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90 Cards in this Set
- Front
- Back
- 3rd side (hint)
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How are UTI's classified?
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Lower Urinary Tract infection
bladder - cystitis urethra - urethritis Upper UTI kidney - pyelonephritis |
Upper and lower
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What is the function of the urinary tract?
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- filtration of blood
- excretion of metabolites, water and minerals Kidneys - regulate BP, erythropoiesis, pH, glucose, calcium reabsorption |
2 general
5 for kidney |
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How much can the bladder store? Normal void?
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up to 1L, 600-800 normal, micturation reflex = 150-300mL
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What is the most common bacterial infection?
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UTI
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What is the female:male of UTI? Why?
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30:1
Shorter urethra, meatus closer to anus |
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What percentage of women will have a UTI in lifetime?
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40-50%
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Who gets UTI? (women and men?)
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Women - sexually active
Men - over 40 from prostatic hypertrophy |
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What is a chronic UTI?
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lasts longer than 2 weeks and does not respond to treatment
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2 definitions
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What is the definition of a recurrent UTI?
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at least 2 in 6 months or 3 in a year
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How are UTIs categorized?
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Upper/Lower
Acute/Chronic/Recurrent Uncomplicated/ complicated ascending/descending asymptomatic |
5 ways
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What are S&S of Lower UTI?
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- abnormal colour - cloudy/hematuria
- abnormal odour - ammonia - pyuria - frequency/ urgency with small volume - dysuria - suprapubic tenderness, pelvic discomfort |
TOPCUD
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What causes the abnormal odour of UTI urine?
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pathogens have urease that converts urea to ammonia
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enzyme
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What is the definition of pyuria
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>8WBC/uL unspun
2-5WBChpf |
unspun or hpf
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What are S&S of pyelonephritis?
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** fever
- suprapubic tenderness -/+ S&S of lower UTI - altered LOC - N&V - peripheral leukocytosis - pyuria |
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What is normal flora of urethra and perineum?
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- diphtheroids
- alpha hemolytic strep - lactobacilli - coagulase neg staph - E. coli - enterococci |
DSSLEE
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What are common causes of uncomplicated UTI?
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75-80% = E.coli
10-15% Staph saprophyticus Klebsiella, Enterococcus faecalis |
ESsKEf
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What are common causes of complicated UTI?
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50% E. Coli
Klebsiella, enterobacter, Serratia, Proteus, P. aeruginosa, E. faecalis, Group B Strep, S. aureus, yeast |
E.c, KESPPaEfSbSaY
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What genetic factors influence susceptibility to cystitis?
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1. expression and secretion of ABO
2. density of adhesion receptors 3. innate immunity - toll like R on GU recognizes pathogens, TammHorsfall proteins prevent E.Coli attchmt, defensins = antimicrobial 4. adaptive immunity |
4
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What pathogenic factors influence susceptibility to cystitis?
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1. colonization of rectum, vagina, perineum and distal urethra
2. E.coli with type 1 and P fimbrae can attach to GU |
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What biological factors influence susceptibility to cystitis?
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1. normal anatomy - female and children more at risk
2. abnormal anatomy 3. urinary obstruction - calculi, tumors, prostatic hypertrophy 4. incomplete emptying of bladder - neurogenic dysfunction, uterine prolapse, pregnancy 5. DM 6. Hx of UTI 7. catheters 8. immunodeficiency 9. altered vaginal microbiota (menopause) |
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What behavioral factors influence susceptibility to cystitis?
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1. sexual intercourse (women)
2. diaphragm/spermicide (alters pH) 3. Abx 4. hygiene, fecal incontinence 5. immobility 6. infrequent voiding |
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What methods are used for urine sample?
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1.First morning, clean catch mid stream
2.In-and-out catheterization (risk of infection) 3.indwelling catheter (never from bag) 4. cytoscopy specimen ileal conduit NEVER - condom catheter, catheter tips |
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How are urine samples collected from pediatric patient?
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1. urine bag adhered to skin - high rates of contamination
2. suprapubic aspiration - 1-2hrs post bolus ingestion, 4 inch, 22gauge |
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What do the following terms mean?
