Urology & STI Flashcards
asymptomatic bacteriuria
screen and treat: all pregnant women
most common UTI bacteria
e. coli
Uncomplicated UTI definition
cystitis/bladder infection/UTI
low risk pt
no systemic symptoms
complicated uti definition
lower or upper (kidneys)
high risk pt
systemic symptoms
UTI Symptoms
dysuria
urgency
frequency
incomplete emptying sensation
suprapubic/back pain
gross hematuria
foul smelling urine
midstream urine culture infection definition
midstream- >100,000 organisms
catheter- >1,000 organisms
Nitrites in urine
infection
nitrates in urine
normal in urine
leukocyte esterase in urine
usually indicates UTI
tests for enzyme produced by WBCs
first line treatment for UTI
nitrofurantoin
uncomplicated uti treatment
nitrofurantoin x3-6 days
dysuria treatment with UTI
antispasmodic (phenazopyridine or flavoxate)
complicated uti symptoms in older adults
fever
fatigue
falls
flaky
complicated uti treatment length
treat 7-14 days
UA with WBC cast indicates
pyelonephritis
outpt pyelonephritis tx
5-14 days (f/u 48 hours)
fluoroquinolones are preferred
urinary incontinence lifestyle treatment
etoh
carbonation
coffee/tea
citrus
artificial sweetener
urinary incontinence behavioral therapy
weight loss
regular voiding
pelvic floor exercise
minimize fluids
Gonorrhea treatment
ceftriaxone
chlamydia treatment
doxycycline
trichomoniasis treatment
metronidazole
PID outpatient treatment
ceftriaxone in single dose PLUS
doxycycline x14 days PLUS
metronidazole x14 days
HIV screening
routine screening all ages 13-64
all pregnant women
if TB, STI
never give these to HIV infected adults
live/attenuated vaccines
BV is
sexually associated, not sexually transmitted
BV
Asymptomatic in about 50% of women
* Profuse grayish-white malodorous vaginal discharge
* Unpleasant, fishy, or musty vaginal odor
* Increased odor after intercourse
* Pruritus and burning of vulvovaginal area
Amsel’s criteria for BV diagnosis requires 3 of the following signs and systems:
Homogenous white discharge coating vulva/vagina
Vaginal pH of >4.7
Fishy odor of vaginal discharge before or after addition of KOH (“whiff test”)
Clue cells on microscopic exam, 1 or more epithelial cells coated with bacteria, obscuring borders
BV treatment
metronidazole x 7 days
NO etoh until 24h after last dose
Chlamydia symptoms
Assessment Findings
* Mucopurulent cervicitis
* Edematous, congested, friable cervix
* Vaginal discharge
* Cervical motion tenderness
* Dysuria/urethritis
* Salpingitis
* Proctitis, epididymitis
* Abnormal vaginal bleeding
Gonorrhea symptoms men
Purulent urethral discharge
Dysuria
Testicular pain
Asymptomatic
gonorrhea symptoms- females
Often asymptomatic
Endocervical discharge
Dysuria
Bartholin’s gland abscess
Abnormal vaginal bleeding
Abdominal/pelvic pain
Adnexal tenderness
Cervical motion tenderness
PID criteria
Lower abdominal pain and/or tenderness
Cervical motion tenderness, +/- mucopus
Adnexal tenderness
trichomoniasis symptoms- female
Asymptomatic (sometimes for decades)
Vaginal discharge: frothy, yellow-green (often variable)
Vulvar irritation
Dysuria
Cervical petechiae = “strawberry cervix”
trichomoniasis symptoms male
Asymptomatic
Urethral discharge
Dysuria
Epididymitis
Prostatitis
trichomoniasis tx
metronidazole
primary syphilis
Chancre at site of inoculation begins as papule, then ulcerates with hard edge and clean, yellow base;
indurated and painless; usually on genitalia; solitary or multiple; persists for 1-5 weeks, heals
spontaneously
Chancre may go unnoticed in women
Regional lymphadenopathy
secondary syphilis
Rash that is bilaterally symmetrical, polymorphic, nonpruritic, frequently on soles and palms, and usually
persists for 2-6 weeks, then spontaneously resolves
Condyloma lata: moist, pink, peripheral warty lesions present on glans, perianal, vulval areas, and
intertriginous areas
syphilis screening test
EIA, CIA
then reflex rpr/vdrl testing
syphilis tx
benzathine PCN
asymptomatic bacteruria could precipitate this in pregnancy
pre term labor
sti increases risk for acquiring hiv if exposed
HSV 2
indications for herpes testing
if sti
<10 partners
hiv +
genital lesion
initial hiv testing should be
ELISA
sti increasing esp in women
syphilis
EIA, CIA used to screen for
syphilis
most frequent sti in america
chlamydia
sti associated with positive chandelier test
PID
