Understanding Urinary Tract Infections & STDs

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

3. Urinary Tract Infection Pyelonephritis Upper UTI Ureteritis Cystitis Lower UTI Urethritis Vesico-ureteral Reflux

4. 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

5. 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)

6. Symptoms

7. 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 (Haematuria, Pyuria, Haziness, Clouding) • Urgency • Temperature (Fever with chills) • Incomplete emptying (Retention) • Incontinence of urine

8. 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) • Scantyfluid intake • Semiconscious (Unconscious), • Site trauma,

9. 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)

10. 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

11. 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……..

12. 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

13. V V V

14. 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. )

15. 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

16. Chancroid • Herpes genitalis • Hepatitis B • AIDS (HIV) • Non-gonococcal urethritis • Donovaniasis • Wart (genital) • Syphilis • Trichomoniasis • Lymphogranuloma inguinalae • Lice • Gonorrhea Clean HAND With Soap To Loose Germs

19. 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

20. 8. Hepatitis B- Lamivudine 9. HIV- Zidovudine and other ART

21. STDs are Very BAD • Valacyclovir (Acyclovir) - Herpes genitalis, Genital Warts • Betalactams • Penicillins- Syphilis • Ceftriaxone - Gonorrhea • Azithromycin - Chancroid • Doxycycline- Chlamydia, Donovanosis, Gonorrhea