Genitourinary tract infections

Question 1

UTI characteristics?

Answer 1

• flushing action of urine helps keel infections to a minimum
  3 categories:
• cystitis = infection of urinary bladder that occurs when urine flow is reduces or bacteria are accidentally introduced to the bladder
• pyelonephritis = infection of kidneys
• urethritis = infection limited to urethra

Question 2

Cystitis signs and symptoms?

Answer 2

Sudden onset of:
- pain
- frequent urges to urinate even when bladder is empty
- dysuria = burning when urinating
- urine is cloudy due to presence of bacteria and WBC
- Hematuria = blood in urine causing orange color
- low grade fever and nausea

Question 3

Pyelonephritis signs and symptoms?

Answer 3

• back pain
• high fever
• serious infection which can cause permanent damage to kidneys

Question 4

Acute uncomplicated UTI affects what organ?

Answer 4

only the bladder

Question 5

UTI casuative agents?

Answer 5

95% cuased by normal biota of gastrointestinal tract
- Escherichia coli (80%)
- staphylococcus saprophyticus
- klebsiella pneumonia
- protues mirablis

Question 6

UTI transmission?

Answer 6

• healthcare associated = catheter associated UTI (CA-UTIs)
  community aquired:
• not transmitted from one person to another
• transmitted via GI tract and urinary system
• more common in women
• E. coli can cause recurrent UTIs by invading deeper tissues of urinary tract

Question 7

UTI treatment?

Answer 7

• various antibiotics
• non-antibiotic drug phenazopyridine (Pyridium) administered simultaneously
  
  • relives uncomfortable symptoms
  • only given for 2 days
  • azo dyes turn urine dark orange or red

Question 8

Gonorrhea signs and symptoms?

Answer 8

Male:
- urethritis
- painful urination
- yellowish discharge
- 10% of cases asymptomatic
- most limited to distal urogenital tract

females:
- Mucopurulent/ bloody vaginal discharge
- painful urination if urethra infected
- salpigitis = inflammation of fallopian tubes
- pelvic inflammatory disease: salpinigitis + inflammation in upper reproductive tract

Question 9

Gonorrhea consequences?

Answer 9

• can enter bloodstream disseminating to joints and skin
• involvement in wrist and ankle = chronic arthritis and rash on limbs
• meningitis and endocarditis can be rare complications
  Children:
  -gonococcal eye infections can result in keratitis, opthalmia neonatorum, and blindness
• antibiotic eye drops/ointments are applied at birth as a precaution

Question 10

Gonorrhea causative agent?

Answer 10

Neisseria gonorrhoeae
- gram-negative diploccoccus
- appears as kidney bean shaped bacteria with their flat sides touching

Question 11

Gonorrhea transmission?

Answer 11

spread through sexual contact except in neonatal cases

Question 12

Gonorrhea epidemiology?

Answer 12

• humans only reservoir
• important to consider the reservoir as asymptomatic males and females (disease can be spread unknowingly
• reportable disease

Question 13

Gonorrhea culture and diagnosis?

Answer 13

males:
- gram stain urethral discharge
females:
- ELISA or PCR tests
- culture on Thayer-Martin agar
Identify bacteria using:
- catalase test
- enzymes for fermenting various carbs
- oxidase test

Question 14

Gonorrhea prevention?

Answer 14

• no vaccine
• protection during sexual intercourse

Question 15

Gonorrhea treatment?

Answer 15

treat both gonorrhea and chlamydia because there is usually coinfection
- N. gonorrhoeae increasing levels of antibiotic resistance

Question 16

Chlamydia causative agent?

Answer 16

Chlamydia trachomatis
- small gram-negative bacteria
- lives in host as obligate intracellular parasite
- majority of cases asymptomatic
most common reportable infectious disease

Question 17

Chlamydia signs and symptoms?

Answer 17

males:
- inflammation in urethra
- discharge
- painful urination
- untreated infections lead to epididymitis

females:
- cervicitis
- discharge
- saphingitis
- PID

Babies:
- eye infections
- pneumonia

Question 18

Chlamydia transmission and epidemiology?

Answer 18

• transmitted vertically or through sexual contact
• humans are reservoir
• broad distribution and incidence is rising in population
• adolescent women more affected than older women

Question 19

Chlamydia prevention?

Answer 19

• aboid contact with infected tissues and secretion
• protection is only prevention
  screening:
• CDC recommends annual screening for women bc of often asymptomatic infection

Question 20

Chlamydia treatment?

Answer 20

doxycycline or azithromycin
- gonorrhea coinfection treated similarly
- retest in 3-4 months after treatment

Question 21

Syphilis characteristics?

Answer 21

3 clinical stages:
- primary syphilis
- secondary syphilis
early latency period
- tertiary syphilis
has latent period
transmissible in primary, secondary, and early latency period

Question 22

Primary syphilis characteristics?

