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GU Infections Flashcards

1
Q

Are LUTI’s most commonly caused by ascending or descending infections?

A

Ascending

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2
Q

What are the 4 LUTI’s

A
  • Cystitis
  • Prostatitis
  • Epidy-dimitus
  • Urethritis
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3
Q

What is an UUTI?

A

Pyelonephritis

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4
Q

What 5 pathogens contribute to nearly all urinary tract infections?

A 
K = Klebsiella spp.
E = E.coli - MOST COMMON 
E = Enterococci 
P = Proteus spp. 
S = Staphylococcus spp
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5
Q

What are the risk factors for uriniary tract infections?

A
  • Female
  • Sex
  • Pregnancy
  • Menopause
  • Decrease in host defence
  • Urinary tract obstruction resulting in urine stasis
  • Catheter
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6
Q

What defines a UTI as being complicated?

A

Infection in patients with abnormal urinary tract e.g. stones, obstruction or systemic disease involving the kidney e.g. diabetes mellitus, sickle-cell, or virulent organism e.g. Staphylococcus Aureus
Treatment failure is more likely
Complications are more likely e.g. renal papillary necrosis and renal abscess
Majority of UTI’s in MEN are considered complicated - associated with urological abnormalities such as bladder outlet obstruction

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7
Q

What is the common cause of UTI’s in men?

A

Enlarged prostate

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8
Q

How does cystitis present?

A

Dysuria, frequency, urgency, suprapubic pain, and white blood cells in urine.

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9
Q

What is cystitis?

A

Urinary infection of the bladder

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10
Q

What pathogen most commonly causes cystitis?

A

E. Coli

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11
Q

What are the risk factors for cystitis?

A
  • Urinary obstruction resulting in urinary stasis
  • Previous damage to bladder epithelium
  • Bladder stones
  • Poor bladder emptying
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12
Q

What are the symptoms of cystitis?

A
  • Dysuria
  • Frequency
  • Urgency
  • Suprapubic pain
  • Haematuria
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13
Q

What is the gold standard investigation in cystitis?

A
  • Microscopy and sensitivity of sterile MID-STREAM URINE
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14
Q

What would be present on a urine dipstick in cystitis?

A

Positive leukocytes, blood and nitrites

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15
Q

What is the first line treatment in cystitis?

A

Trimethoprim or Cefalexin

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16
Q

What is prostatitis?

A

Infection and inflammation of the prostate gland which can be acute or chronic.

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17
Q

What bacteria can be the cause of acute prostatitis?

A
  • Streptococcus faecalis
  • E.coli
  • Chlamydia
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18
Q

What are the bacterial causes of chronic prostatitis?

A
  • Streptococcus faecalis
  • E.coli
  • Chlamydia
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19
Q

What are the non-bacterial causes of chronic prostatitis?

A

Elevated prostatic pressure or pelvic floor myalgia

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20
Q

What are the risk factors of prostatitis?

A
  • STI
  • UTI
  • Indwelling catheter
  • Post-biopsy
  • Increasing age
21
Q

What are the symtoms of acute prostatitis?

A
  • Systemically unwell
  • Fever, rigors, malaise
  • Pain on ejaculation
  • Significant voiding LUTs e.g. poor intermittent stream, hesitancy, incomplete emptying, post micturition dribbling, straining, dysuria
  • Pelvic pain
22
Q

What are the symptoms of chronic prostatitis?

A
  • Acute symptoms (above) > 3 months
  • Recurrent UTIs
  • Pelvic pain
23
Q

On a DRE exam how would the prostate feel in prostatitis?

A

Tender or hot to touch. Possibly hard from calcification.

24
Q

What would a urine dipstick show in prostatitis?

A

Positive for leukocytes and nitrites

25
What antibiotic is used in the treatment of acute prostatitis?
IV Gentamicin + IV Co-Amoxiclav followed by 2-4 weeks on a quinolone e.g. ciprofloxacin
26
What is the treatment for chronic prostatitis?
4-6 week course of quinolone e.g. ciprofloxacin but antibiotics aren't very effective. Can use an alpha blocker as well e.g tamsulosin and NSAIDS as well
27
What is urethritis?
Urethral inflammation due to infectious of non-infectious causes.
28
What is the primary cause of urethritis?
Sexually acquired disease
29
What is the most common STI in in young people aged 15-24 yrs?
Chlamydia
30
What is a gonococcal cause of urethritis?
Neisseria gonorrhoea
31
What are some non-gonococcal of urethritis?
- Chlamydia trachomatis - MOST COMMON CAUSE - Mycoplasma genitalium - Ureaplasma urealyticum - Trichomonas vaginalis
32
What are non-infective causes of urethritis?
- Trauma - Urethral stricture - Irritation - Urinary calculi
33
What are the risk factors for urethritis?
- Sexually active - Unprotected sex - Male to male sex - Male
34
What is the usual presentation of urethritis?
Usually asymptomatic - 95% of the time with gonorrhoea and 50% of the time with chlamydia
35
What are the symptoms of urethritis?
- Dysuria +/- discharge; blood or pus - Urethral pain - Penile discomfort - Systemic symptoms
36
What investigations would you do in urethritis?
- Nucleic acid amplification test (NAAT): Female - self collected vaginal swab (best), endocervical swab, first void urine - Male - first void volume - High specificity and sensitivity - Microscopy of gram-stained smears of genital secretions - Blood cultures - Urine dipstick - to exclude UTI Urethral smear
37
What is the treatment for clamydia?
ORAL AZITHROMYCIN STAT or 1 WEEK ORAL DOXYCYCLINE Tests for other STIs Pregnant: - ORAL ERYTHROMYCIN for 14 days or ORAL AZITHROMYCIN STAT
38
What is the treatment for gonorrhoea?
IM CEFTRIAXONE with ORAL AZITHROMYCIN | Partner notification
39
What is pyelonephritis?
Infection of the renal parenchyma and soft tissues of renal pelvis and upper ureter Majority caused by UPEC - Uropathogenic E.coli
40
What is the infection in pyelonephritis most likely to be a result of?
Due to bacteria (primarily E.coli) from own patients bowel flora
41
What is the most common route of transmission in pyelonephritis?
Via the ascending transurethral route but can be via the bloodstream or lymphatics
42
How is E. coli an adhesive molecule?
- P pilli to allow ureteral ascent - Aerobactin - for Fe acquisition - Haemolysin - for pore formation
43
What is the presentation triad in pyelonephritis?
Loin pain, fever and pyuria
44
What are the signs of pyelonephritis?
- Oliguria (small amounts of urine) if causes AKI - Significant bacteriuria - Rigors
45
In pyelonephritis would you expect the loin to be tender on examination?
Yes
46
What would be positive on a urine dipstick in pyelonephritis?
Nitrites, leukocytes and proteins
47
What is the gold standard for diagnosis in pyelonephritis?
Midstream urine microscopy, culture and sensitivity
48
What is the non-pharmacological treatment for pyelonephritis?
Rest, drink cranberry juice and plenty of water
49
What is the pharmacological treatment for pyelonephritis?
- Analgesia - Antibiotics: Oral Ciprofloxacin or Oral Co-Amoxiclav If severe then IV Gentamicin or IV Co-Amoxiclav

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