urethritis, vaginal discharges, PID, prostatitis, inguinal and scrotal swellings Flashcards
causes of urethritis
chlamydia gonorrhoea NSU - non specific urethritis reactive arthritis herpes adenovirus thrichomonas candida warts foreign body bacterial vaginosis organisms
definition of urethritis
> 5 white blood cells per high powered field from a swab
threads in urine
gonorrhoea
neissferia gonorrhoea
gram negative intracellular diplococcus
human only host
rapid growth
symptoms gonorrhoea
females often asymptomatic, males usually symptomatic
males - urethritis, epidiymitis, proctitis, pharyngitis
females - cervicitis, PID, disseminated disase
local inflammation increases risk of HIV transmission
associated conditions of neissera gonorrhoea
associated rectal infection in 30% of women - most asymptomatic
pharyngitis rarely sole site
- role of saliva
complications:
males- epididymitis, strictures very rare
females - infertility, adhesions
disseminated gonorrhoeal disease
more common in women
arthritis/dermatitis
arthritis - often joint aspirate does not grow bacteria so important for genital testing
skin lesions - necrotic on extremities because bacteria blocks off vessels
diagnosis of gonorrohheae
culture needed - gives antibiotic sensitivities because lots of antibiotics won’t work
pus swab
provide slide for gram stain - intracellular for diagnosis
nucleic acid detection
PCR - duplex test for gonorrhoea and chlamydia
urine as effective as urethral swabs in men - not most useful in women, do self obtained low vaginal swab
not good test for throat and rectum (too many false positives)
2 resistance patterns for neisseria gonorrhoeae
PPNG penicillinase producing plasmid
chromosomally mediated increasingly common
antibiotic relied on for neisseria gonorohheae
ceftriaxone IM or IV plus azithromycin together
consider treating for chlamydia - common co-infection
chlamydia
chlamydia trachomatis
obligate intracellular organism
slow growing
chlamydia life cycle
only effective treatment when reproducing
persistent, non replicating, uncultivable form with potential for reactivation
sequelae for chlamydia
males - urethritis, epididymitis, proctitis, infertility, throat and ractal infections
females - infertility, pelvic pain, adhesions
testing for chlamydia
NAAT - nucleic acid testing via PCR
culture not available
treatment issues with chlamydia
doxycycline drug of choice
azithromycin not good at clearing infection from other sites
POC (proof of clearance) at 4 weeks
