Infectious Diseases Quiz 11

Hovering Negatives

Can change mechanics of urinating; Over time this can increase the risk of urniary tract symptoms (including pelvic floor dysfunction and infections from urinary retention); Path of urine flow is impaired (doesn’t allow full void); Change in flow can develop habits to empty all the way such as straining, which can lead to pelvic floor damage

Prostatitis

Inflammation of the prostate gland, largely due to bacterial infections; Gram negative bacteria are the most common cause of prostatitis

Symptoms of Prostatitis 

Joint pain, Fever and chills, Blood in urine, Urinary frequency and urgency, Night urination, Painful urination, Genital area pain, Abdominal pain, Lower back pain, Muscle pain

Prostatitis Diagnosis

Urine tests, Blood tests, Seminal fluid tests, Post-prostatic massage, Imaging tests 

Prostatitis Treatment

Initially, IV antibiotics, but then switch to oral antibiotics; 4-6 weeks total

STDs

Infections caused by bacteria, viruses, yeast, and parasites that spread from one person to another through sexual contact

STD Common Age Group

15-24 year olds account for half of all new STD infections

STDs are a common ____ problem 

Outpatient; People typically don’t get hospitalized for STDs (most are asymptomatic)

STD incidence ____ with reductions in ____

Increases; Public health funding

The Big 3

Top 3 diseases of nationally notifiable list (all bacterial); Viruses are more common, but they are not on the reportable list; Chlamydia, Gonorrhea, Syphilis 

Most spikes in STIs driven by ____

Gonorrhea

Months With Highest Chlamydia Cases

March, June, August, November

What Population is Disproportionately Burdened by STIs?

Young people; Make up 13% of the population, but have high case percentages; Make up 61% of chlamydia cases and 42% of gonorrhea cases 

Most Infected Male and Female Ages (STDs)

15-24 and 25-39

STD Risks

Unprotected sex, Multiple partners, Alcohol use, Being under 25, Illicit drug use, Serial monogamy, Having an STD, Community with high prevalence of STDs, Having high risk STD partners, Control pills as sole form of contraception 

STD Symptoms

Genital discharge, Frequent urination, Pain during urination, Weight loss, Sore throat, Fever, Muscle and joint pain 

Untreated STD Risks

Increased risk of getting/giving HIV; Long-term pelvic/abdominal pain; Infertility or sterility

Chlamydia Rates of Reported Cases

In 2021, a total of 1.6 million cases were reported in the US (4% increase)

Curable STDs

Chlamydia, Gonorrhea, Syphilis, Trichomoniasis

Incurable STDs (viral infections)

Herpes (HSV), Hep. B, HPV, HIV/AIDS

STD Transmission

Multiple sex partners, Using used razors or blades, Sexual contact, Exchange of unwashed sex toys (Can NOT get STDs from toilet seats)

Reason for Urethritis

Bacteria and viruses; Sexual diseases in the past

STD Virulence Factors

Attachment pili of N.Gonorrhoeae anchor themselves to urethra, leading to urethritis; Non-piliated strains may enter urethra but cannot adhere (flushed out by urine), and DO NOT cause infection 

Urethritis Symptoms

Burning urination, Frequent urination, Urethral discharge (UNIQUE; not seen with UTI or STIs)

Gonococcal Urethritis

Intracellular, gram-negative diplococci

Non-Gonococcal Urethritis

Absence of intracellular, gram-negative diplococci; Chlamydia is significant bacteria that causes non-gonococcal urethritis 

Chlamydia Treatments

Gram-intermediate (can’t be stained because no peptidoglycan); Structurally, organism is gram-negative; Chlamydiaceae family 

Urethritis 

Treatable; Bacteria; treated with antibiotics

Pelvic Inflammatory Disease

Disease of young, sexually active women (mainly) that originates as a bacterial infection; Caused by untreated bacterial infections (like chlamydia or gonorrhea); May cause permanent scarring of reproductive organs; Curable (if untreated, it may cause infertility) 

Most Common Gynecological Disease Seen in the ER

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease Pathology

Not a reportable disease, but about 1 million cases a year diagnosed in US; Spread of cervical microbes to endometrium, fallopian tubes, ovaries, and surrounding pelvic structures

Pelvic Inflammatory Disease - Host Defenses

Endocervical canal serves as a protective barrier (prevents vaginal flora from entering the upper genital tract, maintaining a sterile environment); Menstruation allows vaginal flora to bypass this barrier (Most cases of PID begin within 7 days of menstruation); use of condoms and spermicidal agents protects against PID

PID Causes

Nearly all community-acquired PID is sexually transmitted; Most common causes are N.Gonorrhoeae and C.Trachomatis; If urethritis treatment is delayed, the infection can spread to the uterus and cause PID (happens about 15% of the time); May be accompanied by other pathogens (most commonly Streptococcus Progenies and Haemophilus Influenzae) 

PID Symptoms

Pain in lower abdomen and pelvis that occurs during/immediately after menstruation; Heavy vaginal discharge; Abnormal vaginal bleeding (1/3 cases accompanied by vaginal/uterine bleeding); Pain/bleeding during intercourse; Fever, sometimes with chills (about 50% of cases); Painful/difficult urination 

PID Risk Factors

Younger age (highest incidence among sexually active teenagers), Multiple sex partners, Previous history of PID

Diseases That May Present With Similar Findings to PID

Diverticulitis, Pancreatitis, Perforated Bowel, Appendicitis, Endometriosis, UTIs

Minimum PID Diagnosis Criteria

Minimum criteria involves pelvic pain/lower abdominal pain and cervical motion tenderness, adnexal tenderness, or uterine tenderness

Additional PID Diagnostic Criteria

Fever > 101, abnormal cervical micropurelent discharge, presence of WBC on saline microscopy of vaginal fluid, elevated inflammatory markers (C-reactive protein, Erythrocyte sedimentation rate); Microbiologic testing confirming diagnosis with C.trachomatis or N.gonorrhoeae; Strong suspicion in young, sexually active females with pelvic or abdominal pain (without another explanation)

PID Treatment

To prevent potential complications (infertility) and chronic pain, prompt antibiotic therapy; Often a combination of antibiotics for 14 days