Genitourinary tract infections Notes

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This Osmosis High-Yield Note provides an overview of Genitourinary tract infections essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Genitourinary tract infections:

Pelvic inflammatory disease

Urethritis

NOTES NOTES GENITOURINARY TRACT INFECTIONS GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES ▪ Infections of genital/urinary tract CAUSES ▪ Mostly bacteria RISK FACTORS ▪ Recent sexual activity ▪ High-risk sexual behavior ▪ Previous genitourinary tract infections COMPLICATIONS ▪ Pelvic inflammatory disease, infertility, pyelonephritis, epididymitis, prostatitis, sepsis, abscesses SIGNS & SYMPTOMS ▪ Abdominal pain, altered vaginal/urethral discharge, dysuria, fever DIAGNOSIS LAB RESULTS ▪ Vaginal/urethral discharge microscopy ▪ Nucleic acid amplification tests (NAATs) OTHER DIAGNOSTICS ▪ Clinical examination TREATMENT MEDICATIONS ▪ Antibiotic therapy PELVIC INFLAMMATORY DISEASE osms.it/pelvic-inflammatory-disease PATHOLOGY & CAUSES ▪ Infection, inflammation of upper genital tract (uterus, ovaries, fallopian tubes) in individuals who are biologically female ▪ Common pathogens: Chlamydia trachomatis, Neisseria gonorrhoeae, vaginal flora bacteria (e.g. Gardnerella vaginalis); often polymicrobial ▪ Bacterial vaginosis (alteration in vaginal flora) present in ⅔ of PID cases ▫ Anaerobic bacteria replace lactobacilli in vagina → enzyme production → degradation of cervical mucus, antimicrobial agents → infections spread ▪ Associated syndromes ▫ Endometritis, salpingitis, oophoritis, peritonitis, perihepatitis (liver capsule inflammation), tubo-ovarian abscess ▪ Vaginal mucosa colonization → disruption of endocervical canal barrier → pathogens ascend to upper genital structures → inflammation OSMOSIS.ORG 753
RISK FACTORS ▪ More common in individuals who are biologically female, < 25 years old, sexually active ▪ Multiple sexual partners ▪ Partner with sexually transmitted disease (STD) ▪ Personal history of PID/STD ▪ Unprotected sexual intercourse ▪ Cervix instrumentation (e.g. abortion) COMPLICATIONS ▪ Recurrent PID, hydrosalpinx (fluid-filled fallopian tubes), pyosalpinx (infected fallopian tube filled with purulent matter), chronic pelvic pain, infertility, ectopic pregnancy, ovarian cancer SIGNS & SYMPTOMS Acute symptomatic PID ▪ Bilateral lower abdominal/pelvic pain ▫ Abrupt onset during/after menstruation ▫ Constant, aching ▫ Worsens during sexual intercourse/ movement ▪ Abdominal/pelvic organ tenderness ▪ Feeling of pelvic fullness ▪ Intermenstrual/postcoital bleeding ▪ Dysuria ▪ Low-grade fever ▪ Rebound tenderness, fever, ↓ bowel sounds (severe) Chronic PID ▪ Low-grade fever, weight loss, abdominal pain Perihepatitis (Fitz-Hugh–Curtis syndrome) ▪ Right upper quadrant pain, tenderness DIAGNOSIS DIAGNOSTIC IMAGING Pelvic/abdominal ultrasound ▪ Fluid-filled fallopian tubes with cogwheel sign (thickened loops on cross-section) ▪ Endometrium changes (e.g. wall thickening) 754 OSMOSIS.ORG ▪ Tubo-ovarian abscess (thick walls, multilocular cyst) LAB RESULTS ▪ Vaginal discharge microscopy ▫ Saline microscopy, Gram stain ▫ ↑ leukocytes ▫ Clue cells (epithelial cells surrounded by bacteria) in bacterial vaginosis ▪ Nucleic acids amplification tests (NAATs) ▫ C. trachomatis, N. gonorrhoeae ▪ Tissue biopsy ▫ ↑ plasma cells, neutrophils (inflammation) ▪ Leukocytosis, ↑ C-reactive protein (CRP), ↑ erythrocyte sedimentation rate (severe) OTHER DIAGNOSTICS ▪ Speculum exam ▫ Mucopurulent cervical discharge (positive swab test) TREATMENT MEDICATIONS Broad-spectrum antibiotic therapy ▪ Inpatient (parenteral) ▫ Cefoxitin/cefotetan (cephalosporin) + doxycycline (tetracycline) ▫ Clindamycin (lincosamide) + gentamicin (aminoglycoside) ▪ Outpatient ▫ Ceftriaxone/cefoxitin (cephalosporin) + doxycycline (tetracycline) ▪ Pelvic abscess ▫ Clindamycin/metronidazole + doxycycline Antiemetic medication ▪ E.g. metoclopramide Antipyretic medication ▪ E.g. acetaminophen OTHER INTERVENTIONS ▪ Prevention ▫ Barrier contraception (e.g. condoms) ▫ Abstinence
Chapter 125 Genitourinary Tract Infections Figure 125.1 An MRI scan of the pelvis in the sagittal plane demonstrating a right-sided pyosalpinx. URETHRITIS osms.it/urethritis PATHOLOGY & CAUSES ▪ Inflammation of urethra; more common in individuals who are biologically male with sexually transmitted diseases ▪ Common coinfection with other STDs ▪ Incubation period: 4–8 days CAUSES ▪ Infectious urethritis (most common) ▫ Gonococcal: Neisseria gonorrhoeae ▫ Non-gonococcal: Chlamydia trachomatis (most common), Mycoplasma genitalium ▪ Non-infectious urethritis ▫ Chemical irritation (e.g. soaps, spermicides) ▫ Trauma RISK FACTORS ▪ Individuals who are biologically male, young ▪ Multiple sexual partners ▪ Partner with sexually transmitted disease (STD) ▪ Unprotected sexual intercourse COMPLICATIONS ▪ Reactive arthritis related to C. trachomatis, gonococcal conjunctivitis, epididymitis, prostatitis, penile lymphangitis, periurethral abscess SIGNS & SYMPTOMS ▪ Sometimes asymptomatic ▪ Dysuria ▪ Urethral pruritus, discharge (mucoid, watery, purulent) ▪ Inflammation/edema of urethral meatus OSMOSIS.ORG 755
DIAGNOSIS LAB RESULTS ▪ Diagnosis criteria (≥ one) ▫ Mucopurulent/purulent urethral discharge ▫ ≥ one leukocyte per oil immersion field in Gram stain of urethral discharge ▫ Positive leukocyte esterase, ≥ 10 leukocytes per high-power field (firstcatch urine) ▪ NAATs ▫ C. trachomatis, N. gonorrhoeae ▪ Urethral discharge microscopy (e.g. Gram stain) OTHER DIAGNOSTICS ▪ Clinical examination ▫ Gonorrhoea: purulent discharge ▫ Chlamydia: isolated dysuria ▫ Herpes simplex virus (HSV): dysuria + painful genital ulcers 756 OSMOSIS.ORG TREATMENT MEDICATIONS Antibiotic therapy ▪ Gonococcal urethritis ▫ Ceftriaxone (cephalosporin) + azithromycin (macrolide) ▪ Non-gonococcal urethritis ▫ Azithromycin or doxycycline (tetracycline) ▫ Azithromycin/moxifloxacin (persisent) OTHER INTERVENTIONS ▪ Prevention ▫ Barrier contraception (e.g. condoms) ▫ Abstinence

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Genitourinary tract infections essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Genitourinary tract infections by visiting the associated Learn Page.