Genital and urinary tract infection

Question 1

How do you diagnose gonorrhoea?

Answer 1

culture of urethral / cervical swab

- multiplex PCR on first voided urine more sensitive than culture

Question 2

What is the treatment for gonorrhoea?

Answer 2

high dose penicillin alternatives ceftriaxone or ciprofloxacin

Question 3

What causes chlamydia?

Answer 3

very simple small bacteria
obligate intracellular multiplication as cannot produce own ATP
2 forms elementary body for extracellular survival reticulate body intracellular life
c. trachomatis serotype D-K genitourinary infection, A-C trachoma

Question 4

How is chlamydia trachomatis diagnosed and treated?

Answer 4

PCR on first voided urine

Tetracyclines (beta-lactams not active)

Question 5

When are UTIs more prevalent ?

Answer 5

increase with age but much more common in women

Question 6

What facilitates infections ascent to the kidneys?

Answer 6

faciliated by adhesins (p-pili), obstruction, neurological disease, pregnancy and reflux

Question 7

What factors are involved in invasion of parenchyma?

Answer 7

K polysaccharide (E.coli)
damage caused by:
ischaemia
lysozymes
toxic o2 radicals 
haemolysin

Question 8

What are the symptoms of a urethral UTI?

Answer 8

Burning/ stinging at meatus/perineum
desire to micturate/frequency
dysuria

Question 9

What are the symptoms of .a bladder UTI?

Answer 9

Suprapubic “heaviness” and tenderness

Question 10

What are the symptoms of pyelonephritis?

Answer 10

loin pain 
rigors
bacteremia
pyrexia
leucocytosis

Question 11

What are the majority of uncomplicated UTIs caused by ?

Answer 11

escherichia coli - 80%
remaining 20%
- proteus mirabilis 
- staphylococcus saprophyticus 
- strept B 
- chlamydiae

Question 12

What are the majority of complicated or nosocomial UTIs caused by?

Answer 12

80%

• klebisiella
• pseudomonas aeruginosa serratia
• other enterobacteriaceae

E.coli 20%

Question 13

What are the indicators of significant bacteriuria?

Answer 13

good specimen (no epithelial cells)

• significant pyuria
• purity of culture
• indentity of organism

Question 14

What are the definitions of significant bacteriuria in;

• asymptomatic bacteriuria
• acute pyclonephritis
• women with acute dysuria
• pts with indwelling urinary catheter?

Answer 14

• asymptomatic bacteriuria =>10^5cfu/ml
• acute pyclonephritis=>10^5cfu/ml
• women with acute dysuria=>10^2cfu/ml
• pts with indwelling urinary catheter=>10^2cfu/ml

Question 15

What organisms are commonly found in catheterised patients?

Answer 15

pseudomonas aeruginosa
proteus / providencia
enterococcus facecalis

Question 16

What organism often causes renal stones?

Answer 16

proteus mirabilis

Question 17

What abx are used for simple UTIs?

Answer 17

trimethoprim (15% resistance)
nitrofurantoin (5-8%) 
cephalexein (10%)
ciprofloxacin (20%)
co-amoxiclav (10%) 
short course (48 hours) 90%+ effective 
3-6 days versus 7-14 days showed no difference in cure rate

Question 18

What abx are used for acute pyelonephritis?

Answer 18

cefotaxime (11%) 
gentamicin (9.8%) 
piperacillin - taxobactam (14%) 
ciprofloxacin (18%) 
treat for not less than 7 days