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Engagement and Participation

Focus on keeping participants involved and engaged during the study session.
The session is designed as an interactive, collaborative experience, rather than a lecture.
Participants are encouraged to participate to receive more out of the session.

Participants should place questions in the Q&A section of the chat to streamline responses from the nurse practitioner, Brianna.
Questions should be kept out of the general chat to avoid missing important inquiries and to ensure Brianna can address all inquires efficiently.

The session will cover two major topics: urinary tract infections (UTIs) and sexually transmitted infections (STIs).
- UTIs:
- Pathophysiology
- Common signs and symptoms
- Differentiation between complicated and uncomplicated UTIs
- Treatment approaches
- STIs:
- Review key STIs (gonorrhea, chlamydia, trichomoniasis, syphilis, movis, HPV)
- Clinical presentations and treatments
Throughout the session, questions will be posed for participants to answer in the chat.

Introduction of Waterfall Technique:
- Participants are asked to type out their answers during a countdown timer.
- Answers should only be submitted when the timer hits zero to prevent distraction from others’ responses.
An initial practice question was posed to gauge feelings about the topics, with participants encouraged to respond with emojis or short phrases.

Causative Organism:
- The most common bacteria causing UTIs is E. coli, which colonizes the urethra and can ascend to the bladder.
- The first organ it impacts during ascent is the bladder, with infections therein termed cystitis.

Patients with cystitis typically report symptoms such as:
- Dysuria (painful urination)
- Urinary frequency
- Urgency
- Suprapubic discomfort.
If bacteria ascend to the kidneys, this results in pyelonephritis (termed a complicated UTI).

Patients may report symptoms indicative of pyelonephritis, such as:
- Flank pain
- Costovertebral angle (CVA) tenderness
- Nausea and vomiting
- Fever, chills, and tachycardia.

Diagnosis can be based on clinical signs; however, urinalysis (UA) is often performed for confirmation.
- UA findings:
- Leukocyte esterase: indicates white blood cells are present.
- Nitrites: presence suggests bacteria like E. coli are present.
- Hematuria: indicated by red blood cells may occur due to inflammation of the urinary tract lining.
Conditions to consider with hematuria include:
- Nephrolithiasis (kidney stones), particularly if associated with flank pain.
Gross hematuria with no pain is a red flag for bladder cancer.

Criteria for obtaining a urine culture include:
- Patients demonstrating positive leukocyte esterase and symptoms of UTI, particularly in pregnant patients and those with treatment failure.
- Also warranted for complicated UTIs (e.g., pyelonephritis).

Characteristics that render a UTI complicated include:
- Pregnancy
- Immunocompromised states (e.g., HIV)
- Presence of indwelling urinary catheters.

First-Line Treatments for Uncomplicated UTIs:
- Nitrofurantoin (Macrobid): effective as it concentrates in the bladder.
- Bactrim (Trimethoprim/Sulfamethoxazole): check local resistance patterns before prescribing.
- Fosfomycin: single-dose treatment.
- Mnemonic: “Fix My Bladder” — F (Fosfomycin) M (Macrobid) B (Bactrim).
Considerations When Prescribing:
- Nitrofurantoin: Avoid if creatinine clearance is < 60 mL/min; generally safe in pregnancy during second trimester.
- Bactrim: has resistance patterns; avoid during first trimester and at term due to potential adverse effects, including Stevens Johnson syndrome (SJS).
- Fosfomycin: C. Diff risk is low due to single-dose regimen, but not typically first-line in pregnancy.

Preferred Medications:
- Fluoroquinolones (e.g., ciprofloxacin, levofloxacin): for pyelonephritis.
Concerns with Fluoroquinolones:
- Risk of tendonitis/tendon rupture, especially the Achilles tendon; contraindicated in pregnancy.

Educate patients on:
- Proper genital hygiene
- Hydration
- Consider prophylactic measures post-menopause if recurrent UTIs occur despite hygiene practices.

Main STIs discussed:
- Gonorrhea
- Chlamydia
- Trichomoniasis
- Syphilis
- HPV
Each STI's clinical presentations, diagnostic tests, and treatments were explored.

Presentation: Typically asymptomatic but may present with purulent discharge.
Gold standard diagnostic: Nucleic acid amplification test (NAAT).
First-line treatment: Doxycycline, previously azithromycin due to resistance concerns.

Presentation: Often asymptomatic but may have a “strawberry cervix” appearance and green frothy discharge.
First-line treatment: Metronidazole (Flagyl).

Stages of syphilis:
1. Primary: Painless chancre.
2. Secondary: Rash on palms and soles.
3. Latent: No symptoms present.
4. Tertiary: Severe complications (e.g., aortic aneurysms, neurosyphilis).
Diagnosis: RPR or VDRL tests; confirmation with FTA-ABS test.
Treatment: Penicillin G (Bicillin).

Presentation: Usually asymptomatic; can cause genital warts.
Associated cancers: Cervical cancer (types 16 and 18).
Prevention: Gardasil vaccine recommended for all adolescents before sexual activity.

Transmission: Through sexual contact, needle sharing, pregnancy, childbirth, breastfeeding.
Virulence: Attacks CD4 (helper T cells), essential for immune function.
Normal CD4 range: 500 to 1,500 cells/mm³.
AIDS Diagnosis: Defined if CD4 count drops below 200 or by presence of opportunistic infections.

Gold standard for HIV testing: The HIV-1, HIV-2 antigen-antibody immunoassay.
Importance of partner notification for STI management.

Review of the importance of knowledge for future practices in nursing.
Mention of additional study resources available, including webinars and self-paced courses for deeper learning and board exam preparation.