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
mycoplasmas
very small with no cell wall Mycoplasma hominis - not dangerous Mycoplasma genitalum - the problem one ureaplasma urealyticum - rarely associated with infection but ubiquitous common organisms in gential tract most adults acquire sexually
mycoplasma genitalium
same disease pattern as for chlamydia more men symptomatic some implications for female partners do not use single dose azithromycin - breeds resistance moxifloxacin recommended
reactive arthritis
arthritis, urethritis, conjunctivitis
mucocutaneous lesions
associated with chlamydia, gonorrhoea, urea and mycoplasmas etc.
autoimmune
bacterial vaginosis
profuse malodorous discharge
homogenous discharge
raised pH - lactobacilli absent
not red or inflamed
sequelae of BV
- preterm delivery
- post surgical endometriosis
- ascending infection
- HIV transmission
- NGU in partners
treatment of BV
metronidazole drug of choice orally or topically
clindamycin cream or oral
candidiasis
pruritus, discharge
red inflamed
topical imidazoles
candidiasis
pruritus, discharge
red inflamed
topical imidazoles
trichomonas
parasite
males usually asymptomatic
frothy discharge with itch
red and inflamed
