Urinary Tract Infection and Sexually Transmitted Diseases Prof

Urinary Tract Infection and Sexually Transmitted Diseases Prof. R. K. Dixit Pharmacology and Therapeutics K. G. M. U. Lucknow dixitkumarrakesh@gmail. com

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 p. H • Alkalizers – Potassium Citrate, Baking Soda, • Beware of • Dilution (1: 10) of syrup (Gastric irritant)- 30 ml in 300 ml • 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

üChancroid Clean üHerpes genitalis HAND üHepatitis B üAIDS (HIV) With üNon-gonococcal urethritis Soap üDonovaniasis üWart (genital) To üSyphilis Loose üTrichomoniasis üLymphogranuloma inguinalae Germs üLice üGonorrhea

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 1 g per week for 3 weeks or Doxycycline 100 mg BD for 3 weeks 3. Chancroids 6. (Haemophilus ducreyi) Azithromycin 1 g 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 üRegional treatment : Podophyllotoxin üLaser, freezing (Cryosurgery) üMicrowave üBig 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