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IDMM > urogenital infections (3) > Flashcards

urogenital infections (3) Flashcards

1
Q

name 3 conditions that fall under vulvovaginitis

A

candidiasis
trichomoniasis
bacterial vaginosis

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2
Q

what causes vulvovaginitis

A
  1. non-STI–> bacterial vaginosis (most common cause of vaginal discharge; is an overgrowth of genital tract organisms) or candidiasis (yeast infection, usually C. albicans)
  2. STI–>trichomoniasis vaginalis (a protozoa)
  3. non-infectious–> allergic dermatitis, excessive physiological secretion, atrophic vaginitis
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3
Q

how does trichomoniasis vaginalis present

A

erythema of cervix and vulva

increased vaginal pH

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4
Q

how do you diagnose vulvovaginitis

A
  1. speculum exam to rule out cervicitis
  2. collect sample of discharge and pH (microscopy on discharge)
  3. test for other STIs

culture rarely needed

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5
Q

how does vulvovaginitis present

A 
vaginal discharge
odor
puritis
erythema
dysuria
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6
Q

Tx for bacterial vaginosis

A

metronidazole or clindamycin

DONT treat partners
NOT reportable

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7
Q

Tx for vulvovaginal candidiasis

A

antifungals

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8
Q

Tx for trichomoniasis

A

Metronidazole

treat patient AND partner

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9
Q

what causes urethritis (+ cervicitis in women)

A

chlamydia trachomatis

N. gonorrhea

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10
Q

how does urethritis present in men

A
  1. dysuria (burning/pain on urination)
  2. discharge from penis (purulent or mucopurulent)
  3. rectal pain
  4. lesions
  5. bleeding
  6. meatal erythema
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11
Q

how does urethritis/cervicitis present in women

A
  1. dyspareunia (pain during intercourse)
  2. dysuria
  3. vaginal discharge (purulent or mucopurulent)
  4. abnormal vaginal bleeding/spotting
  5. strawberry cervix
  6. cervical friability

BUT can also be asymptomatic
urethritis can occur without cervicitis

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12
Q

how do you diagnose urethritis

A

specimen collection–> endourethral swab for symptomatic cases and when test of cure is needed; urine samples

lab diagnosis–> urethral swab–> gram stain for DIPLOCOCCI; culture for gonorrhea and susceptibility testing

in urine–> nucleic acid amplification test for gonorrhea and chlamydia

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13
Q

Tx for chlamydia

A

doxycycline

azythromycin

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14
Q

Tx for gonorrhea

A

cefixime

ceftriaxone M

antibiotic resistance is changing rapidly

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15
Q

what is PID

A

pelvic inflammatory disease

infection of upper genital tract in women–> endometrium, fallopian tubes, pelvic peritoneum

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16
Q

what causes PID

A

polymicrobial

  1. STI–> chlamydia, gonorrhea + endogenous orgs
  2. non-STI–> mycoplasma genitalium, bacteroides, E. coli, gardnerella vaginalis

rare STI–> HSV, T. vaginalis

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17
Q

how does PID present? what must you rule out?

A

abdominal pain
+/- fever
uterine, adnexal, cervical motion tenderness

must rule out ectopic pregnancy and acute appendicitis

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18
Q

what is genital ulcer disease

A

erosive, pustular, or vesicular ulcers

+/- regional lymphadenopathy

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19
Q

what causes genital ulcers

A
  1. HSV
  2. syphilis (T. pallidum)
  3. lymphogranuloma verenum (LGV)
  4. chanchroid (Haemophilus ducreyi)
  5. granuloma inguinale (donovanosis; Klebsiella granulomatis)
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20
Q

what does HSV primary infection look like on presentation

A
  • painful, extensive vesiculoulcerative lesions
  • systemic symptoms like fever
  • tender lymphadenopathy
  • complications can include aseptic meningitis
  • may be asymptomatic but can still SHED virus

atypical symptoms = urethritis, cervicitis, aseptic meningitis

appear as GROUPED VESICLES, SUPERFICIAL ULCERS with ERYTHEMATOUS BASE

PAINFUL and/or puritic

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21
Q

how does HSV become latent

A

virus invades local nerve endings and ascends axons

latency in SACRAL GANGLIA until reactivation

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22
Q

incubation period of HSV

A

6 days

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23
Q

what % of population is symptomatic with genital herpes infection

A

10%

24
Q

what percent of canadians have HSV-1

A

60%

25
Q

what percent of canadians have HSV-2

A

15-20%

26
Q

how do you diagnose HSV

A

physical exam
PCR swab of lesion
serology for IgG

27
Q

Tx of HSV

A

no cure

counseling
antiviral therapy for recurrent episodes–> ACYCLOVIR
risk of neonatal infections (i.e from HSV-1) if mother was not exposed due to no IgG passed from mother to child to protect (meningitis)

