Exam 2 - Zoonoses and GU infections Flashcards
dysuria definition
burning/tingling/stinging of urethra and meatus associated with voiding
most common cause of dysuria in women
acute cystitis
acute cystitis mimics
vaginitis, prostatitis, STIs, derm conditions, allergies, hormonal conditions, bladder cancer
anatomic abnormalities predisposing to UTIs
hypospadias, BPH, vesicoureteral reflux, polycystic kidney disease
what is a complicated UTI
everything except simple cystitis in a healthy non-pregnant woman
confounding factors in urinalysis
unclean catch, dilute urine (first morning urine is the best), AZO treatment
major way to estimate gram + vs gram - UTI from urinalysis
gram negative will have nitrites, gram positive will not
major way to determine contamination in urinalysis
presence of moderate-numerous squamous cells
clues to UTI on urinalysis
cloudy color, presence of blood/protein, leukocyte esterase, WBCs, RBCs, bacteria, nitrites
most common UTI pathogen
e coli
which UTI pathogen is associated with struvite stones
proteus
risk factors for pseudomonas uti
chronic catheter, hospitalized patients
risk factors for enterococcus uti
debilitated/hospitalized patients
risk factors for group b strep (agalactiae) uti
diabetes
risk factor for staph saprophyticus uti (coagulase negative)
young, sexually active women
mechanism and pathogen in descending UTIs
staph aureus, hematogenous spread to kidneys
when to treat asymtpomatic bacteriuria
pregnant women, before invasive urologic procedures
simple cystitis ssx
frequency, urgency, dysuria, suprapubic pain, hematuria
pyelonephritis ssx
simple cystitis plus CVA tenderness, fever, flank pain, N/V
simple cystitis tx
nitrofurantoin, cephalexin, bactrim, cipro
pyelonephritis tx
empiric coverage for suspected GNR, consider pseudomonas if hospitalized patient
which STI cannot use PCR for diagnosis and what does it use instead
treponema pallidum, dark field microscopy or RPR/VDRL
gonorrhea morphology
gram negative diplococci
chlamydia morphology
intracellular gram negative rods
trichomonas morphology
parasite - flagellate
BV pathogen
gardnerella vaginalis
gardnerella vaginalis morphology
gram variable rod
candida albicans morphology
budding yeast
treponema pallidum morphology
spirochete
which STI is characterized by clue cells on wet mount
gardnerella (BV)
what does the vaginal pathogens panel consist of?
candida, BV, trichomonas
treatment for gonorrhea
ceftriaxone 500 mg IM x 1 and azithromycin 1 gram PO x 1
treatment for chlamydia
doxycycline x 7 or azithromycin x 1 and ceftriaxone x 1
treatment principle for gonorrhea/chlamydia
treat for co-infection with both organisms
gonorrhea sequelae
PID, neonatal conjunctivitis, bacteremia, septic arthritis, tenosynovitis
chlamydia sequelae
PID, conjunctivitis, trachoma, ectopic pregnancy, chronic pelvic pain, infertility, reactive arthritis
causes of prostatitis
bacteria leaking into prostate gland from urinary tract, direct extension/lymphatic spread from rectum, STIs
prostatitis ssx
dysuria, urinary hesitancy/urgency, painful ejaculation, abd/groin/low back pain
epididymitis causes
UTI/STI
epididymitis ssx
swollen, red, warm scrotum, testicle pain/tenderness of gradual onset
balanitis definition
inflammation of the glans penis most common in uncircumcised men
balanitis causes
candida, irritation from soaps
treatment principle for prostatitis/epididymitis
in younger sexually active males, screen and treat for gonorrhea/chlamydia. In older males suspect UTI organisms
prostatitis/epididymitis treatment
cipro or bactrim x 1-2 weeks
why is cipro often used for prostatitis
it can achieve high concentrations in prostate
non-infectious causes of vaginitis
atrophic (post menopausal), allergies to condoms/spermicides/washes
most common vaginitis pathogens
candida, bacterial vaginosis pathogens, trichomonas
vaginitis treatment challenge
if due to BV, pathogens form biofilm leading to high rates of recurrence
candida vaginitis tx
monistat cream or PO diflucan
bacterial vaginosis ssx
vaginal pain/itching, dyspareunia, thin grayish milky discharge, fishy odor
trichomonas ssx
vaginal itching/pain, thin grayish frothy discharge
bacterial vaginosis diagnosis
PCR, clue cells on wet mount
trichomonas diagnosis
PCR, moving protozoa on microscopy
BV/trichomonas tx
PO metronidazole, vaginal metronidazole, vaginal clindamycin
syphilis tx
PCN
non-treponemal antibody detection
RPR, VDRL: Quantitative, titers go down with treatment, false positives and negatives
treponemal antibody detection
TPPA, MHA-TP, FTA: Qualitative, stays positive for life, more specific than non-treponemal
stages of syphilis
primary, secondary, latent, tertiary
primary syphilis timeline and characteristics
2-3 weeks after infection, chancre at entry site, regional lymphadenopathy, serology may or may not be positive
secondary syphilis timeline and characteristics
6-12 weeks after infection: rash, joint pain, hepatitis, general lymphadenopathy
latent syphilis characteristics
positive blood test with no ssx
tertiary syphilis characteristics
CNS damage, aortitis, gumma
when does neurosyphilis occur
can happen at any stage
how is congenital syphilis transmitted
through placenta
genital ulcers differential diagnosis
HSV II, syphilis, chancroid, HPV, Behcet’s, drug reaction
HSV II ssx
painful vesicular lesions
chancroid ssx
painful necrotic lesions
chancroid pathogen
haemophilus ducreyi