Genitourinary #2 Flashcards by Tyler Cichowski

What are some risk factors for acute cystitis?

Women: sexual intercourse
Pregnancy
Elderly and postmenopausal
Diabetes Mellitus
Indwelling catheter presence
Infants

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What does it mean for acute cystitis to be “complicated”

Symptoms > 7 days
Pregnancy
Diabetics
Immunosuppression
Indwelling catheter
Elderly
Males

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MC cause of acute cystitis

E. Coli

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However, the 2nd MCC of acute cystitis in sexually active women is

Staph Saprophyticus

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In indwelling catheters, a common organism that causes acute cystitis is

Enterococci

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Symptoms of acute cystitis

-Dysuria
-Frequency and Urgency
-Hematuria
-Suprapubic pain and tenderness

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On urinalysis, what is seen in a patient with acute cystitis?

Pyuria (> 10 WBCs/hpf)
Hematuria
Nitrites
Cloudy urine
Increased pH with proteus

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However, the definitive diagnostic for acute cystitis is

Urine culture
-Need a clean catch specimen

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What is seen on urine culture if the urine specimen is contaminated?

Epithelial cells (Squamous cells)

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What is the first-line treatment for Acute cystitis?

Nitrofurantoin or Trimethoprim-Sulfamethoxazole or Fosfomycin

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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)

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What are some recommendations you can tell the patient if he/she has acute cystitis?

Increase fluid intake
Void after intercourse
Hot sitz baths

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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

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If the acute cystitis is complicated, what are the treatment options?

Fluoroquinolones PO or IV
Aminoglycosides x 7-10 days or 14 days

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If there is cystitis in a patient who is pregnant, what is the treatment?

Amoxicillin
Augmentin
Cephalexin

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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