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Applied Pathophysiology > UTI & STIs > Flashcards

UTI & STIs Flashcards

1
Q

Urinary Tract Infections (UTIs) are defined as…

A

the presence of microorganisms in the urine that cannot be accounted for by contamination
* microorganisms have the potential to invade urinary tract tissues and adjacent structures/ organs

(urine is sterile coming out & as it exits it becomes contaminated)

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2
Q

Bacteriuria:

A

presence of bacteria in urine

(amount is what depicts if they’ll be infected or not - but always a % of bacteria in urine)

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3
Q

Abacteriuria:

A

lack of detectable bacteria in urine

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4
Q

Urinary Tract Infections (UTIs) represent…

A

a wide variety of clinical inflammatory syndromes:

Lower tract UTI:
* Urethritis (urethra)
* Cystitis (bladder)
* Prostatitis (prostate)
* Epididymitis (testicular epididymis)

Upper tract UTI
* Pyelonephritis (ureters + kidney)

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5
Q

What are the Lower tract UTIs?

A
  • Urethritis (urethra)
  • Cystitis (bladder)
  • Prostatitis (prostate)
  • Epididymitis (testicular epididymis)
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6
Q

What are the Upper tract UTIs?

A
  • Pyelonephritis (ureters + kidney)
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7
Q

Which are the most common UTIs? Lower or Upper tract?

A

Lower tract

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8
Q

Upper urinary tract has the ____ frequent UTI, with…

A

LESS

0.4 cases/ 10,000 people / month

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9
Q

Lower urinary tract has the ____ frequent UTI, with…

A

MOST

1.5 cases/ 10,000 people/ month

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10
Q

What is included in the Upper urinary tract?

A
  • Diaphragm
  • Adrenal gland
  • Left kidney
  • Right kidney
  • Ureters
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11
Q

What is included in the Lower urinary tract?

A
  • *Bladder
  • *Urethra
  • Female cervix
  • Male prostate
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12
Q

What is the UTIs Epidemiology?

A

UTIs vary by age and sex

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13
Q

What is the UTI epidemiology for Newborns – 6 months?

A

most common in males (1%)
* Due to abnormalities of urinary tract and non-circumcision

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14
Q

What is the UTI epidemiology for >1 year to adulthood (pre-menopause)?

A

most common in FEMALES
* 1 in 5 women will experience a symptomatic UTI in their lifetime

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15
Q

What are the increased UTI risks in >1 year to adulthood (pre-menopause)?

A
  • during and after pregnancy (put weight on bladder & urethra)
  • frequent sexual activity/ multiple partners
  • frequent spermicide, condom, diaphragm use
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16
Q

What is the UTI epidemiology for >65 yrs?

A

EQUAL (50%) among males and females
* (Asymptomatic) increases with hospitalization and nursing home care (ex: diapers)

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17
Q

What is the UTI epidemiology for Prostatitis (prostate infection)?

A

Rarely occurs in young men, 50% OF MEN >30 YRS will experience in lifetime

(prostate grows as men age)

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18
Q

What is a simple way of saying why female may get more UTIs?

A

males have more distance b/t urethra & anus

& females may do improper wiping etc. (many other factors) b/c urethra is closer to anus

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19
Q

What are the 2 types of UTIs?

A

Uncomplicated & complicated

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20
Q

Uncomplicated UTIs:

A

are due to infections that may interfere with the normal flow of urine or the voiding mechanism
* Does NOT include anatomical or neurologic abnormalities
** Primarily involve ADULT PRE-MENOPAUSAL WOMEN

(majority that’ll be in clinic)

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21
Q

Complicated UTIs:

A

result of a predisposing lesion of the urinary tract, such as a congenital abnormality or distortion of the urinary tract: stones, indwelling catheter, prostatic hypertrophy, obstruction, or neurologic deficit that interferes with the normal flow of urine and urinary tract defenses
** EVERYONE EXCEPT “healthy” adult pre-menopausal women

(complicated b/c other factors are at play)

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22
Q

Untreated UTIs are the most common cause of _______ _______ (20%)

A

community-acquired bacteremia

(can lead to sepsis)

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23
Q

Asymptomatic bacteriuria (AB):

A

is absence of UTI signs or symptoms in a patient whose urine culture satisfies criteria for UTI→found mainly in high-risk patient urine screens (for other causes); RARELY TREATED
* ELDERLY PATIENTS (>65 yrs) FREQUENTLY HAVE AB IN URINE
* Altered mental status, catheterization, incontinence (but hard to say)

(self-resolving)

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24
Q

Recurrent UTIs:

A

two or more UTIs occurring within 6 months or three or more within 1 year
* caused by REINFECTION or RELAPSE

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25
Q

What are the 2 reasons for recurrent UTIs?

