Lecture 30 - Urethritis

Question 1

Urethritis

Answer 1

Inflammation of the urethra
-symptoms include - discharge and dysuria

-In males - urethral glands produce a colloid secretion containing glycosaminoglycans which protect the eptihtleium agains urine

Question 2

Causes of vaginal discharge

Answer 2

Urethra shorter in females, doesnt really get as inflammed

Physiological - cyclical variation, cervical mucus

Cervicitis - endocervical infection

Genital candidiasis
bacterial vaginosis

Question 3

Chlamydia

Answer 3

-most common bacterial STI in NZ
-take over host cell ATP production and must replicate inside cells
-different spectrum of disease
-Male - urethritis, epididmytis
Female - cervicitis, sterile pyuria, ectopic pregnancy, infertility

• Initial infection is mild and self-limited
• antibodies against the major outer membrane protein can neutralise organisms - can get latent infection
• recurrent infection can produce severe inflammation resulting in tissue damage and scarring
• due to exaggerated host CMI repsonse
• because cross reacting heat shock protein aggravated by persisting intracellular chlamydia antigen so body reacts to own heat shock protein get damage

collect urine test for male, and a vaginal swab for females

diagnosis - DNA amplification

Question 4

Treatment of chlamydia

Answer 4

Azithromycin -easier for patient adherence, and then Doycycline

Azithromycin - -this works by binding to the 50S subunit of the bacterial ribosome

• chlamydia - not resistant
• long half life
• Need to notify partners

Question 5

Complications of claymidia for males

Answer 5

• can get epididymitis and infertility

- reiters syndrome

Question 6

Gonorrhoea

Answer 6

Niserrea gonorrhoea

gram negative diplococcus

• human is the only host
• infection on non-cornified epithelial cells
• oxidase positive
• fastidious growth
• chromosomal or plasmid mediated antibiotic resistance

Virulence factors
-has pillin , adherence proteins, toxins

-take sample from site of symptoms

Grow on selective artificial media - contain blood, growth promotors, antibiotics

Urethral infection in males - most are symptomatic, anterior urethritis - discharge and dysuria
-untreated men - 95% asymptomatic after 6 months

Question 7

NAAT - nucleic acid testing

Answer 7

-high sensitivity

Question 8

Treatment of gonorrhoea

Answer 8

• is easy if you use high does of cefriaxoane and azithromycin
• cannot use only azithromycin because it is resistant

Question 9

Ciprofloxacin

Answer 9

• problem drug
• has broad spectrum of action
• gonorrhoea can be resistant to it

Question 10

Complications of gonhorrhea in males?

Answer 10

• epididymitis
• can also get rectal infection
• pharangeal infection - from oral sex
• endocervical infection in females but normally asymptomatic (if symptomatic then will get vaginal discharge)
• Pelvic inflammatory disease -

Question 11

PID

Answer 11

primary cervicitis, infection may spread
-long term - csan get chornic pain, inferitlity, ectopic pregnancy

Symptoms - vainal discharge or bleeding, signs - abdominal tenderness

Caues

• chlamydia
• gonohhroea

Treatment 0 depedns on cause

Ceftriazone, plus dozycyline

Complications - chronic pain, inferitlity

Question 12

Non specific urethritis

Answer 12

• Diagnosis depends on -presence of symptoms or signs
• rule out chlaymidia and gonhorrhea
• microscopy of urethral smear lookign for PMNL
• could be mycoplasma genitalium
• adenovirus