Term
| What are the sx/exam of cystitis? |
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Definition
| Dysuria, urgency, and frequency of urination are the most common complaints. |
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Term
| What is the DDX of cystitis? |
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Definition
Urethritis and cervicitis in sexually active patients
Renal stones may present with colicky pain and dysuria. |
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Term
| How do you diagnose cystitis? |
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Definition
| Check UA for the presence of bacteria, WBC, leukocyte esterase, and nitrites. |
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Term
| How do you treat cystitis? |
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Definition
TMP-SMX or a fluoroquinolone for uncomplicated cases
Nitrofurantoin for pregnant women.
IV Ceftriaxone and fluoroquinolone for complicated (Foley related, hospital acquired, recently treated) |
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Term
| What are the sx/exam for pyelonephritis? |
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Definition
Similar to UTI, but patient's are more ill.
Check for CVA tenderness, fever, tachycardia, and hypotension. |
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Term
| How do you diagnose pyelonephritis? |
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Definition
Check UA for significant bacturia, pyuria, and occasional WBC casts. Urine culture should be sent.
Get Blood cultures on admission as 15-20% will be bacteremic. |
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Term
| How do you treat pyelonephritis? |
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Definition
IV fluoroquinolone
If no clinical response, look for intrarenal or perinephric abscess or foreign bodies such as renal calculi with CT or US. |
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Term
| What are the Sx of prostatitis? |
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Definition
Spiking fevers, chills, dysuria, cloudy urine, and even obstructive symptoms.
In patients with chronic prostititis, low back pain or perineal/testicular discomfort may be present. |
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Term
| How do you diagnose prostatitis? |
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Definition
| Urine cultures before and after a prostatic massage to look for G- rods. |
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Term
| How do you treat prostatitis? |
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Definition
TMP-SMX or fluoroquinolone x 14 days.
Chronic: Fluoroquinolone x 1 month; or TMP-SMX x 3 months. |
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Term
| What is primary syphilis? |
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Definition
| Develops within several weeks of exposire; involves one or more painless, indurated, superficial ulcerations. |
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Term
| What is secondary syphilis? |
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Definition
| After initial ulceration has resolved, patients may develop malaise, anorexia, headache, diffuse lymphadenopathy, or rash (mucosal surface, palms and soles). |
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Term
| What is tertiary syphilis? |
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Definition
| Includes cardiovascular, neurologic, and gummatous disease (general paresis, tabes dorsalis, aortitis, meningovascular syphilis.) |
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Term
| How do you diagnose primary,syphilis? |
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Definition
| Do a nontreponemal serologic test (RPR or VDRL). Darkfield microscopy of the lesion's exudate will show the spirochetes. Direct antigen tests MHA-TP or FTA-ABS are used for confirmation |
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Term
| How do you diagnose tertiary syphilis? |
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Definition
| Perform LP when neurologic or ophthalmic signs and symptoms are present; in the setting of treatment failure; or with VDRL of >=1:32 correlate with cardiovascular, neurologic and systemic symptoms. |
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Term
| How do you treat primary and secondary syphilis? |
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Definition
Penicillin G 2.4MU in a single IM dose.
Alternatives include doxycycline or erythromycin x 14 days.
IF disease is >1 year, treat with three doses of PenG IM a week apart. |
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Term
| How do you treat neurosyphilis? |
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Definition
| Penicillin G IV x 14 days |
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Term
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Definition
| Painful grouped vesicles in the anogenital region. Caused by HSV; usually type 2. |
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Term
| What are sx/exam of genital herpes? |
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Definition
| Frequently associated symptoms include tender inguinal lymphadenopathy, fever, myalgias, headaches, and aseptic meningitis. Symptoms are usually more pronounced during the initial episode and grow less frequently with recurrences. |
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Term
| How do you diagnose genital herpes? |
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Definition
| Confirmed by viral PCR of the vesicle fluid. |
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Term
| How do you treat genital herpes? |
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Definition
Acyclovir x 7-10 days (primary infx). Tmx should begin within 1 week of sx onset.
Severe recurrences may need repeat treatment wiht either acyclovir or valacyclovir x 5 days. Daily suppressive therapy can be used for frequent recurrences. |
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Term
| What organisms generaly are involved in STD cervicitis or urethritis? |
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Definition
Chlamydial
Gonococcal
Mycoplasma genitalium |
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Term
| What are the sx/exam of STD cervicitis or urethritis? |
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Definition
Dysuria, dyspareunia, and mucopurulent vaginal discharge are complaints in women.
In men, dysuria and purulent penile discharge predominate. |
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Term
| How do you diagnose STD cervicitis or urethritis? |
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Definition
+endocervical or urethral culture OR
+urine PCR for chlamydia/gonorrhea |
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Term
| How do you treat chlamydia and gonorrhea? |
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Definition
Treat Both together (always!)
Chlamydia: single dose of axithromycin
Gonorrhea: single dose of ofloxacin or cipro OR Im dose of ceftriaxone |
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Term
| What is Pelvic inflammatory disease? |
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Definition
| An upper genital tract infection in women that is usually a complication of chlamydia and or gonorrhea infection. |
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Term
| What are the sx/exam of PID? |
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Definition
Pelvic pain
dyspareunia
vaginal discharge
fever
menstrual irregularities
lower abd tenderness
adnexal tenderness
cervical motion tenderness |
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Term
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Definition
| >10WBC on low-power field on gram stain and endocervical smear is consistent with PID. Rule out pregnancy before treatment. |
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Term
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Definition
2nd gen cephalosporin IV and doxycycline IV.
If pt doesn't improve, consider US to eval for tubo-ovarian abscess that may need drainage. |
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