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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

24
Q

what percent of canadians have HSV-1

25
what percent of canadians have HSV-2
15-20%
26
how do you diagnose HSV
physical exam PCR swab of lesion serology for IgG
27
Tx of HSV
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
manifestations of primary syphilis
solitary, painless chancre at site of inoculation regional lymphadenopathy
29
manifestations of secondary syphillis
rash and generalized lymphadenopathy non-itchy and may be MORBILIFORM PAPULOSQUAMOUS--> rash is on SOLES and PALMS may have systemic symptoms
30
manifestations of tertiary syphilis
develops 3-30 years after initial untreated infection CV syphilis, neurosyphilis, gumma (destruction of any organ)
31
how does syphilis infection occur
invades mucous membrane or abraded skin--> enters lymphatics and bloodstream--> disseminates
32
incubation period of syphilis
about 3 weeks until primary symptoms
33
how is syphilis diagnosed
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
how do you treat primary, secondary or early latent syphilis
benzathine penicillin IM 1 dose
35
how do you treat late latent and CV syphilis
benzathine penicillin IM weekly 3 times
36
how do you treat neurosyphilis
IV penicillin G daily for 10-14 days
37
what causes LGV
(lymphogranuloma verenum) C. trachomatis serovars L1, L2, L3
38
what causes chancroid
haemophilus ducreyi
39
what causes donovanosis
klebsiella granulomatis (painless ulcers, beefy red appearance)
40
what do you screen all pregnant women for?
``` HIV Hep B chlamydia gonorrhea syphilis ```
41
what is chlamydia trachomatis
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
what is the most common STI
chlamydia trachomatis
43
how does N. gonorrhea infection occur
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
list common uropathogens
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
what are the bacterial virulence factors associated with uropathogenic E. coli
P. fimbriae allows uropathogenic E. coli to adhere to urethral and bladder epithelium capsular polysaccharides (K) inhibits phagocytosis HEMOLYSINS damage membrane
46
what factors predispose a host to a UTI
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
what is the most common nosocomial infection?
catheter associated UTIs
48
signs and symptoms of UTI
increased frequency of urination urgency pain on urination **cloudy urine is not diagnostic of a UTI
49
what is the problem with getting a urine sample from a Foley catheter
if its been in longer than 24 hours its likely to be colonized with bacteria anyway, messing up the sample
50
what do you detect on urinalysis 1. macroscopic 2. microscopic
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
Tx for acure cystitis (bladder infection)
nitrofurantoin or fosfymycin
52
clinical presentation of pyelonephritis
lower urinary tract symptoms fever costovertebral angle tenderness renal function loss may result in bacteremia
53
Tx for pyelonephritis
in community: cefixime in hospital: ceftriaxone or gentamycin
54
how do catheter associated UTIs differ from other UTIs
typical symptoms are absent assess for fever, rigors, CVA tenderness
55
Tx for catheter associated UTI
antibiotics | catheter removed or changed

IDMM (29 decks)

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