UTIs Flashcards
What are symptoms of lower UTIs?
- dysuria
- urgency
- urinary frequency
- suprapubic pain
What are symptoms of upper UTIs?
- fever
- flank pain
- N/V
- Clinical sepsis
What’s the difference between an acute and chronic UTI?
Chronic may have high bacterial load but no symptoms
What factors predispose you to an ascending UTI?
- maternal hx of UTIs
- First UTI < 15
- New sex partner
- condom use/spermicides
- Bladder overdistention
What genetic difference would predispose you to a UTI?
- Certain HLA types
2. Short uretural length
How do you diagnose UTIs?
Gram stain and culture
Urinalaysis with 5-10 WBC/hpf
Leucocyte esterase test
nitrite test
What is the criteria for treating a UTI?
Symptomatic and > 100 organsims
Asymptomatic and 10^5 organisms
What would you do to treat a UTI?
3 days of oral antibiotics. If more than 3 re-infections in a year, consider prophylactic antibiotics
How do you tell whether a recurring UTi is a relapse or a reinfection?
Relapse if symptoms recur within 2 weeks. In this case, you want to treat with a longer course of antibiotics
SHould you treat asymptomatic bacteriuria?
NO.
What are your options for treating a lower UTI?
- TMP-Sulfamethoxazole
- Cipro
- Nitrofurantoin
What are your options for treating an upper UTi?
CIPRO empirically.
–Can prophylaxis with cipor, cephalex, TMP-SMX
How do you treat an inpatient with an upper UTI?
Aminoglycoside and Ampicillin
Cipro
Zosyn
At what age can adolescents be treated confidentially?
15-24
Clue cells=buzzword for:
vaginosis
Strawberry cervix=buzzword for
trichomonas
Genital ulcers are caused by:
herpes or syphilis
Causes of vaginitis
candidiasis
bacterial vaginosis
trichomoniasis
Which serovars of chlamydia trachomatis causes STD infections?
D-K serovars
What forms does chlamydia take?
Elementary body is extracellular
Reticulate body is intracellular
What do you need to grow chlamydia?
Tissue culture==it’s an INTRA cellular organism! Can’t grow on its own. It also has NO peptidoglycan wall
How does chlamydia get into cells?
Receptor mediated endocytosis
What does chlamydia cause in the neonate?
Inclusion conjunctivitis (cobblestoning) Also interstitial pneumonia
How do you diagnose chlamydia?
PCR
ligase chain rxn
NAAT
How do you treat chlamydia?
Azithromycin (1 dose)
Doxy (bid for 7 days)
Who should you screen for chlamydia?
- females < 25
- Males < 30, military,
- history of STD
- Retest 3 months after tx
- HIV +
How does N. Gonorrhea cause infection? (pathogenesis)
Uses pili to attach to mucosal surfaces. Also IgA protease
- -Most women are asymptomatic
- -BUT men are commonly symptomatic
What are the different types of invasive gonococcal disease?
- PID
- Perihepatitis (Fitz-hugh-curtis)
- Disseminated infection
- septic arthritis
How do you diagnose gonorrhea?
PCR, ligase, nAAT
What can you grow gonorrhea on in culture?
If sterile: Chocolate agar
If NOT sterile: Thayer martin medium (Vanc, colistin, nystatin)
How do you treat gonorrhea?
Ceftriaxone
ALSO concurrently treat for chlamydia with azithro/doxy
Syphilis–how do you diagnose this?
- darkfield microscopy or direct immunofluorescence
2. VDRL (do not culture! Also cannot see under microscopy)
What kind of a bug is chlamydia (gm pos/neg)?
Gram negative obligate intracellular organism. Cannot make ATP
What can gonorrhea ferment?
ONLY glucose
Which form of chlamydia is infectious?
The elementary body form
Which organisms cause urethritis?
Gonorrhea/chlamydia
–Trichomonas causes cervicitis and epididymitis but not urethritis
When would you want to treat an asymptomatic UTI?
In a pregnant woman
What does secondary syphilis look like?
Rash on hands and feet
Condyloma and lymphadenopathy
What does tertiary syphilis look like?
- Benign gammatous lesions (granulomas)
- Ascending aortitis
- Neurosyphilis
What are the signs of neurosyphilis?
- Asymptomatic (but abnormal CSF)
- meningitis
- tabes dorsalis (demyelination of posterior columns)