28
Q

manifestations of primary syphilis

A

solitary, painless chancre at site of inoculation

regional lymphadenopathy

29
Q

manifestations of secondary syphillis

A

rash and generalized lymphadenopathy

non-itchy and may be MORBILIFORM PAPULOSQUAMOUS–> rash is on SOLES and PALMS

may have systemic symptoms

30
Q

manifestations of tertiary syphilis

A

develops 3-30 years after initial untreated infection

CV syphilis, neurosyphilis, gumma (destruction of any organ)

31
Q

how does syphilis infection occur

A

invades mucous membrane or abraded skin–> enters lymphatics and bloodstream–> disseminates

32
Q

incubation period of syphilis

A

about 3 weeks until primary symptoms

33
Q

how is syphilis diagnosed

A

dark field microscopy

serology–> RPR or VRDL; treponema specific: special stain/PCR of fluid from chancre for primary syphilis

treponemal screen first (EIA) and then confirm with TPPA, LIA

34
Q

how do you treat primary, secondary or early latent syphilis

A

benzathine penicillin IM 1 dose

35
Q

how do you treat late latent and CV syphilis

A

benzathine penicillin IM weekly 3 times

36
Q

how do you treat neurosyphilis

A

IV penicillin G daily for 10-14 days

37
Q

what causes LGV

A

(lymphogranuloma verenum)

C. trachomatis serovars L1, L2, L3

38
Q

what causes chancroid

A

haemophilus ducreyi

39
Q

what causes donovanosis

A

klebsiella granulomatis (painless ulcers, beefy red appearance)

40
Q

what do you screen all pregnant women for?

A 
HIV
Hep B
chlamydia
gonorrhea
syphilis
41
Q

what is chlamydia trachomatis

A

obligate intracellular organism
invades epithelial cells

infection can persist asymptomatically for months when the immune system response is not sufficient, resulting in scarring, adhesions, salpingitis and tubal occlusions

most common STI with increasing rates– > often co-infected with gonorrhea

42
Q

what is the most common STI

A

chlamydia trachomatis

43
Q

how does N. gonorrhea infection occur

A

gram - diplococci

infect and penetrate the columnar epithelium through the submucosa

inflammatory response = sloughing off of epithelium, submucosal microabsesses, exudation of pus

evasion of immune response through INTRACELLULAR replication

44
Q

list common uropathogens

A
  1. enterobacteriaceae (E. coli - most common…. also Klebsiella and Proteus)
  2. Enterococcus spp
  3. Staph. saprophyticus (coagulase - staph… in women)
  4. strep. agalactiae (Group B strep)
45
Q

what are the bacterial virulence factors associated with uropathogenic E. coli

A

P. fimbriae allows uropathogenic E. coli to adhere to urethral and bladder epithelium

capsular polysaccharides (K) inhibits phagocytosis

HEMOLYSINS damage membrane

46
Q

what factors predispose a host to a UTI

A
  1. kidney stones
  2. vesicoureteral reflux (more common in pediatrics–valves may not be as competent)
  3. neurological problems (ie. neurogenic bladder from diabetes)–> unable to empty when full so get urine stasis and bacterial growth
  4. prostate hypertrophy
  5. short urethra (in women)
  6. loss of sphincter control–> urine retention
  7. URINARY CATHETERS–> avoid unless clinically indicated
47
Q

what is the most common nosocomial infection?

A

catheter associated UTIs

48
Q

signs and symptoms of UTI

A

increased frequency of urination
urgency
pain on urination

**cloudy urine is not diagnostic of a UTI

49
Q

what is the problem with getting a urine sample from a Foley catheter

A

if its been in longer than 24 hours its likely to be colonized with bacteria anyway, messing up the sample

50
Q

what do you detect on urinalysis

  1. macroscopic
  2. microscopic
A
  1. leukocyte esterase (+ suggests WBCs are present)
    nitrite (+ if bacteria are present that can reduce nitrate to nitrite like enterobacteriaceae can)
  2. culture (usually avail after 18-24 hours

for mid stream urine sample, if more than 3 bacterial organisms are found, suspect contamination of sample

51
Q

Tx for acure cystitis (bladder infection)

A

nitrofurantoin

or fosfymycin

52
Q

clinical presentation of pyelonephritis

A

lower urinary tract symptoms
fever
costovertebral angle tenderness

renal function loss
may result in bacteremia

53
Q

Tx for pyelonephritis

A

in community: cefixime

in hospital: ceftriaxone or gentamycin

54
Q

how do catheter associated UTIs differ from other UTIs

A

typical symptoms are absent

assess for fever, rigors, CVA tenderness

55
Q

Tx for catheter associated UTI

A

antibiotics

catheter removed or changed

IDMM (29 decks)

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