Lecture 17 - STIs

Question 1

What is the prevalence of symptomatic UTIs in men and young non-pregnant women

Answer 1

men

Question 2

which age group of woman are at the biggest risk of symptomatic UTI

Answer 2

> 80 years incidence of 20%

Question 3

which two groups of people are at the biggest risk of asymptomatic bacteriuria

Answer 3

institutionalised elderly 15-50%

long term indwelling catheters 100%

Question 4

which hormones affect susceptibility to UTI in elderly ladies and how?

Answer 4

• oestrogen deficiency can cause lower lactobacilli levels (normal flora) and allow bacteria such as e.coli to flourish (decreases as older)

Question 5

Name some of the bodies defences against bacteria causing UTI

Answer 5

• Tamm Horsfall protein and IgA are produce by the bod and have mannose on their surface > bacteria bind to and are flushed out with the proteins
• high urea levels kill bacteria
• low pH levels in urine kill bacteria
• Hippuric acid is produced by bod and harder for bacteria to survive in
• cytokines, pmns and immune responses (cell mediated and humoral)

Question 6

how do blood group antigens effect UTIs?

Answer 6

A and b - antigens bind to e.coli in the urine and flush away bacteria (not all people have them in secretions)

Question 7

How has E.coli adapted to the urethral environment

Answer 7

• Type 1 fimbrae and P fimbrae bind to mannose receptors on epithelium and gal gal receptors respectively.
• have flagella
• produce amino acids that allow it to survive in acidic pH

Question 8

Name some risk factors for females getting UTIs

Answer 8

> previous UTIs, sex, not weeing after sex, pregnancy, diabetes, bladder prolapse, low oestrogen

Question 9

Name some risk factors for males getting UTIs

Answer 9

> MSM, prostate enlargement

Question 10

Name some risk factors for BOTH males and females getting UTIs

Answer 10

renal transplant, urologic surgery, catheterisation, UT obstruction, neurogenic bladder, mental impairment,

Question 11

symptoms of cystitis

Answer 11

dysuria, suprapubic pain, frequency, urgency, fever, smelly wee, sometimes haematuria

Question 12

symptoms of pyelonephtiris

Answer 12

loin pain, fever, nausea and vomiting (sometimes LUTI symptoms)

Question 13

Symptoms of UTI in 1) babies 2) elderly

Answer 13

1) failure 2 thrive

2) confusion

Question 14

How do you diagnose a UTI

Answer 14

history, urinalysis, MSU

Question 15

what would you look for in a urine dip in a UTI

Answer 15

nitrates - only released by bacteria (not all though e.g. enterobacteriae do enterococcus dont)
leukocytes - although can have false positives e.g. blood, rifampicin, nitrofurantion, ascorbic acid / or false negatives co- amoxiclav

(if protein and blood then likely more going on)

Question 16

what would you look for when doing microscopy

Answer 16

pyuria (pus) if >100 leukocytes/ml

culture if >105 organisms

Question 17

name some common causes of UTIs

Answer 17

e. coli
s. sapropyticys
proteins
klebsiella
enterobacter
entercoccus
s. aureus

Question 18

how would you manage asymptomatic UTIs

Answer 18

watch for symptoms and monitor DONT TREAT unless pregs

Question 19

how would you manage symptomatic UTIs

Answer 19

• Abx - want to get more in urine than blood
• increased fluid intake
• low pH (cranberry juice)
• analgesia, only paracetamol/ oral pain relief

NB be aware antibiotic dose in renal failure

Question 20

how long would you treat UTIs?

Answer 20

cystitis 3 days
pyelo 10-14 days
(in males treat any 10-14 days)

Question 21

Name four diseases that can cause genital ulcers

Answer 21

HSv, syphilis, chancroid and clamydia

Question 22

Symptoms of HSV and how would you treat it

Answer 22

painful ulcers, and local lymphadenopathy

treat aciclovir p.o. 5 times a day (can use low dose as prophylaxis if recurrent)

Question 23

Describe the stages of syphilis

Answer 23

primary often non painful ulcer and may heal by itself (latent period)
secondary may return as…. macular, coppery rash, palms and soles, general lymphadenopathy, condylomata lata
tertiary v dangerous (stoke etc)

Question 24

How would syphilis be diagnosed

Answer 24

blood sample > EIA screening test, and VDRL TPPA. EIA always be positive so need both to test if re-occurrence

Question 25

What is chancroid

Answer 25

haemaphilus ducreyi - hard to grow

get ulcers with necrotic bases

Question 26

what is urethritis? caused by?

Answer 26

• painful discharge! pyuria

- can be honorrhoea or non gonococcal (HSV, chlymadia, mycoplasm genitailum, trichmonas vaginalis, ureaplasm urelyticam)

Question 27

WHat can gonorrhoea cause?

Answer 27

peri hepatitis, septic arthritis, conjunctivitis, pharyngeal infection, disseminated - USUALLY PUS

Question 28

if a patient came in with urethritis what tests would you perform

Answer 28

swab and gram stain and culture - looking for gram negative diplococci (purple)

Question 29

why is gonorrhoea a worry for the future

Answer 29

increasing resistance, already resistant to penicillin

Question 30

what disease causes genital warts?

Answer 30

HPV - usually asymptomatic

Question 31

how do you treat genital warts

Answer 31

scrape

cryotherapy or kerolytics