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Gonorrhoea Chlamydia UTIs Lectures, osmosis, PTS

1
Q

Describe the epidemiology of chlamydia.

A

Women aged 15-25

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2
Q

What would you consider in your differential diagnosis for chlamydia?

A

Other STIs - ‘they hunt in packs’

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3
Q

Describe the pathophysiology of chlamydia

A

Infect urethra/rectum/mouth if sexually transmitted,

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4
Q

Describe the pathophysiology of chlamydia

A

Chlamydia trachomatis infect urethra/rectum/mouth if sexually transmitted,

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5
Q

Describe the management of chlamydia

A

Azithromycin 1g one dose
Doxycycline - more effective
Erythromycin unless pregnant

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6
Q

What investigations would you do if you suspect chlamydia?

A

Bloods - microbiological cultures. Incubation period 7-10 days in males
NAATs eg PCR
Female - self-collected vaginal swab.
Male - first void urine.

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7
Q

Give 3 potential complications of chlamydia.

A

Reactive arthritis
epididymo-orchitis.
Neonatal transmission: atypical pneumonia.
Pelvic inflammatory disease
Scarring, ectopic pregnancy, infertility.

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8
Q

Describe the pathophysiology of gonorrhoea.

A

Neisseria gonnorhoeae

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9
Q

Describe the management of gonorrhoea.

A

Ceftrioxone 500mg IM with azithromycin 1g stat.
Test for other STIs eg HIV, syphilis
Continuous surveillance of antibiotic sensitivity.

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10
Q

Give 3 symptoms of gonorrhoea.

A

50% of females and 10% of males asymptomatic
More florid manifestations than chlamydia.
Discharge

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11
Q

Give 3 complications of gonorrhoea.

A

Severe PID (pelvic inflammatory disease)
Neonatal transmission to conjunctiva - eyeball can perforate causing BLINDNESS - suspect in sticky eyed baby.
Scarring, ectopic pregnancy, infertility

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12
Q

Give risk factors for gonorrhoea. How is it transmitted?

A

Most common: male age 20-30 (note higher peak age than women)
MSM, women aged 20-25.
MTF sexual transmission 50-90%, FTM 20-70%.
Higher association with recent partner change than chlamydia.

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13
Q

How is gonorrhoea diagnosed?

A

NAATS eg PCR - in community

Cultures - in clinic

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14
Q

What is the diagnostic criteria for a UTI?

A

A pure growth of more than 100,000 UTI-causing organisms per ml collected from a fresh clean catch urine sample, with symptoms.

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15
Q

Give one gram -ve and one gram +ve organism which can cause UTIs.

A

G-: Escherichia coli, klebsiella pneumoniae, proteus mirabilis
G+: Enterococci, staph saprophyticus.

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16
Q

Give 2 indicators of a UTI from a urine dipstick.

A

Positive nitrites, leukocytes, proteins, glucose, ketones

blood can occur but not diagnostic

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17
Q

What is pyelonephritis?

A

Upper UTI affecting the renal parenchyma.

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18
Q

What causes acute pyelonephritis?

A

Normally due to ascending infection from the bladder, so has the same risk factors as for lower UTIs.

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19
Q

Give 3 risk factors of UTIs.

A

Female sex - shorter urethra so easier ascending infection, decreased estrogen causes loss of protective vaginal flora.
Sexual intercourse - bacteria introduced into urethra
Indwelling catheter
Diabetes Mellitus - hyperglycaemia inhibits phagocytosis
Urinary tract obstruction/impaired emptying (causes urinary stasis)

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20
Q

What is vesicoureteral reflux?

A

Backflow of urine up the urinary tract due to failure of the vesicoureteral orifice. It can be congenital or caused by bladder outlet obstruction, which increases pressure in the bladder and distorts the valve.

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21
Q

What causes pyelonephritis via haematogenous spread?

A

Septicaemia or bacteraemia. Usually caused by staphylococcus or E. Coli.

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22
Q

Why does leukocyturia occur?

A

White blood cells migrate to the site of infection and enter the urinary tract, ending up in urine.

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23
Q

What is a WBC cast?

A

WBCs and debris clump together and take the shape of the tubule. This is excreted in urine. [osmosis]

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24
Q

Give 3 symptoms of pyelonephritis.

A 
Fever
Nausea and vomiting
Chills
Flank pain at costovertebral angle (back)
Loin pain in affected side
[osmosis]
25
Q

How is upper UTI differentiated from lower UTI?

A 
Systemic symptoms (fever, nausea/vom, rigors) are only present in upper UTIs.
Upper UTIs cause loin pain, lower UTIs cause suprapubic pain
26
Q

Describe the management of pyelonephritis.