CB, LK, RK, WB, VB1, VB2, EPS, VB3 |
CB - urine from bladder cystoscopy
LK/RK - left/right kidney with cystoscopy WB - bladder washed with 2-3L, instill 100mL, collect VB1 - first voided VB2 - midstream EPS - expressed prostatic secretions following massage VB3 - first void following prostatic massage |
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What are specs on urine specimen transport to lab?
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Must be plated <2hrs post collection
Refrigerate <24hrs preservatives up to 72 hrs - tartaric or boric acids |
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What are screening methods for urine sample?
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1. gram stain uncentrifuged - 1bac hpf, or 1 WBC hpf, squamous cells = contaminated
2. urine dipstick 3. flow cytometry - WBCs 4. fluorescent probes for bacteria 5. microbial ATP detection |
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What does a urine dipstick do?
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1. leucocyte esterase - produced by WBCs in urine
2. nitrite - gram negative bacteria have nitate reductase, so presence of nitrite indicates -ve bac (S. saprophyticus, enterococci) |
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What are methods of bacterial culture for urine?
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1. semi quantitative - plate with calibrated loop
2. media - blood agar + Mac, EMB, CLED |
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What does MAC, EMB and CLED tell you about bacteria?
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Mac - lactose fermentors = red
EMB - eosin methylene blue = lactose fermentors = blue/black +/- green metallic sheen CLED - cystine lactose electrolyte deficience = yellow |
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How do you interpret urine culture?
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>100x10^6 CFU/L --> always significant
10-100x10^6 - significant in Abx, men, very dilute urine <10x10^6 --> contamination unless suprapubic sample, inandout in symptomatic, kidney transplant, acute symptoms, |
3 categories
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What is the significance of a culture with three different organisms?
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considered contaminated - 95% of infections caused by single organism, some by 2, none by 3
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What are the S&S of acute cystitis and tx? Women? Men?
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pyuria, bacteriuria, hematuria
3d Septra, ciprofloxacin or nitrofurantoin Tx men = 7-10d |
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Define and Tx of recurrent cystitis?
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= urine culture >0.1x10^6
prophylactic post coital Abx, self tx, continuous daily Abx |
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Define and Tx of acute uncomplicated pyelonephritis?
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>10x10^6 CFU/L
14d tx with 3rd gen'n cephalosporins or fluoroquinolone |
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Tx complicated UTI and catheter acquired?
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Complicated = >10x106^, 14d tx
Catheter = symptomatic + >1x10^6, remove catheter + 7-10d tx |
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Define and Tx of asymptomatic bacteriuria
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asymptomatic + >100x10^6CFU/L
elderly = >40% with this = DO NOT Tx Preggers = screen at 12-16w GA, tx 3-7d amoxicillin, cephaliexiin, nitrofurantoin, can cause preterm, LBW, pyelonephritis renal pts = tx GU surgery - tx |
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What are some non-pharmaceutical tx for cystitis?
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Cranberries/blueberries/lingonberries - prevent E.coli adherence to urinary epithelium
Lactobacillus - gram +ve, lactose --> LA, normal flora, studies inconclusive Vaccine - heat killed supository - good results |
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What is the prognosis of cystitis and pyelonephritis?
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Cystitis can progress
Pyelonephritis - systemic infxn and scarring of kidney - 1-3% death, assd with age, stones, DM, sickle cell, Ca, kidney disease, immunosuppression |
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What are 5 causes of genital ulcers?
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1. Syphilis
2. HSV1/2 3. Chancroid (H. ducreyi) 4. Lymphogranuloma venereum 5. Granuloma inguinale (donovanosis) |
SHCLG
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What are 3 causes of genital papules?
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1. HPV
2. Molloscum contagiosum 3. secondary syphilis (condyloma latum) |
HMcCl
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What are 2 genital parasites?
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1. scabies (sarcoptes scabiei)
2. phthirus pubis |
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What is GUD?
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Genital ulcerative disease
- ulcerative, erosive, pustular or vesicular genital lesions +/- local lymphadenopathy |
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Epidemiology, hx of HSV1/2
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- 50 million US
- incubation = 6d => primary infxn - latency in sacral ganglia |
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What is the appearance of genital HSV?
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- grouped vesicles
- superficial ulcers on erythrematous base - usually painful and pruritic |
GvSuPP
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How do you Dx HSV?
