UTI, Urethritis and Cervicitis

Question 1

uncomplicated UTIs epi:

Answer 1

• make up most of UTIs
• W > M
• usually E.coli
• ascending route
• readily treatable!
  rx) TMP-sulfa and fluids!

Question 2

Complicated UTIs epi:

Answer 2

• present w/ systemic findings
• M>W
• atypical organisms
• DM > non-DM
• obstruction or catheter
• need imaging!
  rx) Fluroquinolone

Question 3

If a woman presents with dysuria and frequency, and has no vaginal complaints, what is the UTI probability?

Answer 3

> 90%, no need for further w/u

Question 4

(2) antibiotics with good prostate penetration?

Answer 4

TMP-SMX

Quinolones

Question 5

w/u for male with hematuria

Answer 5

• U/A w/ micro and culture

- US for post-void residual urine, cystoscopy or CT

Question 6

(T/F) S. aureus in urine “always” from seeding from another site.

Answer 6

TRUE, need to find that site in order to treat the patient efficiently

Question 7

55 yo male w/ flank pain + urinary findings for several yrs. BUN/creat 30/1.3, urine pH = 7.5, GNR, crystals.

organism?
what do the crystals mean?

Answer 7

proteus, as it is urease (+), making the urine alkaline, which is an ideal environment for struvite crystals for form

Extra: What other organism shares this VF?

H. pylori

Question 8

the major pathogens associated with urethritis

Answer 8

GC

C. trachomatis

Question 9

the major pathogens associated with cervicitis:

Answer 9

GC

C. trachomatis

Question 10

the major pathogens associated with epididymitis:

Answer 10

GC
C. trachomatis
GNR

Question 11

the major pathogens associated with PID

Answer 11

GC
C. trachomatis
vaginal flora

Question 12

What symptoms would suggest an alternative diagnosis to urethritis?

a) dysuria, most marked in the morning
b) dysuria that increased w/ alcohol
c) pain, itching, burning btween urinations
d) discomfort only during ejaculation
e) deep pelvic pain or radiation to the back

Answer 12

Answer: both d and e, think prostatitis or epididymitis

a, b, and c are all common features of the dysuria associated with urethritis

Question 13

20 yo man w/ dysuria. Most likely diagnosis?

-copious purulent urethral discharge, never uses condoms, 10 female partners in 3 months, no lesions. Test him for what?

Answer 13

urethritis, typically STI

GC, chlamydia, syphillis and HIV, but will most likely be GC (GNdiplococci)

Question 14

(T/F) N. gonorrhoeae and C. trachomatis co-infections are overall uncommon.

Answer 14

False, common!

-treat empirically for both! macrolide for chlamydia and 3rd gen cephalosporin for N.gon

Question 15

Symptoms associated with cervicitis:

Answer 15

overall, non-specific

• abnormal vaginal discharge
• intermenstrual bleeding
• dysuria

50% have no symptoms!!

Question 16

Common pathogens of cervicitis:

Answer 16

N. gonorrhoeae, C. tachomatis, herpes simplex