Lecture 30 - Urethritis Flashcards

1
Q

Urethritis

A

Inflammation of the urethra
-symptoms include - discharge and dysuria

-In males - urethral glands produce a colloid secretion containing glycosaminoglycans which protect the eptihtleium agains urine

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2
Q

Causes of vaginal discharge

A

Urethra shorter in females, doesnt really get as inflammed

Physiological - cyclical variation, cervical mucus

Cervicitis - endocervical infection

Genital candidiasis
bacterial vaginosis

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3
Q

Chlamydia

A

-most common bacterial STI in NZ
-take over host cell ATP production and must replicate inside cells
-different spectrum of disease
-Male - urethritis, epididmytis
Female - cervicitis, sterile pyuria, ectopic pregnancy, infertility

  • Initial infection is mild and self-limited
  • antibodies against the major outer membrane protein can neutralise organisms - can get latent infection
  • recurrent infection can produce severe inflammation resulting in tissue damage and scarring
  • due to exaggerated host CMI repsonse
  • because cross reacting heat shock protein aggravated by persisting intracellular chlamydia antigen so body reacts to own heat shock protein get damage

collect urine test for male, and a vaginal swab for females

diagnosis - DNA amplification

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4
Q

Treatment of chlamydia

A

Azithromycin -easier for patient adherence, and then Doycycline

Azithromycin - -this works by binding to the 50S subunit of the bacterial ribosome

  • chlamydia - not resistant
  • long half life
  • Need to notify partners
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5
Q

Complications of claymidia for males

A
  • can get epididymitis and infertility

- reiters syndrome

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6
Q

Gonorrhoea

A

Niserrea gonorrhoea

gram negative diplococcus

  • human is the only host
  • infection on non-cornified epithelial cells
  • oxidase positive
  • fastidious growth
  • chromosomal or plasmid mediated antibiotic resistance

Virulence factors
-has pillin , adherence proteins, toxins

-take sample from site of symptoms

Grow on selective artificial media - contain blood, growth promotors, antibiotics

Urethral infection in males - most are symptomatic, anterior urethritis - discharge and dysuria
-untreated men - 95% asymptomatic after 6 months

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7
Q

NAAT - nucleic acid testing

A

-high sensitivity

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8
Q

Treatment of gonorrhoea

A
  • is easy if you use high does of cefriaxoane and azithromycin
  • cannot use only azithromycin because it is resistant
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9
Q

Ciprofloxacin

A
  • problem drug
  • has broad spectrum of action
  • gonorrhoea can be resistant to it
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10
Q

Complications of gonhorrhea in males?

A
  • epididymitis
  • can also get rectal infection
  • pharangeal infection - from oral sex
  • endocervical infection in females but normally asymptomatic (if symptomatic then will get vaginal discharge)
  • Pelvic inflammatory disease -
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11
Q

PID

A

primary cervicitis, infection may spread
-long term - csan get chornic pain, inferitlity, ectopic pregnancy

Symptoms - vainal discharge or bleeding, signs - abdominal tenderness

Caues

  • chlamydia
  • gonohhroea

Treatment 0 depedns on cause

Ceftriazone, plus dozycyline

Complications - chronic pain, inferitlity

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12
Q

Non specific urethritis

A
  • Diagnosis depends on -presence of symptoms or signs
  • rule out chlaymidia and gonhorrhea
  • microscopy of urethral smear lookign for PMNL
  • could be mycoplasma genitalium
  • adenovirus
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