GU Infections Flashcards
Urethral protective urinary mechanisms
Host defense mechanisms maintain a sterile posterior urethra and bladder in a healthy individual
- pathogens washed out during micturition
- Low pH and high osmolality of urea
- presence of antimicrobial proteins and secretions
- ureterovesical junction: closes to prevent reflux of urine to the uterus and kidneys
- Women: Mucus-secreting glands
- Men: length of male urethra
________ group more prone to what?
Lewis blood group more prone to UTIs
E. coli have ______ or ______ making it easy for it to adhere to ______
pili or fimbrae
adhere to urinary tract
Remember E.coli commonly found in normal GI flora so makes sense that it would cause ________
80-85% of urinary infections
Remember that UTI can cause cystitis or pyelonephritis
Definition of UTI…
Inflammation of the urinary epithelium after invasion of pathogen in urinary tract – retrograde movement of bacteria into the urethra and bladder
What is the most common site of UTI
Acute cystitis (bladder)
-inflammation of the epithelial lining of the bladder more common in women
Older adults acute cystitis (UTI) s/s
confusion, vague abdominal discomfort
_____% with UTI asymptomatic
_____% with symptoms are abacteriuric
30
30
Complicated vs. uncomplicated UTI (cystitis)
uncomplicated - positive dipstick with leuks or blood + symptomatic (tx normally)
complicated cystitis - urine culture of specific microorganism with count of 10,000/mL or more (really unsure why it says this)
-complicated UTI is an infection associated with a condition, such as structural or functional abnormalities of the genitourinary tract or the presence of an underlying disease, which increases the risks of acquiring an infection or of failing therapy
Reasons for complicated cystitis
With complicated cystitis what will you need after tx?
Older adult complication could lead to…
- diabetes
- pregnancy
- symptoms for 7+ days before seeking care
- hospital acquired
- renal failure
- obstruction
- indwelling catheter, stent, nephrostomy tube or urinary diversion in place
- functional or anatomic abnormality
- renal transplant
- immunosuppression
*Will need repeat cultures
*urosepsis
Question: Mechanism that protect the urinary tract from infection include:
- monocytes in the urine
- acidic urine
- decreased urine osmolarity
- type I pili
Acidic urine
Remember that interstitial cystitis is different from acute cystitis
-what is interestitial cystitis?
- another name is painful bladder syndrome
- often mistaken for a UTI, but there is NO infection
causes of interstitial cystitis?
- radiation or chemical
- autoimmune or hypersensitivity
what are the symptoms of interstitial cystitis?
When is this diagnosed?
tx?
s/s: bladder or pelvic pain or pressure and frequent urge to urinate
Dx: after 6 weeks of symptoms with negative urine cultures and no other known cause
Tx: oral and intravesical therapies, sacral nerve stimulation, onabotulinumtoxinA, and surgery
Acute pyelnephritis
Can be caused by UTI
-acute infection of the ureter, renal pelvis of renal parenchyma
Acute pyelonephritis Clinical Manifestations
Evaluation?
Tx?
- flank pain (also possible to have this is acute cystitis if severe)
- fever, chills
- CVA TENDERNESS
- purulent urine
Evaluation - WHITE BLOOD CELL CASTS under microscope…remember CASTS in URINE = RENAL/KIDNEY ETIOLOGY (PYELONEPHRITIS)
Tx - antibiotic administration; IV fluids, hospitalization depending on severity
Chronic Pyelonephritis
- what can this lead to?
- what is the tx?
- PERSISTENT or recurrent infection of the kidneys leading to scarring of the kidneys, leading to scarring of the kidneys
- inflammation and fibrosis, located in the interstitial spaces b/w the tubules, leading to chronic kidney failure
-tx: antibiotic administration, prolonged abx with recurrent infections
Pelvic Inflammatory Disease
Caused by?
-may involve?
PID
- acute inflammation caused by infeciton; STI migrate from the vagina to the upper genital tract
- may involve any organ of the upper reproductive tract (salpingitis - fallopian tube inflammation; oophoritis - inflammation of ovaries)
What is the most common etiology of PID?
What two would you tx for? Would also tx?
