UTI/STI

Question 1

UTI Prevalance

Answer 1

• <0.1 in men
• youn non-preg women 1-3%
• 40-50% of women will acquirea UTI
• INcidence increases with age

Question 2

risk factors UTI

Answer 2

Question 3

Common pathogens UTI

Answer 3

• Escherichia coli
• Staphylococcus saprophyticus
  
  • 5-15% of sexually active young women
• Proteus
• Pseudomonas
• Klebsiella
• Enterobacter
• Enterococcus
• Staphylococcus aureus

Question 4

LOWER UTI symptoms

Answer 4

“Cystitis”

• dysuria
• frequency
• urgency
• suprapubic pain / tenderness
• sometimes haematuria
• sometimes fever
• cloudy, smelly urine

Question 5

Pyelonephritis symptoms

Answer 5

• Loin pain and tenderness
• Fever
• Sometimes nausea and vomiting
• • / - lower tract symptoms

Question 6

Elderly UTI patients may present confused etc

Question 7

Use of Nitrite in urine dip

Answer 7

• Formed by the action of bacterial nitrate reductase (NR) in Enterobacteriacae
• Enterococci do not possess NR

Question 8

False positives andnegative measuring for leucocyte esterate

Answer 8

False negatives

• In presence of blood
• Nitrofurantoin, rifampicin
• Bilirubin
• Ascorbic acid

False positives

• Co-amoxiclav

Question 9

UTI criteria by microscopy and culture

Answer 9

Laboratory based

Pyuria

• >100 leukocytes/ml

Culture

• > 10⁵ organisms / ml

Question 10

Management of UTI

Answer 10

Asymptomatic, culture positive:

• Watch for development, unless pregnant

Symptomatic

• Fluids, low pH is antibacterical, analgesia
• Nitrofurantoin
• Pivmecillinam
• Fosfomycin
• Oral cephalosporins (cephalexin, cefaclor)
• Co-amoxiclav
• iv Tazocin
• iv Aminoglycosides (Gentamicin)
• Quinolones (Ciprofloxacin)

Question 11

Herpes simplex 2

Answer 11

• Painful ulcers with local lymphadenopathy
• Recurrent
• Confirm diagnosis with PCR
• Treat with aciclovir
• Can still spread to tohers at time without ulcers

Question 12

Syphilis-Treponema pallidum, symptoms

Answer 12

Diagnose on dark ground microscopy, Serology

Primary:

• Often non-painful, may heal spontaneously
• Local lymphoadenopathy
• Latency

Secondary:

• many different presentation
• Generalised lymphoadenopathy
• Can fade and become latent

Tertiarty

Question 13

Syphilis treatmen

Answer 13

Early ( primary, secondary, early latent)

• Benzathine penicillin G
  
  • 2.4 million units as a single dose
• Procaine penicillin
  
  • 2.4 million units daily plus probenicid for 14 days
• Doxycycline 100mg bd for 15 days

Tertiary and neurosyphilis:

• Benzathine penicillin
• Doxycycline

Question 14

Chancroid presentation and treatmen

Answer 14

• Ulcers similar to syphilis but the base is more necrotic with exudate

Usually single lesions

Gram-negative organism on swab

• Azithromycin/ceftriaxone

Question 15

Urethritis/cervitis presentation

Answer 15

• Urethral discharge/ cervical discharge
• Dysuria/ Deep dyspareunia
• Swab for Gram stain and microscopy and culture - Looking for Gram negative diplococci – culture of importance for resistance testing
• Urinary or swab NAAT testing. not mid stream. early stream

Question 16

Urethriti/cervitis infections

Answer 16

Neisseria gonorrhoeae

• Non-gonococcal (NGU)
• Chlamydia trachomatis
• Ureaplasma urealyticum
• Trichmonas vaginalis
• Mycoplasma genitalium
• HSV

Question 17

Gonnorhea complications

Answer 17

• Conjunctivitis
• Septic arthritis
• Pharyngeal infection
• Peri-hepatitis (Fitz Hugh Curtis syndrome)
• Disseminated disease

Question 18

Gonorrhoea treatment

Answer 18

• Ceftrb​iaxone 500mg IM single dose PLUS
• Azithromycin 1g oral single dose

Question 19

Non gonococcal gonnorhea treatmen

Answer 19

–CRO 2g IM one off dose

PLUS

–doxycycline 100mg bd po for 7 days

Question 20

Genital warts presentation and treatment

Answer 20

• Diffuse range of size and shape
• Usually asymptomatic
• If very large and cauliflower like called – Condylomata acuminata
• Treatment is with scraping, cryotherapy, keratolytics, podophyllin, imiquimod