UTIs Flashcards
What are the 2 locations of UTIs?
Upper (kidney)
Lower (bladder onwards)
What is an upper tract UTI called?
Pyelonephritis
What are 4 lower tract UTIs?
Cystitis
Prostatitis
Urethritis
Epididymo-orchiditis
What pain is felt in prostatitis?
perianal pain when orgasming
What organism cause UTIs?
What’s the acronym?
KEEPS
Klebsella
Enterobacter
E.Coli
Proteus
S.Saprophyticus
What different organism causes 80% cases?
UPEC
Uropathic E.Coli
Are males or females more affected and why?
Females much more affected as they have shorter urethras therefore closer to anus + easier for bacteria to colonise
What are the lines of investigation (1st and GS) for UTIs?
1st line = urine dipstick
GS = midstream MS+C (microscopy, culture + sensitivity)
What is seen in the urine dipstick?
What does this mean?
+ve leukocytes
+ve nitrites (bacteria breaking down nitrates to nitrites)
+/- haematuria
UTI likely
Why is MC+S used ?
Confirm UTI + ID pathogen
What is pyelonephritis?
Infection of renal parenchyma (pelvis) and upper ureter
Where is infection from and to?
Which is the affecting organism?
ascending infection, from lower to upper
usually UPEC, can be KEEPS
Who is affected?
Females <35
RF for pyelonephritis?
Urine stasis (stones)
Renal structural abnormalities
catheters
Sx for pyelonephritis?
Triad:
Loin pain
Fever
Pyuria (pus and WBC in urine)
Dx of pyelonephritis?
1st = urine dipstick
GS = MC+S
Investigation for stones if suspected
Tx fot pyelonephritis?
Analgesia / paracetamol
Abx = Ciprofloxacin or co amoxiclav (cefalexin if pregnant)
What is cystitis?
Causative organism?
Gender most affected?
Infection of bladder
UPEC
Females
RF for cystitis?
Urine stasis
bladder lining damage
catheters
Sx of cystitis?
Suprapubic tenderness + discomfort
increased frequency + urgency
visible haematuria
Dx of cystitis?
1st = urine dip
GS = MC+S
Tx for cystitis?
when pregnant Tx?
Abx = trimethoprim or nitrofurantoin
(amoxicillin if pregnant)
What is urethritis?
Inflammation of urethra +/- infection
What is the MC cause?
a sexually acquired condition
What are the Infective types of urethritis?
Gonococcal (Neisseria gonorrhoea) - LC
Non gonococcal (Chlamydia trachomatis) - MC
What is non infective of urethritis?
Trauma
RF for urethritis?
MSM
Unprotected sex
What type of bacteria are Neisseria and chlamydia?
Neisseria = Gram -ve diplococcus
Chlamydia = Obligate intracellular gram -ve aerobe (bacillus)
Sx of urethritis?
Dysuria (pain)
+/- Urethral discharge (blood/pus), urethral pain
Dx of urethritis?
NAAT (nucleic acid amplification test) - detects STI
Urine dip (+ve if infectious STI indicated) + MC+S (will detect pathogen ID if UTI)
Tx for NG and CT
NG = IM ceftriaxone + azithromycin
CT = Azithromycin (or doxycycline)
Which disease is urethritis a Sx of?
Reactive arthritis
Can’t see (conjunctivitis) , can’t PEE (URETHRITIS), can’t climb a tree (arthritis)
What is epididymo-orchitis?
due to what organisms depending on age?
Inflammation of epididymus , extending to testis
Usually due to:
Urethritis (STI) <35y
Cystitis (KEEPS) extension >35y
Elderly = due to catheter
Sx of EO?
Unilateral scrotal pain + swelling
Pain relieved when ELEVATING TESTIS (+ prens sign)
Cremaster reflex intact
What is a DDX and why?
Rule out testicular torsion (more acute, N+V, crytorchidism/bell clapper)
Dx ?
NAAT, Urine dip, MC+S
Tx ?
Dep on STI (NG/CT) or UTI , see above Abx Tx
