urogenital infections (3) Flashcards
name 3 conditions that fall under vulvovaginitis
candidiasis
trichomoniasis
bacterial vaginosis
what causes vulvovaginitis
- non-STI–> bacterial vaginosis (most common cause of vaginal discharge; is an overgrowth of genital tract organisms) or candidiasis (yeast infection, usually C. albicans)
- STI–>trichomoniasis vaginalis (a protozoa)
- non-infectious–> allergic dermatitis, excessive physiological secretion, atrophic vaginitis
how does trichomoniasis vaginalis present
erythema of cervix and vulva
increased vaginal pH
how do you diagnose vulvovaginitis
- speculum exam to rule out cervicitis
- collect sample of discharge and pH (microscopy on discharge)
- test for other STIs
culture rarely needed
how does vulvovaginitis present
vaginal discharge odor puritis erythema dysuria
Tx for bacterial vaginosis
metronidazole or clindamycin
DONT treat partners
NOT reportable
Tx for vulvovaginal candidiasis
antifungals
Tx for trichomoniasis
Metronidazole
treat patient AND partner
what causes urethritis (+ cervicitis in women)
chlamydia trachomatis
N. gonorrhea
how does urethritis present in men
- dysuria (burning/pain on urination)
- discharge from penis (purulent or mucopurulent)
- rectal pain
- lesions
- bleeding
- meatal erythema
how does urethritis/cervicitis present in women
- dyspareunia (pain during intercourse)
- dysuria
- vaginal discharge (purulent or mucopurulent)
- abnormal vaginal bleeding/spotting
- strawberry cervix
- cervical friability
BUT can also be asymptomatic
urethritis can occur without cervicitis
how do you diagnose urethritis
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
Tx for chlamydia
doxycycline
azythromycin
Tx for gonorrhea
cefixime
ceftriaxone M
antibiotic resistance is changing rapidly
what is PID
pelvic inflammatory disease
infection of upper genital tract in women–> endometrium, fallopian tubes, pelvic peritoneum
what causes PID
polymicrobial
- STI–> chlamydia, gonorrhea + endogenous orgs
- non-STI–> mycoplasma genitalium, bacteroides, E. coli, gardnerella vaginalis
rare STI–> HSV, T. vaginalis
how does PID present? what must you rule out?
abdominal pain
+/- fever
uterine, adnexal, cervical motion tenderness
must rule out ectopic pregnancy and acute appendicitis
what is genital ulcer disease
erosive, pustular, or vesicular ulcers
+/- regional lymphadenopathy
what causes genital ulcers
- HSV
- syphilis (T. pallidum)
- lymphogranuloma verenum (LGV)
- chanchroid (Haemophilus ducreyi)
- granuloma inguinale (donovanosis; Klebsiella granulomatis)
what does HSV primary infection look like on presentation
- 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
how does HSV become latent
virus invades local nerve endings and ascends axons
latency in SACRAL GANGLIA until reactivation
incubation period of HSV
6 days
what % of population is symptomatic with genital herpes infection
10%
what percent of canadians have HSV-1
60%
what percent of canadians have HSV-2
15-20%
how do you diagnose HSV
physical exam
PCR swab of lesion
serology for IgG
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)
manifestations of primary syphilis
solitary, painless chancre at site of inoculation
regional lymphadenopathy
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
manifestations of tertiary syphilis
develops 3-30 years after initial untreated infection
CV syphilis, neurosyphilis, gumma (destruction of any organ)
how does syphilis infection occur
invades mucous membrane or abraded skin–> enters lymphatics and bloodstream–> disseminates
incubation period of syphilis
about 3 weeks until primary symptoms
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
how do you treat primary, secondary or early latent syphilis
benzathine penicillin IM 1 dose
how do you treat late latent and CV syphilis
benzathine penicillin IM weekly 3 times
how do you treat neurosyphilis
IV penicillin G daily for 10-14 days
what causes LGV
(lymphogranuloma verenum)
C. trachomatis serovars L1, L2, L3
what causes chancroid
haemophilus ducreyi
what causes donovanosis
klebsiella granulomatis (painless ulcers, beefy red appearance)
what do you screen all pregnant women for?
HIV Hep B chlamydia gonorrhea syphilis
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
what is the most common STI
chlamydia trachomatis
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
list common uropathogens
- enterobacteriaceae (E. coli - most common…. also Klebsiella and Proteus)
- Enterococcus spp
- Staph. saprophyticus (coagulase - staph… in women)
- strep. agalactiae (Group B strep)
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
what factors predispose a host to a UTI
- kidney stones
- vesicoureteral reflux (more common in pediatrics–valves may not be as competent)
- neurological problems (ie. neurogenic bladder from diabetes)–> unable to empty when full so get urine stasis and bacterial growth
- prostate hypertrophy
- short urethra (in women)
- loss of sphincter control–> urine retention
- URINARY CATHETERS–> avoid unless clinically indicated
what is the most common nosocomial infection?
catheter associated UTIs
signs and symptoms of UTI
increased frequency of urination
urgency
pain on urination
**cloudy urine is not diagnostic of a UTI
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
what do you detect on urinalysis
- macroscopic
- microscopic
- leukocyte esterase (+ suggests WBCs are present)
nitrite (+ if bacteria are present that can reduce nitrate to nitrite like enterobacteriaceae can) - culture (usually avail after 18-24 hours
for mid stream urine sample, if more than 3 bacterial organisms are found, suspect contamination of sample
Tx for acure cystitis (bladder infection)
nitrofurantoin
or fosfymycin
clinical presentation of pyelonephritis
lower urinary tract symptoms
fever
costovertebral angle tenderness
renal function loss
may result in bacteremia
Tx for pyelonephritis
in community: cefixime
in hospital: ceftriaxone or gentamycin
how do catheter associated UTIs differ from other UTIs
typical symptoms are absent
assess for fever, rigors, CVA tenderness
Tx for catheter associated UTI
antibiotics
catheter removed or changed