Answer 22

early indication is appearacne of hard chancre at sight of entry of pathogen
- ulcers are generally painless and may escape notice
- chancre heals spontaneously without scaring in 3-6 weeks
- sprirochetes have escaped into circulation at this point

Question 23

Secondary syphilis characteristics?

Answer 23

appear 3 weeks- 6 months after chancre heals
- many systems of body have been invaded
- symptoms more profuse and intense

Question 24

Secondary symphilis symptoms?

Answer 24

• fever
• headache
• sore throat
• lymphadenopathy
• red or brown rash on all skin surfaces
• lesions containing viable spirochetes
• major complications linger for months/years

Question 25

Latency and tertiary syphilis characteristics?

Answer 25

30% of infections enter highly varied latent period - can last 20 years or longer * Antibodies to the bacterium are readily detected, but the bacterium is not * This final stage of syphilis is relatively rare today because of widespread use of antibiotics * By the time a patient reaches this stage, numerous pathologic complications occur in susceptible tissues and organs

Question 26

Latent and tertiary syphilis symptoms?

Answer 26

Cardiovascular syphilis: - damage to small arteries in aortic cell wall - aorta subject to distension and rupture - aortic valved can be damaged resulting in heart failure Gummas: - painful, swollen, syphilitic tumors - develop in tissues in liver, bone, skin, and cartilage - usually benign and only occasionally lead to death, but can impare function

Question 27

Congential syphilis characteristics?

Answer 27

syphilis spirochetes can pass to fetal tissues through placenta - leading to congenital syphilis - any of 3 trimesters - inhibits fetal growth and disrupts critical periods of development causing birth defects, spontaneous micarriage, or stillbirth - infants often demonstrate such signs as profuse nasal discharge, skin eruptions, bone deformation, and nervous system abnormalities

Question 28

Syphilis causative agent?

Answer 28

Treponema pallidum - spirochete - thin, regularly coiled cell - gram negative - strict parasite - rapidly destroyed by heat, drying, disinfectants, soap, high oxygen tension, and pH changes

Question 29

syphilis epidemiology?

Answer 29

- humans only host - bacteria cannot survive outside host long (fastidious) - 12-30% risk of infection per encounter

Question 30

Syphilis culture and diagnosis?

Answer 30

- dark-feild microscopy of a suspected lesion is fastest way to diagnose - blood tests based on antibody detection - reacts with treponemal antigens - Rapid plasmin reafin (RPR) test w/ immunoassay

Question 31

Syphilis prevention and treatment?

Answer 31

- prevention relies on treatment of sexual contacts of syphilis patients to contain spread - identified at risk individuals need prophylactic penicillin treatment (single long-acting dose) - Barrier protection - no vaccine - treat w/ antibiotics

Question 32

Genital Herpes signs and symptoms (initial infection)?

Answer 32

Multiple presentations: - initial infection may cause no symptoms - single or multiple vesicles on genitalia, perineum, thigh, and buttocks - vesicles = small and filled with clear fluid (painful) lesions accompanied by: - malaise - anorexia - fever -bilateral swelling and tenderness in groin

Question 33

Gential herpes signs and symptoms (after initial infection)?

Answer 33

- may have recurrent episodes of infection - generally less severe than original symptoms but whole gamit of possible severity is seen as well - some may not have reaccurence - some have nearly constant outbreaks - ~4-5 recurrences a year

Question 34

Herpes in newborn?

Answer 34

- can be distructive and fatal - most infected immediately before or during birth - pregnant woman with history of recurrent infection mist be monitored for signs of viral shedding, especially in last 4 weeks of pregnancy - C-section if outbreak is evident before delivery

Question 35

Gential herpies causative agent?

Answer 35

HSV-1 and HSV-2 - either can effect both oral or genital regions

Question 36

Genital herpes pathogenesis, and virulence factors?

Answer 36

Reactivation triggered by: - stess - UV radiation - Injury - menstration - another microbial infection

Question 37

Genital herpes transmission?

Answer 37

Transmission though direct exposure to secretions containing virus - people with active lesions are more significant source of infection - can spread when no lesions are present

Question 38

Genital herpes epidemiology?

Answer 38

- more common than chlamydia or gonorrhea - not a reportable disease - 50-90% of individuals do not know they are infected due to rare symptoms or being asymptomatic

Question 39

Genital hepes culture and diagnosis?

Answer 39

- sometimes diagnoses based on lesions alone - PCR tests detect these viruses directly from lesions - antibody of viruses can be detected via blood samples

Question 40

Gential herpes prevention?

Answer 40

- no vaccine - avoiding contact with infected body surfaces - protection - careful handling newborns

Question 41

Gental herpes treatment?

Answer 41

acyclovir and derivatives - topical formulation can be applied to lesions - pill form also available - reduce viral shedding and decrease recurrence - not curative