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A13AMC @ UoN > L14 - Sexually Transmitted & Urinary Tract Infections > Flashcards

L14 - Sexually Transmitted & Urinary Tract Infections Flashcards

1
Q

What is the anatomy of the urinary tract?

A

Kidneys to
Ureters to
Bladder to
Urethra

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2
Q

What are risk factors for UTIs?

A

Pregnancy
Age
Females
Indwelling catheters

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3
Q

Describe asymptomatic bacteriuria

A

No adverse outcomes on follow up

More common in the elderly/catheterised

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4
Q

Describe the ascending route of pathogenesis

A

Bacteria ascend through urinary tract via:
Intestinal Flora - Selection of uropathogenic strains
Vaginal/Peri-urethral Colonisation - Diarrhoea, oestrogen deficiency, spermicides, antibiotics
Urodynamics - Poor flow/structure
Ascent - Motile flagellae, adherence

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5
Q

Describe the haematogenous route of pathogenesis

A

Infection of UT through kidneys

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6
Q

What bacterial factors can make UTIs more likely?

A

Type 1 Fimbriae - Bind to mannose containing epithelial receptors
P- Fimbriae - Bind to Gal-Gal receptors on surface of epithelial cells

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7
Q

What is Tamm Horsfall protein?

A

A mannose containing protein that binds and allows for the flushing of bacteria

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8
Q

Why is urine anti-bacterial?

A

Urea is cidal/static
pH is v. low (hippuric acid)
Flow pushes bacteria out

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9
Q

Define secretor status

A

Some people secrete blood group antigens in their saliva, semun, vaginal secretions etc.
Can trick bacteria

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10
Q

What are the most common pathogens causing UTIs?

A

Escherichia coli

S. saprophyticus

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11
Q

What are less common pathogens causing UTIs?

A 
Proteus
Pseudomonas
Klebsiella
Enterobacter
Enterococcus
S. aureus
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12
Q

Define Cystitis

A

An infection of the lower urinary tract (bladder)

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13
Q

Define Pyelonephritis

A

An infection of the upper urinary tract (kidneys)

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14
Q

Describe the symptoms of Cystitis

A 
Dysuria, frequency, urgency
Suprapubic pain/tenderness
Haematuria
Fever
Cloudy, smelly urine
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15
Q

Describe the symptoms of Pyelonephritis

A

Loin pain/tenderness
Fever
Nausea/vomiting
+/- lower tract symptoms

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16
Q

What is a occasional presentation of UTIs in children <2?

A

Failure to thrive due to recurrent infections

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17
Q

What is an occasional presentation of UTIs in the elderly?

A

Increased confusion

‘Off legs’

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18
Q

What is UTI diagnosis based on?

A

History/Examination

Urinalysis (mid-stream urine)

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19
Q

What are positive indicators in urine dipstick tests?

A

Nitrite - Formed by action of bacterial nitrate reductase in enterobacteriae (enterococci do not possess nitrate reductase)
Leucocyte Esterase - Chemical conversion of an ester

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20
Q

What can give false negatives in urine dipstick tests?

A

Presence of blood
Nitrofurantoin, Rifampicin
Bilirubin
Ascorbic acid

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21
Q

What can give false positives in urine dipstick tests?

A

Co-amoxiclav

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22
Q

What are M/C signs for UTIs?

A

Pyuria >100 leukocytes/ml

Culture >10^5 organisms/ml

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23
Q

What is the management of asymptomatic UTIs?

A

If culture is positive repeat and watch for development of symptoms
IF PREGNANT NEEDS TREATING

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24
Q

Describe non-specific therapy for UTIs

A

Fluid re-hydration
Lowering urinary pH
Analgesia not recommended

25
Q

What is a compromising factor in antimicrobial chemotherapy for UTIs?

A

Ability to reach high concentrations in urine modified by renal failure

26
Q

What two antibiotics are most commonly prescribed in UTIs?

A

Trimethoprim

Nitrofurantoin

27
Q

What i.v. antibiotics are useful in treating UTIs?

A

i. v Tazocin

i. v. Gentamicin

28
Q

What is the time course of treatment?