A
  1. Reinfections’
  2. Relapses
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26
Q

What are Reinfections?

A

are caused by a different organism and account
for the majority of recurrent UTIs

(microorganism isn’t responding to AMT, could be b/c of anti-microbial resistance or failure to identify causative agent)

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27
Q

What are Relapses?

A

are caused by repeated infections caused by the same initial organism

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28
Q

UTIs usually originate from…

A

host bowel flora

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29
Q

UTIs primarily due to…

A

bacterial infections
* Specific virulence factors promote common infections

(viral are rare)

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30
Q

Most ______ UTIs are caused by a SINGLE organism

A

UNcomplicated

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31
Q

Describe the etiology for UTIs with Escherichia coli
Gram -

A

80-90% of all community acquired UTIs

top 3 multidrug resistant UTIs (Canada/ World)

Most frequently identified species in hospitalized
patients→accounts for 75% of all UTIs

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32
Q

Describe the etiology for UTIs with Enterococcus spp. Gram +

A

2nd most commonly identified species in hospitalized patients

May be due to overuse of third-generation cephalosporin antibiotics (not active against enterococci)
- 3rd gen B-lactam antibiotic

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33
Q

List other frequently isolated microorganisms that cause UTIs

A
  • Proteus spp. (Gram -)
  • Enterobacter spp. (Gram -)
  • Klebsiella pneumoniae (Gram -)
  • Pseudomonas aeruginosa (Gram -)

** Staphylococcus spp. (Gram +) –> common skin microorganism

** Candida spp. (Fungi)

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34
Q

Describe Staphylococcus spp. which is a frequently isolated microorganisms that cause UTIs

A
  • S. aureus commonly associated with BACTEREMIA that produce metastatic abscesses in kidneys→MRSA
  • could result in PYELONEPHRITIS (serious)
  • S. epidermidis should always be REtested if identified→it is a common skin flora
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35
Q

Describe Candida spp. which is a frequently isolated microorganisms that cause UTIs

A
  • common cause of UTIs in critically ill and chronically catheterized patients (complicated UTIs)

(prob: don’t have enough antifungal antimicrobials & if it become resis. doesn’t have many options)

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36
Q

What is the pathophysiology of UTIs?

A

Route of infection:

2 main routes of UTI entry:
1. Ascending
2. Hematogenous (descending)

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37
Q

Describe the Ascending route of infection for UTIs

A

bacteria → urethra → bladder → kidneys

  • MOST COMMON route of UTI, particularly in females due to anatomy of urethra and its common colonization by FECAL FLORA
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38
Q

Describe the Descending route of infection for UTIs

A

bacteria → kidneys → bladder

  • dissemination of organisms (BACTERMIA) from a distant primary infection in the body to kidneys (PYELONEPHRITIS)
  • Uncommon route (less than 5% of documented UTIs) and involve invasive organisms:
  • S. AUREUS, CANDIDA spp.,Mycobacterium tuberculosis, Salmonella spp., and ENTEROCOCCI
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39
Q

Describe the Descending route of infection for UTIs

A

bacteria → kidneys → bladder

  • dissemination of organisms (BACTERMIA) from a distant primary infection in the body to kidneys (PYELONEPHRITIS)
  • Uncommon route (less than 5% of documented UTIs) and involve invasive organisms:
  • S. AUREUS, CANDIDA spp.,Mycobacterium tuberculosis, Salmonella spp., and ENTEROCOCCI
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40
Q

After bacteria reach the urinary tract, 3 factors determine the development of UTI:

A
  1. SIZE of the bacterial inoculum (HIGHER TITRE ↑ RISK)
    - will overwhelm defenses
  2. VIRULENCE of the microorganism
    * adherent bacteria can easily bind to epithelial cells after urination
    - if tightly bound, it’ll stay & multiple => infection
  3. COMPETENCY of the natural HOST DEFENSE MECHANISMS
    * Most UTIs reflect a failure in HOST DEFENSE MECHANISMS
    * urine chemistry under normal circumstances is capable of inhibiting and killing microorganisms (why only 1/5 women get 1)
    * Bacterial growth is further inhibited in males by the addition of prostatic secretions (another factor why men have fewer UTIs)
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41
Q

What are the Signs & Symptoms of UTIs?

