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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
Q

What antibiotic is used in the treatment of acute prostatitis?

A

IV Gentamicin + IV Co-Amoxiclav followed by 2-4 weeks on a quinolone e.g. ciprofloxacin

26
Q

What is the treatment for chronic prostatitis?

A

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
Q

What is urethritis?

A

Urethral inflammation due to infectious of non-infectious causes.

28
Q

What is the primary cause of urethritis?

A

Sexually acquired disease

29
Q

What is the most common STI in in young people aged 15-24 yrs?

A

Chlamydia

30
Q

What is a gonococcal cause of urethritis?

A

Neisseria gonorrhoea

31
Q

What are some non-gonococcal of urethritis?

A
  • Chlamydia trachomatis - MOST COMMON CAUSE
  • Mycoplasma genitalium
  • Ureaplasma urealyticum
  • Trichomonas vaginalis
32
Q

What are non-infective causes of urethritis?

A
  • Trauma
  • Urethral stricture
  • Irritation
  • Urinary calculi
33
Q

What are the risk factors for urethritis?

A
  • Sexually active
  • Unprotected sex
  • Male to male sex
  • Male
34
Q

What is the usual presentation of urethritis?

A

Usually asymptomatic - 95% of the time with gonorrhoea and 50% of the time with chlamydia

35
Q

What are the symptoms of urethritis?

A
  • Dysuria +/- discharge; blood or pus
  • Urethral pain
  • Penile discomfort
  • Systemic symptoms
36
Q

What investigations would you do in urethritis?

A
  • 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
Q

What is the treatment for clamydia?

A

ORAL AZITHROMYCIN STAT or 1 WEEK ORAL DOXYCYCLINE
Tests for other STIs
Pregnant: - ORAL ERYTHROMYCIN for 14 days or ORAL AZITHROMYCIN STAT

38
Q

What is the treatment for gonorrhoea?

A

IM CEFTRIAXONE with ORAL AZITHROMYCIN

Partner notification

39
Q

What is pyelonephritis?

A

Infection of the renal parenchyma and soft tissues of renal pelvis and upper ureter
Majority caused by UPEC - Uropathogenic E.coli

40
Q

What is the infection in pyelonephritis most likely to be a result of?

A

Due to bacteria (primarily E.coli) from own patients bowel flora

41
Q

What is the most common route of transmission in pyelonephritis?

A

Via the ascending transurethral route but can be via the bloodstream or lymphatics

42
Q

How is E. coli an adhesive molecule?

A
  • P pilli to allow ureteral ascent
  • Aerobactin - for Fe acquisition
  • Haemolysin - for pore formation
43
Q

What is the presentation triad in pyelonephritis?

A

Loin pain, fever and pyuria

44
Q

What are the signs of pyelonephritis?

A
  • Oliguria (small amounts of urine) if causes AKI
  • Significant bacteriuria
  • Rigors
45
Q

In pyelonephritis would you expect the loin to be tender on examination?

A

Yes

46
Q

What would be positive on a urine dipstick in pyelonephritis?

A

Nitrites, leukocytes and proteins

47
Q

What is the gold standard for diagnosis in pyelonephritis?

A

Midstream urine microscopy, culture and sensitivity

48
Q

What is the non-pharmacological treatment for pyelonephritis?

A

Rest, drink cranberry juice and plenty of water

49
Q

What is the pharmacological treatment for pyelonephritis?

A
  • Analgesia
  • Antibiotics: Oral Ciprofloxacin or Oral Co-Amoxiclav
    If severe then IV Gentamicin or IV Co-Amoxiclav

GU (9 decks)

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