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Medical Microbiology > Bacterial sexually transmitted & urinary tract infections > Flashcards

Bacterial sexually transmitted & urinary tract infections Flashcards

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1
Q

What are the 2 types of UTIs?

A

Complicated
Uncomplicated

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2
Q

Describe uncomplicated UTI

A

Non-pregnant women
No known relevant anatomical/functional abnormalities in urinary tract
Acute, sporadic, recurrent cystitis (inflammation of the bladder)

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3
Q

Describe complicated UTI

A

Congenital abnormality - obstruction, neurological dysfunction
Acquired abnormality - obstruction, neurological dysfunction
Catheter if symptomatic
Young male patient - men do not get UTIs unless there is an underlying reason
Pregnancy
Repeated upper urinary tract infection
Recurrent infections may be common

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4
Q

Why is the incidence of UTIs higher in females?

A

Shorter urethra so bacteria can ascend through the ureters faster

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5
Q

What is the source of organisms causing UTIs?

A

Bacterial flora of the large bowel
Uropathogenic properties

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6
Q

What is vesico-ureteric reflux?

A

Abnormal flow of urine back up the ureters to the kidneys
Can lead to upper urinary tract infection (pyelonephritis)

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7
Q

What is pyelopnephritis?

A

Bacterial infection causing inflammation of kidneys
Occurs as consequence of ascending UTI which spreads from bladder to kidneys

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8
Q

What is the main cause of complicated and uncomplicated UTIs?

A

UPEC (uropathogenic Escherichia coli)

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9
Q

What is asymptomatic bacteriuria?

A

Presence of bacteria in a urine sample of an individual that shows no signs or symptoms of a UTI

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10
Q

Why is asymptomatic bacteriuria important?

A

Rarely causes serious problems unless there is presence of urinary reflux or stasis, in which case cystitis or pyelonephritis may develop

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11
Q

What are risk factors of getting asymptomatic bacteriuria?

A

Female sex
Sexual activity
Diabetes particularly women
Age
Institutionalisation
Presence of catheter

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12
Q

Describe urethral syndrome

A

UTI symptoms but no evidence of infection
Occurs in women ages 30-50
Unknown cause of infection with unusual organisms
Variety of non-antibiotic treatments

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13
Q

What is cystitis?

A

Superficial inflammation of urethra and bladder
More frequent in women

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14
Q

What can cystitis lead to?

A

Upper tract infection

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15
Q

What are symptoms of cystitis?

A

Frequency
Dysuria - pain when passing urine
Haematuria - blood in urine
Urgency
Suprapubic discomfort
Polyuria

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16
Q

What is pyelonephritis?

A

Upper UTI
Direct invasion of renal tissue

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17
Q

What are signs and symptoms of pyelonephritis?

A

Back pain
Fever
Rigors
Renal angle tenderness
May have cystitis
May develop bloodstream infection/sepsis

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18
Q

What can develop from bacteraemia?

A

Renal abscess - blood borne spread e.g Staphylococcus aureus

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19
Q

How are UTIs diagnosed?

A

Urinary dipsticks

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20
Q

What do urinary dipsticks look for?

A

Nitrite detection - bacteria convert nitrate to nitrite
RBCs
WBCs
Protein

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21
Q

What is another quick test that can be done to check for a UTI?

A

Check if urine is turbid (cloudy) - indicates discharge of blood/pus due to UTI OR increased WBCs in urine due to UTI

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22
Q

How is microscopy used to look for UTIs?

A

Presence of WBCs, RBCs, bacteria, casts

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23
Q

How are cultures used to look for UTIs?

A

Quantification of bacteria on selective/differential media
Can see lower counts in early stages of UTI

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24
Q

How is sensitivity used for UTI testing?