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Culture swab base - viral transport media
PCR - highly sensitive and specific Serology IgG - type testing and seroconversion in 3-6 weeks |
Seroconversion?
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Etiology and pathogenesis of syphilis?
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Treponema pallidum
Incubation = 3wks 1ry ->2ry -->30% 3ry(late syphilis) /70% lifetime latency |
incubation? types? percents?
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What are the S&S of primary syphilis?
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solitary ulcer at site of inoculation
- painless (as opposed to HSV) - indurated regional lymphadenopathy, rubbery and non-tender |
UIPless
Lymph nodes? |
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What are the S&S of secondary syphilis?
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rash and generalized lymphadenopathy
- non-itchy, morbilliform, papulosquamous - trunk, palms, soles, genitals Mucocutaneous lesions - condylomata lata Pt well but with general malaise, feer, wt loss, h/a etc... |
R,NI,M
Where? CL = ? |
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Define latent syphilis
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positive serology with no symptoms
variable duration ~25% relapse into secondary 1/3 to tertiary |
Percent relapse into 2ry?
Percent into 3ry? |
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What are the types of tertiary syphilis?
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1. cardiovascular - eg. aortic aneurism
2. neurosyphilis - Argyll Robertson pupils - accomodate but do not react 3. gumma - tissue destruction (any organ) |
HBG
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How do you diagnose syphilis?
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1. darkfield microscopy on a lesion
2. serology - screening - RPR + ELISA - highly sensitive not specific - Confirmatory = Treponemal specific with MHA-TP and FTA Abs |
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What is MHA TP and FTA Abs
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MHA TP = Microhemagglutination Assay Treponema pallidum
FTA Abs = Fluorescent treponemal antibody absorbed |
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How do you treat syphilis?
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1ry, 2ry and early latent = Benzathine penicillin, IM x1
Late latent, cardio = Benzathine pen IM weekly x3 Neuro = IV penicillin G daily x10-14d Need to f/u and repeat RPR Contact tracing |
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What are rare causes of GUD?
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1. H. ducreyi - chancroid, rare
2. C. trachomatis L1, L2, L3 causing lymphogranuloma venereum, invasive but rare 3. Klebsiella granulomatis - donovanosis |
HCK
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What are S&S of urethritis? Microscopy definition?
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inflammation +/- discharge (purulent or mucopurulent), dysuria, urethral pruritis or meatal erythema
>5PMN/hpf |
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What are causes of urethritis?
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Neisseria gonorrhoeae
Non-gonococcal - Chlamydia trachomatis - trichomonas vaginalis - ureaplasma urealyticum - mycoplasma genitalium - HSV |
Ng, CtTvUuMgH
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What are S&S of cervicitis? Microscopy defn?
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mucopurulent cervical discharge, cervical friability,
vaginal discharge strawberry cervix - uscope - DO NOT r/o gonorrhea if negative with staining (low population) |
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What are causes of cervicitis?
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- N. gonorrheae
- C. trachomonas - Trichomonas vaginalis (parasite) - HSV |
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How is urethritis diagnosed?
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- endourethral specimen collection/ urine
- Lab dx - gram stain for intracellular diplococci, swab/urine NAAT (n.a. amplification test) |
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How is cervicitis Dx?
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Endocervical swab
Urine samples NAAT - N gonorrheae and C. trachomatis |
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What are S&S of epididymitis/orchitis?
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Unilateral testicular pn/swelling
erythema/edema of overlying skin +/- urethral discharge fever |
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What is the etiology of epididymitis?
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STI - C.trachomatis, N.gonorrhea
Non-STI - bacterial infcn, mumps need to r/o testicular torsion |
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What is PID?
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INfection fo female upper genital tract - endometrium, fallopian tubes, pelvic peritoneum
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How is PID Dx?
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S&S are non-specific = fever, abdominal pain, uterine/adnexala dn cervical motion tenderness
r/o ectopic pregnancy and acute appendicitis |
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What is the etiology of PID?
