UTI- Pyelonephritis, Cystitis, Epidydmo-Orchitis and Urethritis (STDs)

Question 1

What is a UTI? and how are they categorized

Answer 1

A urinary tract infection is an infection that affects part of the urinary tract.

UTI are categorized on location of infection (upper/lower) or the presence of comorbidities (Complicated or uncomplicated)

Question 2

Describe the categorizations of UTI?

Answer 2

Upper UTI: infection of the kidney (pyelonephritis)

Lower UTI: infection of the bladder (cystitis), urethra (urethritis), prostate (prostatitis), Epididymitis (testicles/epididymis)

Uncomplicated UTI: if occurring in healthy non-pregnant adult women

Complicated UTI: MEN UTIs + the presence of factors that increase the risk of treatment failure (e.g diabetes, structural abnormalities, catheter and other devices)

Question 3

What pathogens are associated with UTI

Answer 3

KEEPS
Klebsiella Pneumoniae
Escherichia coli (MC)
Enterobacter spp
Proteus Spp / Proteus Mirabilis
Staphylococcus saprophyticus

Question 4

What causes epidydmo-orchitis?

Answer 4

If patent is younger than 35 - likely to be an STI

If patient is old than 35 - Likely to be a KEEPS UTI

Thus treat accordingly

Question 5

Pathophysiology of UTI

Answer 5

Colonisation and ascending spread of microorganisms from the urethra into the bladder (lower) and kidney (upper),

or

Haematogenous spread via the blood

Question 6

RF for a UTI

Answer 6

Recent sexual intercourse
Diabetes
History of UTIs
Spermicide use
Catheters

Question 7

UTI Sx

Answer 7

Typical clinical features of UTIs include dysuria (painful/burning) and increased frequency.

Symptoms:
Dysuria
Frequency
Urgency
Incontinence
Suprapubic pain
Haematuria
N&V

Signs
Fever
Rigors
Flank pain
Confusion
suprapubic tenderness

Question 8

How would pyelonephritis present?

Answer 8

Pylon nephritis signs : Triad - N/V, HIGH FEVER, LOIN PAIN

Question 9

How would Epidydimal-orchitis present?

Answer 9

Unilateral scrotal pain and swelling
(pain relived by elevating testes)

DDx- Testicular torsion - more acute n/v

Question 10

What is the pathophysiology of pyelonephritis?

Answer 10

1. Colonization
   Pathogen colonizes urethra and ascends
2. Uroepithelium penetration
   Pathogen attaches to bladder epithelial cells and penetrate bladder wall. Replication
3. Ascension
   Pathogen colony enters the ureter and ascends to the kidney releasing toxins.
   -toxins inhibit peristalsis = supporting infections
4. Pyelonenephritis
   Infection of renal parenchyma
5. Acute kidney Injury - IF untreated

Question 11

What are the cardinal signs of pyelonephritis?

Answer 11

LOIN pain, FEVER, Pyuria (WCC in urine)

Question 12

What is a complication of UTI?

Answer 12

Urosepsis - sepsis that originate from UTI
Defined as 2 or more feature of system inflamm response syndrome and a suspected UTI source.

Dysregulated host response can lead to:

haemodynamic instability, tachypnea, changes to mental status, reduced urine ouput and pyrexia

Manage w/ SEPSIS 6
3 IN(o2, Ab, Iv Fluids) + 3out (Blood culture, urine output, lactate)

Question 13

UTI diagnosis

Answer 13

Definitive diagnosis-
Clinical features: Dysuria + Pyuria (Wcc in urine)
->Urine dipstick

If complicated UTI (Systemic upset, DM, Preggo):

Urinalysis - Urine dipstick (++WCC, ++Nitrites, +/-hematuria)
and Urinary Midstream (MC&S)

Other: FBC/ ESR/CRP

Question 14

UTI TX

Answer 14

Acute Uncomplicated UTI
Trimethoprim / Nitrofurantoin (teratogenic in last trimester)
if CI - Amoxicillin

Complicated UTI / Acute pyelonephritis
Oral fluoroquinolones - Ciprofloxacin

Severe: Urosepsis / severe pyelonenpehritis
IV Broadspec AB - Co-amoxiclav

Question 15

What is urethritis?

Answer 15

Urethral inflammation +/- infection

Most commonly caused by STD

Question 16

STDs are the most common cause of urethritis. Name 3 common pathogens?

Answer 16

Infection:
Non-gonoccocal - Chlamydia trachomatis (MC)
Gonoccol- Neisseria Gonorrhoea

Non-infective - Trauma

Question 17

What type of bacteria is chlamydia trachomatis?

Answer 17

Gram negative aerobic bacilli

Question 18

What type of bacteria is Neisseria gonorrhoea?

Answer 18

Gram negative diplococci within polymorphonuclear cells.

Question 19

How do you treat Neisseria Gonorrhoea?

Answer 19

Ceftriaxone (Cephalosporin)
+
Azithromycin (Ci preggo)

Question 20

How do you treat chlamidya?

Answer 20

Chlamydia - Azithromycin / doxycycline (CI - pregenancy)

REMEMBER TO CONTACT TRACE

Question 21

General PX of Urethritis

Answer 21

Majority are Asx

Dysuria pain
+/- Urethral discharge (pus or blood)
Urethral pain (pelvic pain),
Itching
+/-Testicular pain
LUTS

Question 22

STI diagnosis?

Answer 22

1st line - NAAT
Nucleic acid amplification test of specimen retrieved from:
vaginal swabs, urethral swabs, first-catch urine sample

+ Urinalysis - Urine dipstick + Midstream MC+S

Question 23

Complication of STDs

Answer 23

REACTIVE ARTHRITIS - CANT SEE CANT PEE CANT CLIMB A TREE

Question 24

What is syphilis?

Answer 24

Syphilis is predominantly a sexually transmitted infection (STI)
fluid/blood transmission

Caused Treponema pallidum - Gram negative bacteria

Question 25

How does syphilis present

Answer 25

Primary syphilis:
Chancre: Papules -> Ulcers

After 4-12wks

Secondary Syphilis: Systemic features
General Sx - fever, headache, myalgia, malaise, anorexia, sore throat and/or weight loss.

Dermatological - Systemic rash, alopecia, maculopapular skin rash
GI - Hepatitis, splenomegaly
MSK - Synovitis + peritonitis
Ophthalmic - uveitis
CVD Syphilis (80%): Endarteritis, Aortitis (Aortic reg, HF)
Neurosyphilis (10%): Meningitis, CN palsies

Question 26

Syphilis TX

Answer 26

Benzathine penicillin
+ prednisolone (if late)

Question 27

Prostatitis sx

Answer 27

Peri anal pain when orgasm