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Urinary Tract Infection and Sexually Transmitted Diseases Prof. R. K. Dixit Pharmacology and Therapeutics K.G.M.U. Lucknow [email protected] Urinary Tract Infection Pyelonephritis Upper UTI Ureteritis Vesico-ureteral Reflux Lower UTI Cystitis Urethritis •Upper Urinary tract (Kidney, Ureter)•Less common but More dangerous, •Long term therapy •Lower Urinary tract (Bladder, Urethra)•More common but Less dangerous •Short term therapy •Organisms•Mostly Gram Negative (E.coli, Klebsiella, Proteus, Pseudomonas, Enterobacter,) •Others- Staphylococcus, Viral, Fungal, … • Single in acute, mixed in chronic •Entry•Mostly from lower to upper (Ascending ), •Some times •Directly from the surrounding sites or •From blood (bacterimia) Symptoms Symptoms- (Severe Pain During UTI) •Systemic symptoms- myalgia, vomiting, weakness etc. •Pain (Pelvic, Rectal, lower abdomen or renal angle) •Pungent smell of urine •Dysuria (Burning), •Denies urination (Fear of Urination) •Discharge through urethra •Discoloration of urine •Urgency •Temperature (Fever with chills) •Incomplete emptying (Retention) •Incontinence of urine (Haematuria, Pyuria, Haziness, Clouding) •More common in Females- Anatomical differences •Other part involved •Prostate, Epididymis •More common if•Stones •Strictures •Stents (Urinary Catheter) •Structural abnormality •Straight entry of ureter •Sexually active •Store urine (Faulty urinary habit) •Surgical (abdomen) •Scanty fluid intake •Semiconscious (Unconscious), •Site trauma, Treatment of UTI •Increased Fluid Intake and Voiding •Analgesics, Antipyretics, Anti-inflammatory (NSAIDs) •Alteration of pH •Alkalizers – Potassium Citrate, Baking Soda, •Beware of •Dilution (1:10) of syrup (Gastric irritant)- 30 ml in 300ml •Not with Nalidixic acid, Nitrofurantoin, Methenamine •Proteus which split urea and produce ammonia and make urine alkaline. Acidify with vitamin C, Mandelic acid (Syrup of Ammonium Mandelate) and Cranberry (Karaunda) •Urinary analgesics (Local)•Phenazopyridine (Symptomatic relief only, No antibacterial property, Urine becomes orange red) •Urinary antiseptics•Nitrofurantoin•Generates nitro-anion superoxide to damage bacterial DNA, •Dark brown urine, •Peripheral neuritis, Intra-hepatic cholestasis •Antagonism with Nalidixic acid •Methenamine – •Releases formaldehyde in acidic urine, •Antagonism with sulfonamides Antimicrobials------------------------(Q-BACTS) •Quinolones -(Nalidixic acid, Norfloxacin……) •Betalactams- Ampicillin/ Amoxicillin, •Aminogycosides- Gentamicin, Amikacin, … •Cephalosporins- Third generation •Tetracyclines •Sulfonamides and Cotrimoxazole •Other Antimicrobials•Chloramphenicol, Methicillin, Carbenicillin etc…….. •Prophylaxis for UTI- Needed in •Catherised, •Uncorrectable anatomical abnormalities •Inoperable prostate, •Septicemia, •Immuno-compromised, •Trauma •Note•In patients with impaired renal functions avoid •Nitrofurnatoin, Nalidixic acid, • Aminoglycosides, •Potassium salt, and Acidifying agents V V V Sexually Transmitted Diseases (STD) (Sexually Transmitted Infections (STI) • Transmitted through sexual contacts • Usual Presentations –Genital ulcers –Discharge (Urethral and vaginal) –Abdominal Pain –Swelling surrounding genital area –Systemic symptoms (Fever, weakness etc. ) • Important STDs – – – – Syphilis (Chancre (Hard sore, Painless) Chancroid (Soft sore, Painful) Gonorrhea Non-gonococcal urethritis (Nonspecific) • Chlamydia, Ureoplasma, Haemophillus, Mycoplasma – – – – – – – – Herpes genitalis AIDS (HIV) Hepatitis B Donovaniasis Trichomoniasis Wart (Genital Wart, Human Papilloma Virus strain 6 and 11) Pubic Lice Lymphogranuloma inguinalae Chancroid Clean Herpes genitalis HAND Hepatitis B AIDS (HIV) With Non-gonococcal urethritis Soap Donovaniasis Wart (genital) To Syphilis Loose Trichomoniasis Lymphogranuloma inguinalae Germs Lice Gonorrhea DISEASES DRUG OF CHOICE 1. Neisseria gonorrhoea ( gonococcus) 2. Syphillis -Primary( chancre) Early Ceftriaxone 250 mg I.M/ Azithromycin/ Doxycycline Amoxicillin/ Cefixime/Ciprofoxacin (Single dose) Procaine Penicillin-G 2.4 M.U. daily for 10 to 14 days or Benzathine penicillin G 2.4 M.U Once -Secondary (Condeloma Lata) -Latent (< 1 yr) - Latent (>1 yr) or -cardiovascular syphillis -Tertiary -Neurosyphillis Benzathine penicillin G 2.4 M.U. weekly for 3 weeks or Procaine Penicillin G 2.4 M.U. for 3 weeks DISEASES DRUG OF CHOICE Herpes simplex Acyclovir/ Valacyclovir 4. (Non specific urethritis) Lymphogranuloma venereum Chalmydiae trachomatis Doxycycline 100 mg BD for three weeks or Azithromycin 1 gm oral per week for three weeks 5. Donovanosis (Calymmatobacterium granulomatis) Granuloma Inguinale Azithromycin 1g per week for 3 weeks or Doxycycline 100mg BD for 3 weeks 3. Chancroids 6. (Haemophilus ducreyi) Azithromycin 1g oral single dose Or Ceftriaxone 250 mg I.M sing dose or Erythromycin 500 mg QID for one week 7.Condyloma acuminatum • Human Papilloma Virus strain 6 and 11 Treatment Antiviral therapy: Interferon, Valaciclovir Regional treatment : Podophyllotoxin Laser, freezing (Cryosurgery) Microwave Big wart: excise by operation Remember it ‘s different: To Condyloma lata- Secondary Syphilis 8. Hepatitis 9. B- Lamivudine HIV- Zidovudine and other ART STDs are Very BAD • Valacyclovir (Acyclovir) - Herpes genitalis, Genital Warts • Betalactams –Penicillins- Syphilis –Ceftriaxone - Gonorrhea • Azithromycin - Chancroid • Doxycycline- Chlamydia, Donovanosis, Gonorrhea