Genitourinary Infections/Sexually Transmitted Infections Flashcards by Derrick Obeng

What are the classifications of genitourinary infections

UTIs
Genital tract infections

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What is the most common GUI

UTI

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UTIs are more common in women
True or false

True

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Which bacteria are responsible for non-nosocomial uncomplicated UTI

Coliforms especially E. coli

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What is an uncomplicated UTI

A symptomatic bladder infection with a normal urinary tract

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What is a complicated UTI

A symptomatic infection of any part of the urinary tract with a functional or structural urinary

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What are some host factors predisposing to UTI

Female sex
Sexual intercourse
Use of spermicides
Urinary stasis or BPH
Comorbities especially diabetes mellitus, Immunosuppression
Institutionalized patients
Increasing age
Eradication of vagina commensalism organisms
Urinary tract stones
Urinary catheter
Hugh concentrated urine (>800mOsmol/kg) or failed urinary acidification (pH>5)

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Which bacteria cause UTIs

E. coli
Klebsiella
Enterococci
Pseudomonas
Proteus mirabilis
Citrobacter
Staphylococcus aureus
Coagulate negative staphylococci

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Acute cystitis is an infection of which part of the body

Bladder

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What are some symptoms of UTIs

Offensive urine
Suprapubic discomfort
Irritating voiding symptoms
Frank hematuria
In the elderly, UTI may present with confusion

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What are some laboratory findings of cystitis

Urinalysis shows pyuria, bacteriuria and varying degrees of hematuria (the degree of pyuria and bacteriuria does not necessarily correlate with the severity of symptoms)
Urine culture is positive for the offending organism

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To test for acute pylonephritis, what physical examination could you do

Renal angle tenderness

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Mention some investigations of UTI

Dipstick urine
Clean catch MSU for microscopy
Urine culture
Imaging
WCC, CRP, serum creatine, U&E

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What are some investigatory imaging for UTIs

USG to exclude obstruction with hydronephrosis and diagnose stones
Non-contrast CT
Pre and post-micturution images of the bladder to exclude
Urodynamic flow studies
Cytoscopy

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Who needs a closer attention wrt UTIs

Males
Children (they might have posterior urethral valves so their pee does not come out regularly)
Recurrent UTI
Pregnant women
Immunocompromised
Kidney stones
Proteus UTI
Indwelling catheter or ureteric stent
Known abdominal UTI

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What are some things to start while waiting for culture

Flouroquinolones (Ciprofloxacin)
Rehydration with 0.9% NaCl

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What are things to do in an uncomplicated lower UTI (cystitis) when waiting for culture

(Mention the specific antibiotics)

Oral cephalosporins
Fosfomycin
Encourage high fluid intake

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What sign in imaging confirms a xanthogranulomatous pyelonephritis

Bear paw sign

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When the PSAs go up, what is feared but isn’t necessarily fixed to be that

Cancer of the prostate

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A sterile inflammatory cystitis, presenting in females
What disease is this

Interstitial cystitis

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Reactive arthritis is a triad which is made up of

Arthritis
Urethritis
Conjunctivitis

What is asymptomatic bacteriuria

The isolation of >105 CFU ml of bacteria from an appropriately collected clean urine specimen

What is the requirement of urine in asymptomatic bacteriuria for women

Two consecutive voided urine specimen

Asymptomatic bacteriuria is more prevalent in what type of women

Pregnant women
Postmenopausal women
Diabetics
Persons > 70 years of age
Patients needing intermittent catheterization or in patients with an indwelling urinary catheter

What are some lavatory findings in a asymptomatic bacteriuria

Urine culture is positive for the offending organism but colony counts exceed 105/ml are not required for the diagnosis Patients with asymptomatic bacteriuria or colonization are expected to have positive urine cultures but do not require treatment except in pregnant women

What are the initial assessments to determine if admission is necessary in acute pyelonephritis

Nausea and vomiting Systemically unwell

What are some treatment suggestions in an acute pyelonephritis patient whose urine culture awaits

