Lecture 30: Dysuria-UTI Flashcards
18 y/o woman with burning discomfort on passing urine. New boyfriend - sex without condoms?
Chlamydia and Gonorrhoea in women usually present with cervicitis and further up (in men they present with urethritis)
Chlamydia and gonorrhoea present in women with more than just pain as well
Cystitis (bladder infection) is most likely
18 y/o male presents with burning discomfort on passing urine and has been having unprotected sex with new male partner.
Not pyelonephritis as no signs like back pain or systemic problems
Young men don’t often get cystitis as it is a lot further to get in males then females
Gonorrhoea and chlamydia will both most likely cause urthethritis so the correct answer is Urethritis
18 y/o male with new boyfriend + unprotected sex = discomfort on urination. Most useful thing to do?
Always counsel and prescribe condoms but not the next thing to do
A midstream urine looks for what is in the bladder/urine and not what is in the urethra, a urethral swab looks at what is in his urethra.
The next thing would actually be to get a further history to understand what it is most likely to be - Does he have urinary frequency? Visible haematuria? Discharge (indicative of urethritis typically from gonorrhoea)? Suprapubic discomfort when not urinating?
18 y/o woman presents with burning on urination. Bladder cramping and urinary frequency. New boyfriend + inprotected sex. Next most useful thing to do?
She has cystitis most likely so we get a midstream urine and test by dipstick (super cheap and very easy to do) - looking for WBC to see if there is inflammation in the bladder.
We treat from there with broad spectrum antibiotics. If the symptoms persist then we send a sample off to the lab to see if it is a resistant bacteria.
18 y/o shows high WBC on her urine dipstick. How should we treat?
She has cystitis. Treat her with trimethoprim 300mg nocte for 3 nights. We are not preventing a horrible outcome but rather stopping them from feeling average and having pain everytime they urinate for the next 3 weeks.
Cystitis from E. Coli very rarely ever goes on to give people pyelonephritis and does not need to be worried amount massively but if they have systemic symptoms (fever - generally unwell) then they should be treated for pyelonephritis.
Treatment for cystitis?
99% of E. coli in human bladders are susceptable to nitrofurantoin (must be taken 4 times daily) - a sulphonamide that inhibits dihydroteroate synthetase and then dihydrate synthetase eventually inhibiting DNA replication
80% of E. Coli in humans are susceptable to trimethoprim (once at night time for 1-3 days) - interfers with purine synthesis (messes with folic acid) used in DNA - Don’t want to give to pregnant women…