A

signs and symptoms of UTIs in adults are recognized easily
* Hematuria – blood in urine
* Dysuria – painful urination
* Pyuria* – pus (white blood cells) in urine
* Presence of microorganisms in urine by Gram stain*
*CANNOT BE USED AS DIAGNOSIS ON ITS OWN

many patients with significant bacteriuria are asymptomatic (AB)

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42
Q

Hematuria:

A

blood in urine

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43
Q

Dysuria:

A

painful urination

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44
Q

Pyuria:

A

pus (white blood cells) in urine

*CANNOT BE USED AS DIAGNOSIS ON ITS OWN

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45
Q

Many patients (with a UTI) with SIGNIFICANT BACTERIURIA are ________

A

asymptomatic (AB)
* symptoms alone are not reliable to discriminate upper and lower UTIs
* elderly patients often do not exhibit typical UTI symptoms; see altered mental status, changes in eating habits, or gastrointestinal (GI) symptoms

(confirm diagnostic before antimicrobials with urine)

46
Q

____ _____often do not exhibit typical UTI symptoms; see altered mental status, changes in eating habits, or gastrointestinal (GI) symptoms

A

Elderly patients

47
Q

What are the UTI Signs & Symptoms in Adults?

A
  • GROSS HEMATURIA (red, bloody urine)
  • LOWER UTI: Dysuria (painful), urgency, frequency, nocturia, and suprapubic heaviness (pain discomfort in lower abdominal region near groin)
  • (still check kidneys just to make sure)
  • UPPER UTI: Flank pain, fever, nausea, vomiting, and malaise (b/c kidney function)
48
Q

What is the Physical Examination for Adults with a UTI?

A
  • UPPER UTI: Costovertebral (back bottom ribcage) tenderness
49
Q

What are the Laboratory Tests: Urinalysis for UTIs in Adults?

A
  • MICROSCOPY: Gram stain of urine
  • Urine CULTURING on growth medium
  • > 105 BACTERIA/mL [108/L] of urine = significant bacteriuria
  • Pyuria:
  • in symptomatic patients >10 white blood cells (WBC)
    /mm3 [10 × 106/L] = significant bacteriuria
  • CHEMICAL:
  • Nitrite-positive urine→detects nitrate-reducing bacteria
  • Leukocyte esterase-positive dipstick urine test
  • IMMUNOFLUORESCENT: antibody (immunoglobulin G; IgG)-coated bacteria (UPPER UTI)
  • (to see if it’s a kidney inf. –> pyelonephritis)
  • PROSTATITIS: test for bacteriuria in EXPRESSED PROSTATIC SECRETIONS (EPS) after prostate massage
  • (can determine if it’s in urine tract or prostate)
50
Q

When are urine culturing on growth medium (for UTIs) good for?

A

relapsing! b/c want to make sure you identify & why it’s not responding

51
Q

What is the UTIs treatment?

A

UTIs are primarily treated with antimicrobial agents
→ UNCOMPLICATED UTIs: E.coli 1st line antibiotic therapies (b/c most common)
* trimethoprim-sulfamethoxazole (TMP-SMX), nitrofurantoin, fosfomycin, or β-lactams (amoxicillin-clavulanate, cefdinir, cefaclor)
* antibiotic treatment is restricted by KIDNEY (GLOMERULAR) FILTRATION RATES and if the drug is ACTIVELY SECRETED INTO THE URINE

52
Q

What do Antimicrobial therapeutic treatments depend on?

A
  • Gram staining type ( ̶ versus +)
  • severity of the presenting signs and symptoms (is there blood etc.)
  • the site of infection (upper vs. lower UTI)
  • uncomplicated vs. complicated UIT status
  • antibiotic susceptibility test results (can look for key genes associated with antimicrobial resistance)
  • Past-history of UTIs and antibiotic treatments
53
Q

UTI Treatment dets

A

slide 23 (draw it out)

54
Q

What are STDs/ STIs?

