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

Cystitis
Lower UTI
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(Haematuria, Pyuria, Haziness, Clouding)

•Urgency
•Temperature (Fever with chills)
•Incomplete emptying (Retention)
•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
 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
Herpes genitalis
Clean
Hepatitis B HAND
AIDS (HIV)
Non-gonococcal urethritis
With
Donovaniasis Soap
Wart (genital)
Syphilis
To
Trichomoniasis Loose
Lymphogranuloma inguinalae
Lice
Germs
Gonorrhea
 DISEASES DRUG OF CHOICE
Ceftriaxone 250 mg I.M/ Azithromycin/
1. Neisseria gonorrhoea Doxycycline
( gonococcus) Amoxicillin/ Cefixime/Ciprofoxacin
(Single dose)

2. Syphillis Procaine Penicillin-G 2.4 M.U. daily for

-Primary( chancre) 10 to 14 days or
Benzathine penicillin G 2.4 M.U Once
Early -Secondary (Condeloma Lata)

-Latent (< 1 yr)

- Latent (>1 yr) Benzathine penicillin G 2.4 M.U. weekly

or for 3 weeks
-cardiovascular syphillis or
-Tertiary Procaine Penicillin G 2.4 M.U. for 3
-Neurosyphillis weeks
 DISEASES DRUG OF CHOICE
Acyclovir/ Valacyclovir
3. Herpes simplex

Doxycycline 100 mg BD for three weeks

4. Chalmydiae trachomatis
or
(Non specific urethritis) Azithromycin 1 gm oral per week for
Lymphogranuloma venereum three weeks

5. Donovanosis Azithromycin 1g per week for 3 weeks

(Calymmatobacterium granulomatis) or
Granuloma Inguinale Doxycycline 100mg BD for 3 weeks

Azithromycin 1g oral single dose

6.Chancroids Or
(Haemophilus ducreyi) 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 B- Lamivudine
9. 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