Usually polymicrobial - you would tx for both Chlamydia trachomatis and Neisseria gonorrhea
Would also tx sexual partner
Diagnosis of PID - what s/s + something else
What should you do to r/o?
Sexually active women who have abdominal or pelvic tenderness and one of the following signs:
- Cervical motion tenderness
- Uterine tenderness
- Adnexal tenderness
ALWAYS DO PREGNANCY TEST TO RULE OUT ECTOPIC PREGNANCY
What are some complications of PID?
Infertility and Ectopic Pregnancy
Vaginitis
- causes?
- clinical manifestations?
- tx?
- infection of the vagina with irritation of the vagina (vaginosis)
- could be from STI, Trichomonas vaginalis
- could be do to disruption of microbiomee: Candida albicans (abx, immunosupprssed, diabetes); or could be Bacterial vaginosis
- acidic environment of vagina provides some protection
- s/s: copious, malodorous, or irritating discharge
- Candida - thick, white discharge that looks like cottage cheese
- tx: antibiotics or antifungal, maintain acidic environment, relieve symptoms (usually pruritius), probiotic supplement
Cervicitis
- caused by?
- causes what?
- what is a clinical sign of this?
- tx?
- sometimes get this mixed up with?
Inflammation or infection of the cervix
- caused by one or more STIs: Chlamydia trachomatis, Neisseria gonorrhea
- causes mucopurulent cervicitis (MPC)
- causes cervical motion tenderness
- tx: antiibiotics for pt and partner
- usually hard to distinguish b/w this and PID but with PID you usually have abdominal pain too and this more so just the cervical motion tenderness
Clinical manifestations of PID
Sudden, severe abdominal or pelvic pain with fever
May be asymptomatic
Also remember the 3 signs:
cervical motion tenderness, uterine tenderness, adnexal tenderness
Vulvodynia
-causes:
called vulvitis, vestibulitis, or vulvovestibulitis
- chronic pain in the vulva, the area on the outside of a woman’s genitals. It is usually described as a sensation of burning, stinging, itching or rawness
- causes: soaps, detergents, lotions, sprays, shaving, pads, perfumed toilet paper, or tight-fitting clothes, vaginal infections that spread to the labia
Vulvodynia
tx: avoid irritants, wear loose cotton clothing, behavioral tx, topical xylocaine, topical of systemic antidepressants, botox of affected nerve, vestibulectomy
Remember that bartholinitis can be caused by
bacterial infection that clogs duct…tx w/antibiotics and drian
Question: PID is
1 - associated with infertility
2- primarily caused by S. aureus
3- associated with hyperandrogenic state
4- caused by an infection of the cervic
1- answer
2- primary cause Chlamydia trachomatis of Neisseria gonorrhea
4- cervicitis
(PID involvese salping and oophor)
Bacterial prostatitis caused by?
Usually in what ages?
Also associateed with _____ in older men?
ascending UTI - bacteria in urine leaks into prostate
30-50
BPH
What are the clinical manifestations of Bacterial Prostatitis?
Palpation…?
s/s: sudden onset of malaise, low back pain, perineal pain, high fever, chills, dysuria, urinary retention, painful ejaculation
Palpation: always be gentle so as to not cause bacteria to enter into blood stream
Upon palpation - enlarged, tender, and swollen prostate that is indurated (hard) and warm to touch
-NEVER MASSAGE an acutely infected person b/c this can cause bacteria to enter the bloodstream
Diagnosis of Bacterial Prostatitis?
Urinalysis and cultures
Abx
- Severe cases may need hospitalization and IV antibiotics
- If there is urinary retention, urethral catheterization is contraindicateed - would need suprapubic
Chronic Bacterial Prostatitis
Most common…
Symptoms?
Exam?
If urinalysis is clean?
Recurrent prostatitis
Most common UTI in men
Symptoms: frequency, urgency, dysuria, low back pain, perineal discomfort, myalgia, sexual dysfunction
Exam: Enlarged, boggy prostate; if fibrosis from repeated infections theen may be irregular or firm
- If urinalysis is clean then prostatic massage is done to express secretions
- Referral to urologist for ongoing management