Start fluoroquinolones (cipro and levo) for 14 days. Alternatives include co-amoxiclav IVI, then PO or a 3rd generation cephalosporin IVI then PO for 14 days Consider an additional single dose gentamicin (3-5mg/kg IV) Rehydration with 0.9% NaCl Appropriate analgesia and antiemetics ## Footnote (Acute pyelonephritis is to fluoroquinolones, cephalosporins and gentamicin)

What is the treatment of catheter related UTI

Continue antimicrobials for a minimum of 7 days and remove the catheter if possible

How is catheter related UTI diagnosed

Cultures positive for 710 cfu/ml and heavy pyuria (pyuria is not always a reliable marker of infection in this context)

What is the best treatment for catheter related UTI

Prevention is best. Avoid catheterization or remove Cather as soon as possible after use

What is emphysematous pyelonephritis

It is a necrotizing infection of the renal parenchyma and its surrounding areas that results in the presence of gas in the renal parenchyma, collecting system or perinephritic tissue

What causes emphysematous pyelonephritis

Gas causing enterobacteriaceae and occurs predominantly in diabetic patients (90%) and presents as a severe pyelonephritis

Which imaging could be used to investigate emphysematous pyelonephritis

KUB x-ray or CT

Is mortality high in emphysematous pyelonephritis

Yes

What are some ways of treating emphysematous pyelonephritis

Broad spectrum antibiotics Urgent nephrectomies

What is a xanthogranulomatous pyelonephritis

It is a chronic unilateral pyelonephritis associated with renal calculi or obstruction and causes widespread parenchyma destruction. It is more common in diabetes mellitus. Presents as a fever, nausea, anorexia, weight loss, flank pain and systemic upset. The affected kidney is often palpable

What are some treatments for xanthogranulomatous pyelonephritis

Nephrectomy

What are some imaging investigations to be done in xanthogranulomatous pyelonephritis

Urinalysis and MSU UTI is usually proteus spp. or other gram negative bacteria CT confirms diagnosis Relapse is common Treat initially for pyelonephritis

What is hyperthermia

It is an unregulated rise in body temperature due to a failure of temperature homeostasis

What is fever of unknown origin

Continous fever of at least 3 weeks duration with daily temperature elevation above 38.3 oC and remaining undiagnosed after a week of intensive study in hospital

What are the four categories of FUO

Classical Nosocomial Immune deficient/Neutropenic HIV associated *Each group has a unique differential diagnosis based on characteristics and vulnerabilities and, therefore, a different process of evaluation*

Typical subgroups used in the differential for classical FUO are

Infection Malignancy Non-infectious/Inflammatory diseases Miscellaneous Undiagnosed

Mention some infections which cause PUO

Bacterial TB UTI Abscesses Sinusitis Endocarditis Viral

What are some viral causes of PUO

CMV EBV

What are some granulomatous infections for PUO

TB Fungal

What are some pyogenic infections that could cause PUO

RUQ infections (Cholangitis, cholecystitis,liver abscess, subphrenic, subhepatic) Abscess secondary to bowel diseases (Diverticulitis, appendicitis) PID Renal infections (pyelonephritis, perinephric, subhepatic abscesses)

What are some miscellaneous infections that could cause PUO

Malaria IMN CMV disease Amoebiasis Coxsackie B diseases trichinosis Q fever AIDS

What are some investigations to make in stage one of an FUO

FBC ESR (erythrocyte sedimentation rate) BF - Malaria parasites Blood C/S Sputum (cell type/ count, Gram stain, C/S, AFBs for TB) Urine R/E & urine C/S Blood urea, creatinine and electrolytes

What are some investigations to make in stage two of an FUO

CT scan (chest/ abdomen/ pelvis) Markers of connective tissue disease eg. Rh factor, ANA, etc Tumor markers. Eg. PSA, CEA

What are some investigations to make in stage three of an FUO

Invasive tests such specialised test eg echocardiography, electrocardiography, lumbar puncture, biopsy etc

What are some history to take in an FUO patient

Sexual history Travel history (including foreign travel) IV drug use Immunosuppressive illness Contact history (people and animal contacts)