A

Infections of the genital tract are referred to as Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs)

55
Q

What are the STDs/ STIs caused by?

A
  • gonorrhea, syphilis, chlamydia, chancroid, trichomoniasis, HUMAN IMMUNODEFICIENCY VIRUS (HIV), herpes simplex virus (HSV), human papillomavirus (HPV) (& monkey pox)
56
Q

STIs presents with:

A
  • diverse clinical manifestations
  • changing drug-susceptibility patterns of some pathogens (gonorrhea, HIV, chlamydia) frequency of multiple STIs occurring
  • (diff. to treat & complicate them this way)
  • higher simultaneously in infected individuals
57
Q

The diagnosis and management of patients with STIs are…

A

much more complex and can be lifelong
* Cures are fewer than treatments→increase in ANTIMICROBIAL DRUG RESISTANCE

58
Q

How many new infections/yr in the US & what does it cost for STDs/STIs?

A

20 million new infections/ yr in the United States
* total prevalence of 110 million infections→total medical cost of $116 billion to the US healthcare system

59
Q

What do the stats look like for STDs/STIs in Canada? & Winnipeg?

A

IN CANADA: reported cases of chlamydia, gonorrhea, syphilis infectious syphilis have been rising since 2000
* WINNIPEG has a current outbreak of SYPHILIS
* 120 cases in 2015
* >1000 active cases in 2020

60
Q

New STIs/year is roughly _____ between genders*

A

EQUAL
* complications of STIs generally are more frequent and severe in WOMEN
* complications associated with pregnancy, and transmission
of infection to the fetus or newborn

61
Q

STIs ____ damage to reproductive organs and risk of cancer

A

INCREASE

(such as HPV)

62
Q

_______ complicate STI treatments/ cures

A

Co-infections (can become life-long infection)
* 50% of female patients with gonorrhea are coinfected with
chlamydia, only 20% in men
* Frequent co-association between syphilis and HIV infections (b/c it targets & inhibits proper function of immune system (WBCs in particular)

63
Q

What is the greatest STI risk factor?

A

is the NUMBER of sexual PARTNERS
* ↑ sexual partners = ↑STI rates

64
Q

↑ sexual partners =

A

↑STI rates

65
Q

With INCREASING age, the incidence of most STIs ______ exponentially

A

decreases

66
Q

STIs are reported at higher frequency by…

A

men who have sex with men (MSM) than in heterosexuals (& even LGBTQ2+)

67
Q

MSM also have higher rates of ____ _____ STIs eg. ____ _____ and _____ ______

A

LESS COMMON

ENTERIC PROTOZOAN

BACTERIAL PATHOGENS

68
Q

Prostitution, illicit drug and needle use ____ STI rate/ risk

A

↑

69
Q

What are examples of unique factors that place youth at risk for STIs?

A
  • Insufficient Screening: many young women don’t receive the chlamydia screening CDC recommends
  • Confidentiality Concerns: many are reluctant to disclose risk behaviours to doctors
  • Biology: young women’s bodies are biologically more susceptible to STIs
  • Lack of Access to Healthcare: youth often lack insurance or transportation needed to access prevention services
  • Multiple Sex Partners: many young people have multiple partners, which increases STI risk
70
Q

Serious SEQUELAE of STIs are associated with ____ or _____ infections

A

congenital

perinatal (passing STI onto fetus/newborn)

(sequelae = long term effects of a temporary disease/injury)

71
Q

Serious sequelae of STIs are associated with congenital or perinatal infections…

A
  • NEONATAL STIs are acquired at birth, after infant passage through an infected cervix or vagina
  • ↑ risk of infant death/ miscarriage
  • TRANSPLACENTAL INFECTIONS (syphilis) cause congenital fetal infections (cross placental barrier)
72
Q

What are ways to Prevent STIs?

A
  • complete ABSTINENCE
  • mutually MONOGAMOUS sexual relationship between uninfected partners
  • BARRIER CONTRACEPTIVE methods (reduce risk)
  • MALE and female CONDOMS → LATEX CONDOMS better than natural skin + water based LUBRICANTS (K-Y jelly, etc.)
  • diaphragm, cervical cap, vaginal sponges, vaginal spermicides alone or in combination

(better @ preventing pregnancy than inf.)

