1 / 19

Urethritis

Urethritis. Urethritis. inflammation of the urethra Infectious causes (typically sexually transmitted) Gonococcal urethritis (GCU) - Neisseria gonorrhea Nongonococcal urethritis (NGU) - Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma genitalium, or Trichomonas vaginalis.

shiro
Download Presentation

Urethritis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Urethritis

  2. Urethritis • inflammation of the urethra • Infectious causes (typically sexually transmitted) • Gonococcal urethritis (GCU) - Neisseria gonorrhea • Nongonococcal urethritis (NGU) - Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma genitalium, or Trichomonas vaginalis.

  3. Urethritis • Presentation & Findings: • Urethral discharge, dysuria and urethral pruritus • 40% GCU and 25% NGU= asymptomatic • Complications • Men: epididymitis and Reiter’s syndrome • Women (female sex partners): pelvic inflammatory disease, ectopic pregnancy and infertility • Children: neonatal pneumonia and ophthalmia neonatorum

  4. Diagnosis • Traditional diagnostic algorithm • Microscopy exam of Gram’s stained urethral smear • Nucleic acid amplification testing –using first void urine

  5. Management 1. Antibiotic Regimen • Gonococcal Infections • Cefixime, 400 mg as a single dose; or ceftriaxone, 125 mg as a single IM dose; or ciprofloxacin, 500 mg as a single oral dose’ or ofloxacin, 400 mg as a single oral dose, plus azithromycin, 1 g as asingle oral dose; or doxycyline, 100 mg orally twice a day for 7 days. • Non-gonococcal Urethritis • Azithromycin, 1 g as a single oral dose; or doxycycline, 100 mg orally twice a day for 7 days • Recurrent and persistent urethritis • Metronidazole, 2 g as a single oral dose, plus erythromycin base, 500 mg orally 4 times a day for 7 days; or eryhtromycin ethylsuccinate, 800 mg orally 4 times a day for 7 days 2. Sex partners should be referred for appropriate evaluation and treatment.

  6. Follow-up • Presence of any of the following clinical signs: • Mucopurulent urethral discharge on PE • > 5 leukocytes per oil immersion field of the Gram’s stained urethral secretion • (+) leukocyte esterase test on first-void urine • > 10 leukocytes per high-power microscopic field of the first void urine

  7. Epididymitis

  8. Epididymitis • inflammation of the epididymis • Bacterial infection results in the infiltration of white blood cells into the epididymal connective tissue, with resultant congestion and edema. • Men <35 y/o  STDs • Homosexual men (anal intercourse)  E. coli • Children & older men  urinary pathogens (E. coli)

  9. Epididymitis • Presentation & Findings • Severe scrotal pain that may radiate to the groin or flank • Scrotal enlargement

  10. Epididymitis • Physical Examination • Edematous tender epididymis • Erythematous edematous scrotum • Prehn sign: distinguish epididymitis from testicular torsion. • Urethral discharge (10%) • Fever or other constitutional symptoms with progression of disease

  11. Epididymitis • Presentation and Findings • Urinalysis: WBCs and bacteria in the urine or urethral discharge • Serum blood analysis: leukocytosis • Radiologic Imaging • Scrotal Doppler UTZ or radionuclide scanning • Epididymitis: enlarged epididymal head • Diagnosis: • Urine gram stain and culture • Syphilis serologic and HIV tests

  12. Epididymitis • Management • Antimicrobial regimen: • Gonococcal or chlamydial infection • Ceftriaxone, 250 mg in a single IM dose, plus doxycycline, 100mg orally twice a day for 10 days • Enteric infection • Ofloxacin, 300 mg orally twice a day for 10 days • Bed rest, scrotal elevation & NSAIDS – until fever and local inflammation subside • Sepsis or severe infection  hospitalization & parenteral antibiotic therapy • Abscess  open drainage • Chronic, relapsing epididymitis & scrotal pain  epididymectomy

  13. CANDIDIASISEtiology Candida albicans - yeastlike fungus that is a normal inhabitant of the vagina, respiratory and gastrointestinal tracts

  14. CANDIDIASISPathogenesis • Intensive use of potent and modern antibiotics disturbs the normal balance between the pathogenic and non-pathogenic forms of the organism • Fungi overwhelms an otherwise healthy organ • Usually involves the urinary bladder and the kidney

  15. CANDIDIASISSigns & Symptoms • Vesical irritability • Symptoms of pyelonephritis • Spontaneous passage of fungus balls

  16. CANDIDIASISDiagnosis • Microscope -mycelial or yeast forms in a urine specimen • Culture • Excretory Urograms -caliceal defects -ureteral obstruction (fungus masses)

  17. CANDIDIASISTreatment Vesical Candidiasis • Alkalinization of the urine with Sodium Bicarbonate (pH 7.5) • Amphotericin B via catheterization 3x a day Renal Involvement • Irrigation of the renal pelvis with Amphotericin B

  18. CANDIDIASISTreatment Systemic involvement/Candidemia • Flucytosine (Ancobon): DOC dosage: 100 mg/kg/d orally in divided doses given for 1 week in cases of serious involvement: dosage: 600 mg IV (1st day) shift to oral form

  19. CANDIDIASISTreatment Systemic involvement/Candidemia • Nifuratel (nitrofuran antibiotic) dosage: 400 mg 3x daily for 1 week • Ketoconazole 200-400 mg/d for 2-3 weeks or more depending on the effect • Amphotericin B (Fungizone) 1-5 mg/d IV in divided doses dissolved in 5% dextrose

More Related