Gyno UTI Flashcards
Why are urinary tract infections (UTIs) more common in women than in men, and what factors contribute to this difference?
• Women: Urethra closer to anus, shorter, making contamination and bacterial reach to the bladder easier • Men: Higher risk of underlying causes, requiring further investigation
How does the empirical antibiotic treatment approach differ in women and men for uncomplicated UTIs, and what antibiotics and durations are commonly prescribed for women?
• Women: Empirical antibiotic treatment given more readily and for a shorter duration • Common antibiotics and durations: Trimethoprim (200mg twice daily) or nitrofurantoin (50mg four times daily) for three days
What considerations are there for pregnant women with UTIs, and how should they be managed?
• Pregnant women should be referred for prompt assessment and treatment to minimize the risk of complications
Why is there a higher risk in men that UTI symptoms may have an underlying cause, and what is the recommended antibiotic treatment for men with uncomplicated UTIs?
• Men: Higher risk of underlying causes • Recommended antibiotics and duration: Trimethoprim or nitrofurantoin for seven days after excluding underlying causes
What precautions and contraindications should be considered with urinary alkalinising products, and how do they interact with nitrofurantoin?
• Precautions and contraindications: Care needed with potassium-containing products in patients with hyperkalaemia, renal or cardiac impairment; contraindicated in pregnant patients and those with hypertension for products with high sodium content • Interaction with nitrofurantoin: Markedly reduces efficacy; avoid during treatment
How can pain and raised temperature associated with UTIs be managed, and what are some recommended analgesics?
• Manage with simple analgesics such as paracetamol or ibuprofen unless contraindicated
Why should children complaining of symptoms of pain on passing urine with frequency be referred to the GP, and what does this suggest?
• Children should be referred to the GP as there may be an underlying cause for the UTI that needs investigation
What practical tips are recommended for managing lower urinary tract infections (UTIs), and how can individuals minimize the risk of UTIs?
• Practical Tips: . Drink normally, avoiding irritants like alcohol and coffee . Double micturition to remove residual urine 3. Wipe from front to back after defecation 4. Micturition after intercourse 5. Wear cotton underwear and avoid tight clothes 6. Use a hot water bottle for relief 7. Cranberry products may help prevent bacterial infections by inhibiting E coli adherence; evidence for prevention, not treatment
What is the commonality in lower urinary tract infections (UTIs), and which parts of the urinary tract can be involved?
• Common, especially in women • Usually self-limiting or treated with antibiotics • Involves the bladder (cystitis), urethra (urethritis), or both
What are the typical symptoms of a lower UTI, and how does it generally manifest?
• Acute onset and rapid progression • Increased frequency of passing urine, often with urgency • Burning, stabbing pain in the urethra and perineum • Burning pain on passing urine • Traces of blood, cloudy or malodorous urine • Sensation of incomplete emptying
What factors may contribute to UTI symptoms, aside from bacterial infection, and what more generalized symptoms may be indicative of bacterial infection?
• Symptoms may be related to sexual intercourse, anxiety states, irritable bladder, or chemical sensitivity (e.g., to soaps or spermicides) • Generalized symptoms: nausea, vomiting, fever, low back pain
When is urgent referral to a GP necessary for a lower UTI, and what symptoms indicate a potential upper UTI?
• Urgent referral if symptoms of upper UTI: fever, back (flank) pain, vomiting, visible haematuria
What are potential differential diagnoses for lower UTI symptoms, and what conditions may be considered if vaginal discharge is present?
• Differential diagnoses: pelvic inflammatory disease, acute pyelonephritis, kidney stones, bacterial vaginosis, thrush, chlamydia, non-bacterial cystitis • Urinary dipsticks can help determine if symptoms are caused by UTI
What is the primary cause of vulvovaginal candidiasis, and which yeast species are commonly responsible?
• Vulvovaginal candidiasis is caused by abnormal colonization of the vagina by yeast cells, primarily Candida albicans (80-95% of cases) and C. glabrata (5%). Other less common causes include Candida tropicalis, C. parapsilosis, C. krusei, C. kefyr, C. guilliermondii, or Saccharomyces cerevisiae, which may be harder to treat and are often resistant to fluconazole.
What are the symptoms of vulvovaginal candidiasis, and who is more susceptible to infection?
• Symptoms include vulval itching, local erythema, white, curd-like, odourless vaginal discharge, dyspareunia (pain on intercourse), and dysuria (pain during urination). Women of childbearing age are more susceptible as the yeast prefers an estrogen-rich environment. Women aged over 60yrs, under 16yrs, or pregnant should be referred.
How are the symptoms of thrush different from bacterial vaginosis, and what other infections can be confused with thrush?
