Genitourinary #2 Flashcards
What are some risk factors for acute cystitis?
Women: sexual intercourse
Pregnancy
Elderly and postmenopausal
Diabetes Mellitus
Indwelling catheter presence
Infants
What does it mean for acute cystitis to be “complicated”
Symptoms > 7 days
Pregnancy
Diabetics
Immunosuppression
Indwelling catheter
Elderly
Males
MC cause of acute cystitis
E. Coli
However, the 2nd MCC of acute cystitis in sexually active women is
Staph Saprophyticus
In indwelling catheters, a common organism that causes acute cystitis is
Enterococci
Symptoms of acute cystitis
-Dysuria
-Frequency and Urgency
-Hematuria
-Suprapubic pain and tenderness
On urinalysis, what is seen in a patient with acute cystitis?
Pyuria (> 10 WBCs/hpf)
Hematuria
Nitrites
Cloudy urine
Increased pH with proteus
However, the definitive diagnostic for acute cystitis is
Urine culture
-Need a clean catch specimen
What is seen on urine culture if the urine specimen is contaminated?
Epithelial cells (Squamous cells)
What is the first-line treatment for Acute cystitis?
Nitrofurantoin or Trimethoprim-Sulfamethoxazole or Fosfomycin
However, if the patient has a sulfa allergy or increased resistance patterns, what is the first-line medical treatment for acute cystitis?
Fluoroquinolones such as Ciprofloxacin or Levofloxacin (Cephalosporins or Cefpodoxime)
What are some recommendations you can tell the patient if he/she has acute cystitis?
Increase fluid intake
Void after intercourse
Hot sitz baths
Phenazopyridine is a bladder analgesic that can be used as adjunct treatment for acute cystitis. What are two things to remember about this drug?
Do not use it more than 48 hours due to side effects
Turns urine an orange color
If the acute cystitis is complicated, what are the treatment options?
Fluoroquinolones PO or IV
Aminoglycosides x 7-10 days or 14 days
If there is cystitis in a patient who is pregnant, what is the treatment?
Amoxicillin
Augmentin
Cephalexin
Name some medications for cystitis that should be avoided in pregnancy?
Bactrim
Aminoglycosides
Fluoroquinolones
Doxycycline
What is pyelonephritis
Infection of the upper genitourinary tract (kidney and renal pelvis)
MCC of pyelonephritis
E. Coli
Risk factors for pyelonephritis
Diabetes Mellitus
History of recurrent UTIs
Kidney Stones
Pregnancy
Symptoms of pyelonephritis
Fever
Chills
Back or Flank Pain
Nausea and vomiting
Dysuria, Frequency, Urgency
What are three things that are on exam of a patient with pyelonephritis?
CVA tenderness
Fever
Tachycardia
What is hallmark on a UA for pyelonephritis?
-Pyuria ( > 10 WBCs/hpf)
-Nitrites
-WBC casts (MOST SENSITIVE)
However, definitive diagnostic for pyelonephritis is
Urine culture
Outpatient management for pyelonephritis
-Fluoroquinolones (-oxacin)
-If resistance > 10%, IV Ceftriaxone or Gentamicin followed by oral Fluoroquinolone
If the patient is pregnant and have pyelonephritis, what is the treatment?
IV Ceftriaxone
(Aztreonam if PCN allergic)
Inpatient management for pyelonephritis
-3rd or 4th Gen Cephalosporins
-Fluoroquinolones
-Aminoglycosides
-Extended spectrum PCN for 2 weeks
What are 4 criteria for admission for a patient with pyelonephritis
-Older age
-Signs of obstruction
-Comorbid conditions
-Inability to tolerate oral ABX
MCC of non-gonococcal urethritis
Chlamydia Trachomatis
Symptoms of chlamydia trachomatis urethritis
5-8 days incubation period followed by purulent discharge
Pruritus, hematuria, dyspareunia
40% are asymptomatic
If the urethritis is gonococcal related, what are the onset and symptoms?
Abrupt onset of symptoms (within 3-4 days)
Opaque, yellow, white or clear thick discharge
Pruritus
20% are asymptomatic
What are some symptoms of urethritis
-Urethral discharge
-Penile or vaginal pruritus
-Dysuria
-Abdominal pain
-Abnormal vaginal bleeding
Most sensitive diagnostic test for urethritis
Nucleic acid amplification
However, a gram stain can be done for urethritis. What is suggestive of urethritis?
2 or more WBC/hpf
True or False: 25-30% of patients have a co-infection of both Gonorrhea and Chlamydia so empiric treatment of both is recommended if test results are not available?
True
Treatment for gonorrhea urethritis
Ceftriaxone 250 mg IM x 1 dose PLUS Azithromycin 1g x 1 dose
Treatment for Chlamydial urethritis
Azithromycin 1g orally or Doxycycline 100 mg orally x 10 days
