Lecture 16: UTI, Urethritis, and Cervicitis Flashcards
What kind of women get UTIs?
a. Women – the vast majority of UTI occur in women; cystitis accounts for the bulk of these infections i. Younger: hygienic practices, intercourse, spermicides, pregnancy ii. Older: loss of anatomic support of pelvis due to aging, compromised sphincter integrity, post menopausal hormone withdrawal effect on mucosa and vaginal colonization. * Hospitalized pts: catheter related or other interventions involving the GU tract
What kind of men get UTIs?
b. Men- i. Older: 2° prostate enlargement with relative obstruction, incomplete bladder emptying and urinary retention ii. Young boys – congenital anatomic abnormalities very common (true but to a lesser extent for young girls too) iii. Typically require investigation of structure and function
What organisms cause UTIs?
1) E.coli 2) Staphylococcus saphrophyticus 10-15% UTI 3) klebsiella 4) proteus 5) pseudomonas 6) enterococci (typically older pts and complicated infection)
E. coli and UTIs
E. Coli: cause 80-90% UTI 1. E. coli sero-grouped according to LPS (O ), flagella (H), capsule (K) antigens 2. Relatively few serogroups cause UTI = UPEC 3. UPEC virulence factors a. Adhesion molecules i. Type 1 (mannose sensitive) fimbriae (pili); predominate in cystitis ii. P fimbriae (mannose resistant – recognize P blood group antigen); predominate in pyelonephitis b. Siderophores c. α hemolysin d. biofilm formation
“always” means blood stream infection (e.g. endocarditis) with seeding of kidney and spill over into urine.
staph aureus
typically in the setting of pts on antibiotics; most often as a complication of indwelling catheter but can occur in immune- compromised pts.
Candida
How does UTI clinically present?
a. Onset: typically acute (90% if woman has dysuria and frequency but no vaginal discharge or irritation
What labs do you do for UTI?
i. Urinalysis 1. microscopy: TNTC PMN and organisms in stained or unstained samples 2. dipstick: a. esterase: (+) test indicates presence of PMN b. nitrite: (+) test indicates presence of bacteria [neg. c Gm (+) orgs] ii. Culture and antibiotic sensitivity testing Indicated if pt has recurrent infection, lack of response to therapy (suggests antibiotic resistance), complicated UTI iii. Imaging studies are indicated in males, certain complicated UTI and when complications occur
What conditions do you need to exclude in UTIs?
-The main conditions to exclude are those that cause dysuria. -In adolescents and young adults—>sexually transmitted infections must be excluded. - -Kidney stones and chemical irritants are also on the DDx list.
Summary
*Most UTI are uncomplicated and most occur in women. A woman with a history of dysuria and frequency but also has no vaginal irritation or discharge has >90% probability of UTI. In this common situation, laboratory testing is not indicated because even if the tests are negative the probability of UTI is still sufficiently high to indicate treatment.
Patient presents with following symptoms….what do they have? 1) Purulent or mucopurulent urethral discharge – Often accompanied by dysuria 2) Discharge may be clear or cloudy • Asymptomatic in 10% of cases • Incubation period: usually 1-14 days for symptomatic disease, but may be longer
Male Urethritis
Describe when dysuria is worst with urethritis
1) Maybe most marked with first morning urination due to increased acidity or solute content 2) may increase with alcohol consumption 3) between micturitions may be perceived as pain, itching, frequency, urgency 4) discomfort only during ejaculation, deep pelvic pain, or radiation to back suggest alternative diagnosis (Ex. prostatitis, epididymitis)
What is the differential if you have a man presenting with dysuria?
1) Urethritis– more common in sexually active men 2) Prostatitis– seen in both young and older men 3) Epididymitis– sexually acquired or seen in conjunction with acute prostatitis 4) Urinary tract infection– more common in older men, history of urinary tract instrumentation, or abnormal GU tract anatomy
What do you do during physical exam in a patient with Urethritis?
1) instruct patient not to pee for at least 2 hrs before exam 2) check for inguinal adenopathy, lesions, testicular/spermatic cord masses/tenderness 3) examine urethral meatus for dried crusts, redness, and spontaneous discharge 4) If NO spontaneous discharge, may have to try to express discharge
Main points of gonococcal urethritis? -incubation -discharge -symptoms -co-infection
1) Incubation period = 3-10 days 2) Risk of infection following single episode of intercourse with an infected partner is 17% 3) Discharge usually profuse &purulent 4) Discharge present at the meatus without stripping strongly suggests GC – “Sock sign” 5) Up to 2/3 of infected men have no to minimal symptoms 6) Up to 20% of patients with gonorrheal urethritis are co-infected with C. trachomatis
Dysuria in men-cystitis, urethritis, epididymitis
Dysuria in women-cystitis, ulcer disease, cervicitis