• Symptoms of thrush and bacterial vaginosis can be difficult to distinguish; bacterial vaginosis usually presents without itch. Other possible infections confused with thrush include trichomoniasis (frothy, grey, malodorous discharge), chlamydia (no itch), gonorrhoea (pain and fever usually present), and genital herpes (pain is a defining symptom). Referral to the GP is required if these infections are suspected.
What are the treatment options for vulvovaginal candidiasis, and what topical preparations are effective?
• Topical imidazoles (clotrimazole, econazole, miconazole) are equally effective. Intravaginal treatment, via a pessary or intravaginal cream, is more effective than external application alone. Male partners with symptoms should also be treated with topical imidazoles. There is no evidence that treatment of asymptomatic partners is required.
What practical tips can be offered to patients to avoid fungal infections like candidiasis?
- Avoid wearing tight-fitting trousers or tights. <br></br> - Choose loose-fitting, cotton underwear for better ventilation. <br></br> - Iron or tumble-dry underwear to eliminate fungal spores. <br></br> - Discourage the use of irritant or perfumed products like vaginal deodorants or soaps. <br></br> - Caution against using spermicides such as nonoxynol-9, which may disrupt the vaginal flora.
What should be considered in the management of recurrent vulvovaginal candidiasis?
- Treatment failure occurs in 20% of cases. <br></br> - Recurrent cases (four or more in a year) affect up to 50% of women. <br></br> - Recognize the impact on mental health. <br></br> - Refer women with more than two cases in six months to the GP.
How should vulvovaginal candidiasis be managed in pregnant women?
- Pregnant women with vulvovaginal candidiasis should be referred to the GP. <br></br> - Over-the-counter preparations are not recommended during pregnancy. <br></br> - Fluconazole (150mg capsule) is effective but contraindicated in pregnancy and breastfeeding.
What is an alternative to topical treatment for vulvovaginal candidiasis?
- Fluconazole ( 50mg capsule) is an effective oral treatment. <br></br> - Some patients may prefer it, especially if applicator use is painful.
What can cause thinning and reduced elasticity of vaginal walls in post-menopausal women?
Lack of estrogen.
What symptoms can atrophic vaginitis cause?
Pain during sex, discomfort, itch, urinary problems (frequency, urgency, dysuria, incontinence).
What autoimmune disease is associated with dry mouth, dry eyes, and vaginal dryness?
Sjörgen’s syndrome.
What are danger symptoms for atrophic vaginitis?
Symptoms of dry eyes, dry mouth, and atrophic vaginitis warrant referral to the GP.
What is the differential diagnosis consideration for post-menopausal women with vaginal symptoms?
Vaginal infections need to be ruled out through appropriate questioning.
What are the OTC treatment options for atrophic vaginitis?
Lubricating gels or vaginal moisturisers.
Are Replens MD® and Sylk hormonal vaginal moisturisers?
No, they are non-hormonal.
What makes Replens MD® a bioadhesive vaginal moisturiser effective?
It exhibits statistically significant increases in vaginal moisture, fluid volume, elasticity, and a return of premenopausal pH state.
What is the purpose of water-based lubricants like KY jelly® in atrophic vaginitis?
Lubricate the vagina for several hours, can be applied to the vaginal opening to prevent pain during intercourse.
What advice would you give to a patient requesting information on atrophic vaginitis treatment?
Avoid douching, avoid perfumed soaps and bath products that may be irritant.
What might cause pain during sex in post-menopausal women with atrophic vaginitis?
The vagina is smaller, drier, and less likely to become lubricated during sex.
How might discomfort manifest in atrophic vaginitis?
The vulva or vagina may be sore and inflamed, leading to persistent discomfort.
What could an itch/scratch cycle indicate in atrophic vaginitis?
Sensitivity and itching around the vulva, causing a cycle that can be difficult to break.
What urinary problems may arise due to atrophic vaginitis?
Thinning and weakening of tissues around the neck of the bladder or urethra, leading to symptoms like frequency, urgency, dysuria, stress, or urge incontinence.
Why should patients with symptoms of dry eyes, dry mouth, and atrophic vaginitis be referred to their GP?
It could indicate Sjörgen’s syndrome, an autoimmune disease.
What role do hormones play in the treatment of atrophic vaginitis?
Hormone replacement therapy (HRT) and estrogen cream are prescription-only treatments.
Why is douching discouraged for atrophic vaginitis?
Douching disrupts the normal chemical balance of the vagina, leading to dryness and irritation.
What should post-menopausal women with atrophic vaginitis avoid in terms of hygiene products?
Avoid perfumed soaps and bath products that may be irritant.
What considerations are important for post-menopausal women with recurrent thrush seeking treatment?
They should be referred to the GP, as treatment failure with antifungals occurs in 20% of cases.
What impact can recurrent vulvovaginal candidiasis have on individuals?
It can lead to depression and psychosexual problems.