A 
Antibiotics
-not pregnant-> ciprofloxacin 7 days/ co-amox 14 days
-pregnant -> cefalexin 10-14 days
HYDRATION! (treatment and prevention)
Pain relief
[PTS]
27
Q

What are the complications of acute pyelonephritis?

A 
Renal abscess
Recurrent infections (due to anatomical problem) lead to chronic pyelonephritis, and papillary necrosis which can reduce kidney function.
28
Q

How are UTIs diagnosed?

A
  1. MC&S of MSU
  2. Dipstick
  3. Bloods
29
Q

What is chronic pyelonephritis?

A

Recurrent infection of the renal pelvis resulting in scarring.

30
Q

What causes bilateral obstruction of the urinary tract?

A

Congenital malformation of the posterior urethral valve
Benign prostatic hyperplasia in men
Cervical carcinoma in women

31
Q

What causes unilateral obstruction of the urinary tract?

A

Urinary calculi

32
Q

Where does tubular atrophy and interstitial fibrosis mainly occur?

A

The upper and lower poles of the kidney.

33
Q

What might be seen on CT urogram in chronic pyelonephritis?

A

Blunted calyces

34
Q

What might be seen on histology in chronic pyelonephritis?

A

Dilated tubule containing colloid casts. These colloid casts may show in urine.

35
Q

What is xanthogranulomatous pyelonephritis?

A

A kidney stone in the ureter gets infected and causes chronic obstruction. This causes inflammation and increased pressure in the kidney, which leads to formation of granulomatous tissue. This is full of foam cells which make it look like a kidney tumour.

36
Q

What would you do to exclude tubal/ovarian/appendix pathology in a woman with loin pain?

A

Vaginal examination.

37
Q

What is cystitis?

A

Inflammation of the bladder. When due to infection, it is a type of lower UTI.

38
Q

What is the pathophysiology of cystitis?

A

Some bacteria, eg E coli, are able to colonise the bladder mucosa.

39
Q

Which organism is most likely to cause UTI in young, sexually active women?

A

Staphylococcus saprophyticus

[osmosis]

40
Q

Give 3 signs/symptoms of cystitis.

A 
Haematuria
Frequency
Urgency
Dysuria (pain/difficulty urinating)
Suprapubic pain
41
Q

What might be seen in urinalysis of the urine of a person with cystitis?

A

Cloudy due to pyuria (>5 WBCs in urine)

42
Q

Why might nitrites be seen in urine dipstick for cystitis?

A

Some gram -ve bactera (eg E coli) can convert nitrate to nitrite.
[osmosis]

43
Q

What antibiotics could you give a catheterised man with cystitis?

A

Nitrofurantoin
Trimethoprim
[PTS]

44
Q

What antibiotics could you give a woman who might be pregnant with a UTI and how long for?

A

Cefalexin 7 days
Nitrofurantoin safe in 1st trimester
Trimethoprim safe in 3rd trimester

45
Q

What is sterile pyuria?

A

Pyuria (WBCs in urine) with negative urine culture. It suggests urethritis.

46
Q

What is urethritis?

A

Inflammation of the urethra.

47
Q

Give 3 common causative organisms of urethritis.

A

Neisseria gonorrhoeae

Non-gonococcal: Chlamydia trachomatis, ureaplasma urealyticum, mycoplasma genitalium

48
Q

How is urethritis normally transmitted?

A

Sexually

49
Q

Give an antibiotic that can be used to treat urethritis.

A

Same as gonorrhoea/chlamydia Mx.

Doxycycline (chlamydia)

50
Q

What is an uncomplicated UTI?

A

A UTI in a non-pregnant, mainly healthy woman.

51
Q

Describe the management of an uncomplicated UTI.

A

3 days antibiotics, adjust according to MSU if sent but not essential
Drink water
Void often, especially pre-and post-intercourse
Wipe from urethra to rectum

52
Q

Describe the management of a complicated UTI.

A

Always send MSU for culture, treat accordingly with 7 days antibiotics.

53
Q

Describe the management of asymptomatic bacteriuria in over 65s.

A

Do not treat!

54
Q

What is prostatitis?

A

Inflammation of the prostate gland. Affects 35-50% of men.

55
Q

Give 3 symptoms of prostatitis.

A

Pain: perineum, rectum, scrotum, penis, bladder, lower back
Systemic: fever, malaise, nausea

56
Q

What would a DRE show in prostatitis?

A

Swollen, tender prostate

57
Q

Describe the management of acute prostatitis.

A

Admit if severely ill or unable to take oral abx
Quinolone abx eg ciprofloxacin 28 days
Paracetamol, ibuprofen

58
Q

What is chronic prostatitis?

A

Symptoms >3 months with recurrent UTIs.

59
Q

How is chronic prostatitis treated?

A

Paracetamol, ibuprofen
Stool softener
Quinolone abx eg ciprofloxacin 4-6 weeks
Alpha-blocker can treat retention

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