Lecture 17 - STIs Flashcards
What is the prevalence of symptomatic UTIs in men and young non-pregnant women
men
which age group of woman are at the biggest risk of symptomatic UTI
> 80 years incidence of 20%
which two groups of people are at the biggest risk of asymptomatic bacteriuria
institutionalised elderly 15-50%
long term indwelling catheters 100%
which hormones affect susceptibility to UTI in elderly ladies and how?
- oestrogen deficiency can cause lower lactobacilli levels (normal flora) and allow bacteria such as e.coli to flourish (decreases as older)
Name some of the bodies defences against bacteria causing UTI
- 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)
how do blood group antigens effect UTIs?
A and b - antigens bind to e.coli in the urine and flush away bacteria (not all people have them in secretions)
How has E.coli adapted to the urethral environment
- 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
Name some risk factors for females getting UTIs
> previous UTIs, sex, not weeing after sex, pregnancy, diabetes, bladder prolapse, low oestrogen
Name some risk factors for males getting UTIs
> MSM, prostate enlargement
Name some risk factors for BOTH males and females getting UTIs
renal transplant, urologic surgery, catheterisation, UT obstruction, neurogenic bladder, mental impairment,
symptoms of cystitis
dysuria, suprapubic pain, frequency, urgency, fever, smelly wee, sometimes haematuria
symptoms of pyelonephtiris
loin pain, fever, nausea and vomiting (sometimes LUTI symptoms)
Symptoms of UTI in 1) babies 2) elderly
1) failure 2 thrive
2) confusion
How do you diagnose a UTI
history, urinalysis, MSU
what would you look for in a urine dip in a UTI
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)
what would you look for when doing microscopy
pyuria (pus) if >100 leukocytes/ml
culture if >105 organisms
name some common causes of UTIs
e. coli
s. sapropyticys
proteins
klebsiella
enterobacter
entercoccus
s. aureus
how would you manage asymptomatic UTIs
watch for symptoms and monitor DONT TREAT unless pregs
how would you manage symptomatic UTIs
- 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
how long would you treat UTIs?
cystitis 3 days
pyelo 10-14 days
(in males treat any 10-14 days)
Name four diseases that can cause genital ulcers
HSv, syphilis, chancroid and clamydia
Symptoms of HSV and how would you treat it
painful ulcers, and local lymphadenopathy
treat aciclovir p.o. 5 times a day (can use low dose as prophylaxis if recurrent)
Describe the stages of syphilis
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)
How would syphilis be diagnosed
blood sample > EIA screening test, and VDRL TPPA. EIA always be positive so need both to test if re-occurrence
What is chancroid
haemaphilus ducreyi - hard to grow
get ulcers with necrotic bases
what is urethritis? caused by?
- painful discharge! pyuria
- can be honorrhoea or non gonococcal (HSV, chlymadia, mycoplasm genitailum, trichmonas vaginalis, ureaplasm urelyticam)
WHat can gonorrhoea cause?
peri hepatitis, septic arthritis, conjunctivitis, pharyngeal infection, disseminated - USUALLY PUS
if a patient came in with urethritis what tests would you perform
swab and gram stain and culture - looking for gram negative diplococci (purple)
why is gonorrhoea a worry for the future
increasing resistance, already resistant to penicillin
what disease causes genital warts?
HPV - usually asymptomatic
how do you treat genital warts
scrape
cryotherapy or kerolytics