73
Q

Bacterial STIs Etiology:

A
  • Gonorrhea: Neisseria gonorrhea (Gram –negative diplococci)
  • becoming drug resistant
  • Syphilis: Treponema pallidum (Gram-negative spirochaete)
  • Chlamydia: Chlamydia trachomatis (no stain type)
  • no PG (or not thick enough associated with mycoplasma)
  • Non-specific urethritis: Ureaplasma urealyticum (no stain type)
  • no PG (or not thick enough associated with mycoplasma)
  • Chancroid: Haemophilus ducreyi (Gram-negative coccobacillus)
74
Q

Parasite STI (tropical/ equatorial regions) Etiology:

A
  • Trichomoniasis: Trichomonas vaginalis

(equatorial - can spread b/c of travel)

75
Q

Virus STIs Etiology):

A
  • Human immunodeficiency virus (HIV)
  • drug based therapies therefore not curable yet
  • Herpes simplex virus (HSV)
  • drug based therapies therefore not curable yet
  • Human papilloma viruses (HPV) –> vaccine preventables
  • Hepatitis A, B, C virus (HAV, HBV, HCV)→targets the liver, A&B are vaccine preventable)
  • but can be sexually transmitted (particular C)
76
Q

What’s the difference b/t Prevalence & Incidence?

A

Prevalence is the estimated # of infections - new or existing - in a given time

Incidence is the estimated # of new infections - diagnosed or undiagnosed

77
Q

STI Prevalence and Incidence for HPV

A

more prevalance

78
Q

STI Prevalence and Incidence for HSV-2

A

more prevalance

79
Q

STI Prevalence and Incidence for Trichomoniasis

A

more incidence (tourism/immigration)

80
Q

STI Prevalence and Incidence for Chlamydia

A

more incidence

81
Q

STI Prevalence and Incidence for HIV (ages 13 & older)

A

more prevalance

82
Q

STI Prevalence and Incidence for Gnorrhea

A

more incidence

83
Q

STI Prevalence and Incidence for Syphilis (ages 14 & older)

A

pretty even but more prevalance

(outbreaks in patients with inaccess to healthcare &/or communities with increase needle/drug use)

84
Q

STI Prevalence and Incidence for HBV

A

pretty even but more prevalance

85
Q

Tend to see more _____ > ______

A

prevalance > incidence

86
Q

STI Signs and Symptoms:

A
  • For a many STIs, signs and symptoms *overlap (with non/other one’s) preventing accurate diagnosis without a MICROBIOLOGIC AGENT CONFIRMATION
  • Frequently, symptoms are minimal or absent despite infection

PCR is gold standard

87
Q

Commonly Implicated Pathogens of Urethritis
(inflammation of the urethra)

A

Chlamydia trachomatis
(chlamydia), herpes simplex virus, Neisseria gonorrhoeae, Trichomonas vaginalis (Trichomoniasis), Ureaplasma spp., Mycoplasma genitalium

88
Q

Common Clinicial Manifestations of Urethritis
(inflammation of the urethra)

A

Urethral discharge (pyuria), dysuria
- typ. not associated with non-sexually transmitted inf’s

89
Q

Commonly Implicated Pathogens of Epididymitis
(inflammation of the coiled tube behind the testicle)

A

C. trachomatis, N. gonorrhoeae

90
Q

Common Clinical Manifestations of Epididymitis
(inflammation of the coiled tube behind the testicle)

A

Scrotal pain, inguinal pain, flank pain, urethral discharge
- similar with UTI

91
Q

Commonly Implicated Pathogens of Cervicitis/ vulvovaginitis (inflammation of the cervix)

A

C. trachomatis, Gardnerella vaginalis, herpes simplex virus, human papillomavirus, N. gonorrhoeae, T. vaginalis
-*not really a STI but it can be transmissible sexually if it’s a high enough titre b/t m & f (typ. a normal flora in f’s)

92
Q

Common Clinical Manifestations of Cervicitis/ vulvovaginitis (inflammation of the cervix)