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STI - C.trachomatis, N.gonorrhea, (rare HSV, Trachomonas)
Non-STI - mycoplasma genitalium, bacteriodes, E.coli, Gardnerella vaginalis |
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Describe C.trachomatis
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Obligate intracellular organism
2key biovars - trachoma A-C = eye infxn trachoma D-K - genital Lymphogranuloma venereum - L1, L2, L2a and L3) |
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Describe the pathogenesis of C.trachomatis
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Incubation = 2-3wks (up to 6wks)
Can persist for months w/o S&S invades epithelial cells - immune response insufficient can result in scarred tissues, adhesions, salpingitis, tubal occlusions |
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WHat is the most common STI with increasing rates?
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Chlamydia
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Chlamydia - prevalence? men/women?
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Youth 15-24 = 2/3 of cases
females 2x men |
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What are S&S of chlamydia - female?
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- asymptomatic
- vaginitis - cervicitis - dysuria, dysparenuria - lower abd pn/PID/infertility - proctitis - Reiter's syndrome (arthritis following infection + can't see/pee) - pregnancy complications - preterm, eye infxn, neonatal pneumonia |
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What are S&S of chlamydia - males?
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- asymptomatic
- urethral discharge - urethral itch - dysuria - epididymititis/ orchitis - infertility - proctitis - Reiter's syndrome |
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How do you dx C.trachomatis?
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- NAAT - highly sensitive and specific
- culture - special request - DFA - rapid - newborn ophthalmitis/ pneumonia |
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What is the pathogenesis of gonococcal infxns?
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- gram -ve,
- infects and penetrates columnar epithelium throught o submucosa - inflammatory response = sloughing of epithelium, submucosal micoabscesses, exudation o fpus - intracellular replication |
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Manifestations/ complications of N.gonorrhea (female)
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- cervicitis
- urethritis - PID - Ectopic pregnancy - infertility - perihepatitis (Friz-Hugh-Kurtis Syndrome - gono or chlam around liver capsule) - Bartholinitis (greater vestibular gland) |
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Manifestations/ complications of N.gonorrhea (male)
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Urethritis
Epididymitis orchitis |
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Manifestations/ complications of N.gonorrhea - both genders
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- pharyngeal infection
- conjunctivitis - Proctitis - Disseminated - arthritis, dermatitis, endocarditis, meningitis |
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How do you dx n.gonorrhea?
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urethral/cervical swab/throat/rectal - symptomatic/PID/sexual abuse/tx failure
Urines for NAAT blood culture - disseminated |
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Mngmnt of n.gonorrhea?
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Uncomplicated = Cefixime 400mg PO single dose + doxy/azithromycin
Disseminated = Cetriaxone IV/IM |
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Tx of c.trochomatis
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Doxy - 100mg po BID x7d
Azithromycin - 1g po single dose |
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What are S&S of vulvovaginitis?
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- vaginal discharge, odour, pruritis, erythema
- dysuria |
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What are common causes of vulvovaginitis?
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STI - trichomoniasis
non-STI - bacterial vaginosis, candidiasis Non infectious - allergic dermatitis, excessive secretions, atrophic vaginitis |
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Trichomoniasis - etiology, epidemiology, S&S
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Trichomonas vaginalis - protozoan parasite
STI - 3-20% prevalence 10-50% asymptomatic - vag discharge (yellow, off white, frothy), itch, dysuria, strawberry cervix |
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Tx trichomonas
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Metronidazole
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What is bacterial vaginosis
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overgrowth of genital flora - gardnerella, prevotella, mobiluncus + depletion of lactobacilli
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Epidemiology of bacterial vaginosis
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~10% of patients
10-30% of pregnant women ass'd with PID with IUD ass'd with increased HIV risk |
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S&S bacterial vaginosis
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50% asymptomatic
vaginal discharge - grey, pH >4.5, whiff test (add KOH and smell!) gram stain for clue cells |
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What is normal vaginal pH?
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3.8-4.5
>4.5 = bacterial vaginosis, trichomoniasis and atrophic vagina |
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Etiology of vulvovaginal candidiasis? Epidemiology
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C. albicans >90%
~75% women have at least one episode |
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S&S of candidiasis?
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- vaginal discharge: white curdly
- itch - external dysuria - dysparenuia - erythema and edema of vagina and vulva - pH <4.5 - gram stain = PMN + budding yeast |
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