
Host/microbiome related Rx failure

47
Q

What is the chromosomal mediated mechanism?

A

Resistance genes easily transferred between strains through highly competent DNA transformation - pil-IV ComP receptor for DNA uptake sequences
Mosaics common
Mutation and clonal expansion
Mutation and internal recombination

48
Q

Where is M.genitalium detected?

A

Upper GI tract in women with pelvic inflammatory disease

49
Q

What can M.genitalium cause?

A

Cervicitis
Pelvic inflammatory disease
Preterm birth
Spontaneous abortion
Infertlity

50
Q

Describe antibiotic resistance to macrolides

A

Mutations at A2058, A2059, A2062 in 23S rRNA

51
Q

Describe antibiotic resistance to quinolones

A

Mutations at M95 and D99 in gyrA
Mutations at S83 and D87 in parC within QRDR

52
Q

Where do macrolides act?

A

Bind to 50S subunit targeting 23S rRNA

53
Q

Where do quinolones act?

A

Bind to DNA gyrase and topoisomerase IV

54
Q

Where do tetracyclines act?

A

Bind to 30S ribosomal subunit in mRNA complex

55
Q

What is used to treat Chlamydia trachomatis?

A

Doxycycline

56
Q

What is used to treate Neisseria gonorrhoea?

A

Ceftriaxone
Azithromycin

57
Q

What is used to treat Trichomonas vaginalis?

A

Metronidazole

58
Q

What is used to treat Mycoplamsa genitalium?

A

Doxycyline + Azithromycin OR
Moxifloxacin or Pristinamycin

59
Q

Describe antibiotic resistance of Neisseria gonorrhoeae

A

In UK 50% not resistant to ciproflaxacin /penicillin

60
Q

Describe antibiotic resistance of Mycoplasma genitalium

A

40-50% not resistant to azithromycin
50-80% not resistant to moxifloxacin

61
Q

What is the classification of chlamydia?

A

Intracellular bacterium serovars D-K of C. trachomatis

62
Q

What are clinical features of chlamydia in males?

A

50% asymptomatic
Urethral discharge
Dysuria
Epididymo-orchitis

63
Q

What are clinical features of chlamydia in females?

A

80% asymptomatic
Post-coital bleeding
Deep pain with sex
Pelvic pain, cervicitis
Vaginal discharge (rare)
Tubal-factor infertility

64
Q

What are some complications of chlamydia?

A

Reactive arthritis
Reiters syndrome
Conjunctivitis
Neonatal infection

65
Q

How is chlamydia diagnosed?

A

Nucleic acid amplification test (NAAT) - urethra cervix, vulvo-vagina, rectal, urine

66
Q

How is chlamydia managed?

A

Doxycycline 1 week
Abstinence for 1 week
Contact tracing

67
Q

How is gonorrhoea classified?

A

Intracellular bacterium Neisseria gonorrhoeae

68
Q

What are clinical features of gonorrhoea in males?

A

Asymptomatic
Urethral discharge
Dysuria
Epididymo-orchitis

69
Q

What are clinical features of gonorrhoea in females?

A

Asymtomatic
Deep pain with sex
Pelvic pain
Bartholins abscess

70
Q

What are some complications of gonorrhoea?

A

Disseminated infection
Arthritis
Conjunctivitis
Neonatal infection

71
Q

How is gonorrhoea diagnosed?

A

Gram stained smear and culture
NAAT

72
Q

How is gonorrhoea managed?

A

3rd gen cephalosporin or if sensitivity is known then ciproflaxin/amoxicillin with probenecid
PLUS empirical treatment for chlamydia (doxycyline for 1 week)
Abstinence for 1 week
Contact tracing

73
Q

How is trichimonas vaginalis classified?

A

Flagellate protozoan trichomonas vaginalis

74
Q

What are clinical features of TV in males?

A

Mostly asymptomatic
Urethral discharge
Dysuria

75
Q

What are clinical features of TV in females?

A

10-50% asymptomatic
Vaginal discharge
Vulval irritation

76
Q

How is TV diagnosed?

A

Microscopy of vaginal discharge in saline on a glass slide demonstrating motile protozoa
Culture on Feinberg Whittington medium
PCR

77
Q

What are complication of TV?

A

Preterm delivery - low birth weight
Pelvic inflammatory disease
May facilitate HIV acquisition

78
Q

How is TV managed?

A

Metronidazole 400mg BD 5 days
Abstinence for 1 week
Contact tracing (current partners)

Medical Microbiology (23 decks)

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