Lecture 30 - Urethritis Flashcards
Urethritis
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
Causes of vaginal discharge
Urethra shorter in females, doesnt really get as inflammed
Physiological - cyclical variation, cervical mucus
Cervicitis - endocervical infection
Genital candidiasis
bacterial vaginosis
Chlamydia
-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
Treatment of chlamydia
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
Complications of claymidia for males
- can get epididymitis and infertility
- reiters syndrome
Gonorrhoea
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
NAAT - nucleic acid testing
-high sensitivity
Treatment of gonorrhoea
- is easy if you use high does of cefriaxoane and azithromycin
- cannot use only azithromycin because it is resistant
Ciprofloxacin
- problem drug
- has broad spectrum of action
- gonorrhoea can be resistant to it
Complications of gonhorrhea in males?
- 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 -
PID
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
Non specific urethritis
- 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