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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.

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Urethritis

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  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

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