L14 - Sexually Transmitted & Urinary Tract Infections Flashcards by Tim Resch

What is the anatomy of the urinary tract?

Kidneys to
Ureters to
Bladder to
Urethra

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What are risk factors for UTIs?

Pregnancy
Age
Females
Indwelling catheters

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Describe asymptomatic bacteriuria

No adverse outcomes on follow up

More common in the elderly/catheterised

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Describe the ascending route of pathogenesis

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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Describe the haematogenous route of pathogenesis

Infection of UT through kidneys

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What bacterial factors can make UTIs more likely?

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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What is Tamm Horsfall protein?

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

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Why is urine anti-bacterial?

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

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Define secretor status

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

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What are the most common pathogens causing UTIs?

Escherichia coli

S. saprophyticus

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What are less common pathogens causing UTIs?

Proteus
Pseudomonas
Klebsiella
Enterobacter
Enterococcus
S. aureus

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Define Cystitis

An infection of the lower urinary tract (bladder)

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Define Pyelonephritis

An infection of the upper urinary tract (kidneys)

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Describe the symptoms of Cystitis

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

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Describe the symptoms of Pyelonephritis

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

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

Failure to thrive due to recurrent infections

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What is an occasional presentation of UTIs in the elderly?

Increased confusion

‘Off legs’

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What is UTI diagnosis based on?

History/Examination

Urinalysis (mid-stream urine)

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What are positive indicators in urine dipstick tests?

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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What can give false negatives in urine dipstick tests?

Presence of blood
Nitrofurantoin, Rifampicin
Bilirubin
Ascorbic acid

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What can give false positives in urine dipstick tests?

Co-amoxiclav

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What are M/C signs for UTIs?

Pyuria >100 leukocytes/ml

Culture >10^5 organisms/ml

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What is the management of asymptomatic UTIs?

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

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Describe non-specific therapy for UTIs

Fluid re-hydration
Lowering urinary pH
Analgesia not recommended

What is a compromising factor in antimicrobial chemotherapy for UTIs?

Ability to reach high concentrations in urine modified by renal failure

What two antibiotics are most commonly prescribed in UTIs?

Trimethoprim | Nitrofurantoin

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

i. v Tazocin | i. v. Gentamicin

What is the time course of treatment?

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

What are the four possible outcomes of treatment?

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

What are the main presentations of STIs?

Genital ulcers Genital discharge Suprapubic pain Other lesions

What is the presentation of Herpes Simplex 2?

Painful ulcers with local lymphadenopathy | Recurrent

What is the management of Herpes Simplex 2?

Confirm diagnosis with PCR | Treat with aciclovir (5x daily)

What is the pathogenic organism that causes Syphillis?

Treponema Pallidum

What are the four categories of Syphilis?

Primary Latency Secondary Tertiary

Describe the characteristics of primary syphilis

Chancre, non-painful, heals spontaneously, local lymphadenopathy

Describe the characteristics of secondary sphyilis

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

Describe the characteristics of tertiary spyhillis

Neurospyhillis | Infection of the aortic arch

How is Syphilis diagnosed?

Dark ground microscopy | Serology (EIA, VDRL, TPPA)

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

``` 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) ```

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

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

What is Chancroid?

An STI characterised by painful sores on the genitalia

What organism causes Chancroid?

Haemophilus ducreyi

How is the Chancroid ulcer different from the Syphilitic ulcer?

Base is more necrotic with exudate | Usually single lesions

How is Chancroid diagnosed?

Gram-ve organisms on swab | PCR

What is the treatment for Chancroid?

Azithromycin/Ceftriaxone (single dose)

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

``` Granuloma inguinale (Klebsiella granulomatis) Lymphogranuloma venereum (Chlamydia trachomatis) ```

Define Urtheritis

Inflammation of the urethra characterised by urethral discharge and dysuria

What tests should be done upon seeing Urethritis?

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

What pathogen most commonly causes Urethritis?

Neisseria gonorrhoeae

What are the non-gonococcal causes of Urethritis?

``` C. trachomatis U. urealyticum T. vaginalis M. genitalium HSV ```

What are the widespread complications of gonorrhoea?

Conjunctivitis Septic arthritis Pharyngeal infection Peri-hepatitis

What is the treatment for Gonorrhoea?

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

To what antibiotic class is Gonorrhoea almost completely resistant?

Beta-lactams (penicllins etc.)

What is the treatment for Non Gonorrhoeal Urethritis?

Ceftriaxone Azithromycin Doxycycline

What is the causative organism of Genital Warts?

Human Papillomavirus (HPV)

How do genital warts present?

Usually asymptomatic | Diffuse range of size/shape

What are large/cauliflower like genital warts called?

Condylomata acuminata

What is the treatment for genital warts?

Scraping, cryotherapy, keratolytics Podophyllin Imiquimod