A

Abnormal vaginal discharge, vulvar itching/irritation, dysuria, dyspareunia (genital pain that occurs with sex - before, during &/or after)

93
Q

Commonly Implicated Pathogens of Genital ulcers (painful sores)

A

Haemophilus ducreyi
(chancroid), herpes simplex virus

94
Q

Common Clinical Manifestations of Genital ulcers (painful sores)

A

Usually multiple vesicular/pustular (herpes) or papular/pustular
(H. ducreyi) lesions that can coalesce; painful, with tender lymph nodes

95
Q

Commonly Implicated Pathogens of Genital ulcers (painless sores) (can be overlooked/unnoticed)

A

Treponema pallidum (syphilis), Chlamydia trachomatis

96
Q

Common Clinical Manifestations of Genital ulcers (painless sores) (can be overlooked/unnoticed)

A

Usually single papular lesion (raised and < 1 cm around); unnoticed

97
Q

Commonly Implicated Pathogens of Genital/anal warts (condylomas)

A

Human papilloma virus (HPV)

98
Q

Common Clinical Manifestations of Genital/anal warts
(condylomas)

A

Multiple lesions ranging in size from small papular warts to large exophytic condylomas
- large & deep lesions

99
Q

STIs can also affect _____

A

eyes, throat and gastrointestinal regions (don’t limit to genitals)

100
Q

Commonly Implicated Pathogens of Pharyngitis

A

C. trachomatis, herpes simplex virus, N. gonorrhoeae

101
Q

Common Clinical Manifestations of Pharyngitis

A

Symptoms of acute pharyngitis, cervical lymphadenopathy, fever

102
Q

Commonly Implicated Pathogens of Proctitis
(inflammation of the rectum)

A

C. trachomatis, herpes simplex virus, N. gonorrhoeae,
T. pallidum

103
Q

Common Clinical Manifestations of Proctitis
(inflammation of the rectum)

A

Constipation, anorectal discomfort, tenesmus (need to pass stools - even though you don’t; could be symptom of sexual practice too not just STI), mucopurulent rectal discharge

104
Q

Commonly Implicated Pathogens of Salpingitis
(inflammation of fallopian tubes)

A

C. trachomatis, N. gonorrhoeae

105
Q

Common Clinical Manifestations of Salpingitis
(inflammation of fallopian tubes)

A

Lower abdominal pain, purulent cervical or vaginal discharge, adnexal swelling, fever

106
Q

What is the STI Detection?

A
  • Depending on the suspected STI site tests will involve:
  • Physical examination and symptom description:
  • chancroid, warts, HSV, syphilis
  • SWABS: of lesion or mucosal site for MICROBIOLOGICAL CULTURES
    SEROLOGY, and PCR TESTING (go-to) →vaginal, anal, or throat * Chlamydia and gonorrhea
  • URINALYSIS: chlamydia and gonorrhea
  • BLOOD TESTS: detect HIV, syphilis, herpes (by flare up) (antibody and PCR tests)
  • HIV has point of care blood tests
  • PAP SMEAR detect cancerous lesions and cervix swabs
  • Cancerous lesions: human papilloma virus (HPV)
  • chlamydia and gonorrhea
107
Q

What is the Treatment for Syphilis (Treponema pallidum) STIs?

A

primary, secondary, latent stages are treatable
* Parenteral high dose benzathine penicillin G (1st Gen β-lactam)

108
Q

What is the Treatment for Chlamydia (Chlamydia trachomatis) and Ureaplasma?

A
  • Lacks a peptidoglycan cell wall: tetracyclines, macrolides and some fluoroquinolones
109
Q

What is the Treatment for Gonorrhea (Neisseria gonorrhea)?

A
  • Few antimicrobial therapies remain effective (v. resistant)→3rd generation
    cephalosporin β-lactams: ceftriaxone or cefixime
110
Q

What is the Treatment for Trichomoniasis (Trichomonas vaginalis)?

A
  • anti-parasitic metronidazole (Flagyl) or tinidazole
  • resistant most likely will grow & few med’s for it
111
Q

STI treatment dets

A
  • Lifelong uncurable but treatable symptoms: HIV, HSV
  • No treatment or cure: HPV (vaccine preventable), end-stage tertiary/ neurosyphilis

Applied Pathophysiology (34 decks)

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