A

Cystitis - 3 days (10-14 in young men)

Pyelonephritis - 10-14 days

29
Q

What are the four possible outcomes of treatment?

A

Cure (-ve culture 1-2wks post treatment)
Persistence (bacteruria after 48h)
Relapse (within 1-2wks, same organism)
Reinfection (diff. bacterium)

30
Q

What are the main presentations of STIs?

A

Genital ulcers
Genital discharge
Suprapubic pain
Other lesions

31
Q

What is the presentation of Herpes Simplex 2?

A

Painful ulcers with local lymphadenopathy

Recurrent

32
Q

What is the management of Herpes Simplex 2?

A

Confirm diagnosis with PCR

Treat with aciclovir (5x daily)

33
Q

What is the pathogenic organism that causes Syphillis?

A

Treponema Pallidum

34
Q

What are the four categories of Syphilis?

A

Primary
Latency
Secondary
Tertiary

35
Q

Describe the characteristics of primary syphilis

A

Chancre, non-painful, heals spontaneously, local lymphadenopathy

36
Q

Describe the characteristics of secondary sphyilis

A 
Many different presentations:
Macular, coppery rash (palms + soles)
Core generalised lymphadenopathy
Condylomata lata
Can become latent
37
Q

Describe the characteristics of tertiary spyhillis

A

Neurospyhillis

Infection of the aortic arch

38
Q

How is Syphilis diagnosed?

A

Dark ground microscopy

Serology (EIA, VDRL, TPPA)

39
Q

What is the treatment for Syphilis? - Early (primary, secondary, early latent)

A 
Benzathine penicillin G (2.4 mill units, single dose)
Procaine penicllin (2.4 mill units + probenicid for 14 days)
Doxycycline (100mg b.d. for 15 days)
40
Q

What is the treatment for Syphilis? - Tertiary/Late latent

A

Benzathine penicillin G (2.4 mill units, 3x wk)
Doxycycline (100mg b.d. for 28 days)
Monitor serological response

41
Q

What is Chancroid?

A

An STI characterised by painful sores on the genitalia

42
Q

What organism causes Chancroid?

A

Haemophilus ducreyi

43
Q

How is the Chancroid ulcer different from the Syphilitic ulcer?

A

Base is more necrotic with exudate

Usually single lesions

44
Q

How is Chancroid diagnosed?

A

Gram-ve organisms on swab

PCR

45
Q

What is the treatment for Chancroid?

A

Azithromycin/Ceftriaxone (single dose)

46
Q

What are possible causes of genital ulcers, other than Chancroid or Syphilis?

A 
Granuloma inguinale (Klebsiella granulomatis)
Lymphogranuloma venereum (Chlamydia trachomatis)
47
Q

Define Urtheritis

A

Inflammation of the urethra characterised by urethral discharge and dysuria

48
Q

What tests should be done upon seeing Urethritis?

A

Gram stain (Gram-ve diplococci)
M/C
Urinary NAAT testing

49
Q

What pathogen most commonly causes Urethritis?

A

Neisseria gonorrhoeae

50
Q

What are the non-gonococcal causes of Urethritis?

A 
C. trachomatis
U. urealyticum
T. vaginalis
M. genitalium
HSV
51
Q

What are the widespread complications of gonorrhoea?

A

Conjunctivitis
Septic arthritis
Pharyngeal infection
Peri-hepatitis

52
Q

What is the treatment for Gonorrhoea?

A

Ceftriaxone (125mg i.m.)
Azithromycin (2g o.d.)
Quinolones

53
Q

To what antibiotic class is Gonorrhoea almost completely resistant?

A

Beta-lactams (penicllins etc.)

54
Q

What is the treatment for Non Gonorrhoeal Urethritis?

A

Ceftriaxone
Azithromycin
Doxycycline

55
Q

What is the causative organism of Genital Warts?

A

Human Papillomavirus (HPV)

56
Q

How do genital warts present?

A

Usually asymptomatic

Diffuse range of size/shape

57
Q

What are large/cauliflower like genital warts called?

A

Condylomata acuminata

58
Q

What is the treatment for genital warts?

A

Scraping, cryotherapy, keratolytics
Podophyllin
Imiquimod

A13AMC @ UoN (20 decks)

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