A

Check what antibiotics the organisms are sensitive/susceptible to

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25
What factors determine management of UTIs?
Age Sex Pregnancy Catheter Or any other complications
26
What are symptomatic treatments of UTIs?
Hydration Analgesia Alkalisation of urine - potassium citrate; relieves symptoms Can be combined with antibiotics unless mild infection in adult female where antibiotics may be delayed
27
What is antibiotic-prophylaxis?
Antibiotics given to prevent infection Recommended in children with recurrent infection Used in some adults with recurrent infection No help in preventing catheter related infections Use if instrumentation of infected urine to prevent bacteraemia
28
What are non-antibiotic treatments for UTIs?
Oestrogen suppositories for post-menopausal women L-Mannose Cranberry juice/capsules - polyphenols/proanthocyanidins inhibit adhesion of type-1 pili & reduce inflammation
29
What types of STIs are there?
Bacterial Viral Parasitic Infestations
30
What are STI syndromes?
Genital discharge Genital ulcer disease Genital and pelvic pain Dermatoses
31
What increases the risk of HIV?
Herpes Syphilis
32
What are long-term consequences of STIs?
Infertility Ectopic pregnancy Mother to child (MTC) transmission
33
Describe AMR gonorrhoea
High fluoroquinolone resistance Increasing azithromycin resistance Emerging resistance of extended-spectrum cephalosporins
34
What are the 4 curable STIs?
Chlamydia Gonorrhoea Trichomoniasis Syphilis
35
What causes genital ulcer disease?
Syphilis Herpes Chancroid Lymphogranuloma venereum (LGV) Granuloma inguinale (Donovanosis) Bacterial infection e.g Staphylococcus infection
36
What is the bacterium causing syphilis?
Treponema pallidum
37
What is early syphilis?
First 2 years of infection High replication rate of T.pallidum Relapsing early disease and infectious
38
What is late syphilis?
After 2 years of infection Low replication rate of T.pallidum Late disease over decade Non-infectious Remains in the body and can reactivate over decades and cause various diseases
39
What is the timeline of syphilis infection including symptoms?
Primary syphilis - incubation 9-90 days, chancres Secondary syphilis - up to 2 years, skin and systemic features Tertiary syphilis - over 10 years later, neuro, cardiac and skin
40
What are condylomata lata?
One of the cutaneous signs of secondary syphilis Wart-like lesions on genitals Most infectious skin lesions in syphilis
41
How is syphilis diagnosed?
Dark ground microscopy from early lesions - scrub lesion with n.saline, scrape tissue fluid from ulcer base, with cover slip - under microscope look for corkscrew motility, slinky motility, bendy motility Alternative = PCR based tests
42
What is another way of diagnosing syphilis?
Serological tests on blood
43
Describe gonorrhoea
Gram negative intracellular diplocccus Genital discharge syndrome 50% of men are asymptomatic Less than 5% of females are asymptomatic 50% have concurrent other STIs e.g. Chlamydia
44
What can gonorrhoea cause?
Ophthalmia neonatorum Keratitis and rapid corneal scarring Pelvic inflammatory disease Ectopic pregnancy Infertility Congenital disease Adult gonococcal conjunctivits Disseminated gonococcal infection
45
What increases with gonorrhoea infection?
Risks of HIV transmission Antimicrobial resistance
46
What are mechanisms of Neisseria gonorrhoeae resistance to antimicrobials?
Chromosomal mediated Plasmid mediated Host/microbiome related Rx failure
47
What is the chromosomal mediated mechanism?
Resistance genes easily transferred between strains through highly competent DNA transformation - pil-IV ComP receptor for DNA uptake sequences Mosaics common Mutation and clonal expansion Mutation and internal recombination
48
Where is M.genitalium detected?
Upper GI tract in women with pelvic inflammatory disease
49
What can M.genitalium cause?
Cervicitis Pelvic inflammatory disease Preterm birth Spontaneous abortion Infertlity
50
Describe antibiotic resistance to macrolides
Mutations at A2058, A2059, A2062 in 23S rRNA
51
Describe antibiotic resistance to quinolones
Mutations at M95 and D99 in gyrA Mutations at S83 and D87 in parC within QRDR
52
Where do macrolides act?
Bind to 50S subunit targeting 23S rRNA
53
Where do quinolones act?
Bind to DNA gyrase and topoisomerase IV
54
Where do tetracyclines act?
Bind to 30S ribosomal subunit in mRNA complex
55
What is used to treat Chlamydia trachomatis?
Doxycycline
56
What is used to treate Neisseria gonorrhoea?
Ceftriaxone Azithromycin
57
What is used to treat Trichomonas vaginalis?
Metronidazole
58
What is used to treat Mycoplamsa genitalium?
Doxycyline + Azithromycin OR Moxifloxacin or Pristinamycin
59
Describe antibiotic resistance of Neisseria gonorrhoeae
In UK 50% not resistant to ciproflaxacin /penicillin
60
Describe antibiotic resistance of Mycoplasma genitalium
40-50% not resistant to azithromycin 50-80% not resistant to moxifloxacin
61
What is the classification of chlamydia?
Intracellular bacterium serovars D-K of C. trachomatis
62
What are clinical features of chlamydia in males?
50% asymptomatic Urethral discharge Dysuria Epididymo-orchitis
63
What are clinical features of chlamydia in females?
80% asymptomatic Post-coital bleeding Deep pain with sex Pelvic pain, cervicitis Vaginal discharge (rare) Tubal-factor infertility
64
What are some complications of chlamydia?
Reactive arthritis Reiters syndrome Conjunctivitis Neonatal infection
65
How is chlamydia diagnosed?
Nucleic acid amplification test (NAAT) - urethra cervix, vulvo-vagina, rectal, urine
66
How is chlamydia managed?
Doxycycline 1 week Abstinence for 1 week Contact tracing
67
How is gonorrhoea classified?
Intracellular bacterium Neisseria gonorrhoeae
68
What are clinical features of gonorrhoea in males?
Asymptomatic Urethral discharge Dysuria Epididymo-orchitis
69
What are clinical features of gonorrhoea in females?
Asymtomatic Deep pain with sex Pelvic pain Bartholins abscess
70
What are some complications of gonorrhoea?
Disseminated infection Arthritis Conjunctivitis Neonatal infection
71
How is gonorrhoea diagnosed?
Gram stained smear and culture NAAT
72
How is gonorrhoea managed?
3rd gen cephalosporin or if sensitivity is known then ciproflaxin/amoxicillin with probenecid PLUS empirical treatment for chlamydia (doxycyline for 1 week) Abstinence for 1 week Contact tracing
73
How is trichimonas vaginalis classified?
Flagellate protozoan trichomonas vaginalis
74
What are clinical features of TV in males?
Mostly asymptomatic Urethral discharge Dysuria
75
What are clinical features of TV in females?
10-50% asymptomatic Vaginal discharge Vulval irritation
76
How is TV diagnosed?
Microscopy of vaginal discharge in saline on a glass slide demonstrating motile protozoa Culture on Feinberg Whittington medium PCR
77
What are complication of TV?
Preterm delivery - low birth weight Pelvic inflammatory disease May facilitate HIV acquisition
78
How is TV managed?
Metronidazole 400mg BD 5 days Abstinence for 1 week Contact tracing (current partners)

Medical Microbiology (23 decks)

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