Urethra infections

This chapter discusses drug s used to treat urinary tract infections (UTIs) and certain miscellaneous drag > used to relieve the symptoms associated with an overactive bladder (involuntary contractions of the detrusor or bladder muscle). Structures of the urinary system that may be affected include the bladder (cystitis), prostate gland (prostatitis), the kidney, or the urethra (see Pig. 47-1). These drug s also help control the discomfort associated with irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, and endoscopic procedures. 

Urinary tract infection (UTI) is an infection caused by pathogenic microorganisms of one or more structures of the urinary tract. The most common structure affected is the bladder, with the urethra, prostate, and kidney also affected (see Pig. 47-1). Display 47-1 identifies the disorder most frequently associated with each of these structures within the urinary system. Clinical manifestations of a UTI of the bladder (cystitis) include urgency, frequency, burning and pain on urination, and pain caused by spasm in the region of the bladder and the suprapubic area. 

Uncomplicated infections of the cervix, urethra, and rectum can be treated with one of the following regimens in adults ... 

Uncomplicated Infections of the Cervix, Urethra, and Rectum in Children (less than 45 kg)... 

Since HSV is only found in humans, infection may only be transmitted from infectious secretions onto mucosal surfaces (i.e., cervix or urethra) or abraded skin. It has also been noted that the virus may survive for a limited amount of time on environmental surfaces. 

Lower urinary tract infection (UTI) Includes infections of the bladder, urethra, and (in men) prostate and epididymis. 

Site of infection Most common-urethra Others-rectum (usually due to rectal intercourse in men who have sex with men), oropharynx, eye Most common-endocervical canal Others-uretfira, rectum (usually due to perineal contamination), oropharynx, eye... 

Type of Infection Uncomplicated infections of the cervix, urethra, and rectum in adultsc,d Recommended Regimens0 Ceftriaxone 125 mg IM once/ or cefixime 400 mg po once/5 or ciprofloxacin 500 mg po once/ or ofloxacin 400 mg po once/ or levofloxacin 250 mg po once plus A treatment regimen for presumptive C. trachomatis coinfection if chlamydial infection has not been ruled out (see Table 121 -8 in Pharmacotherapy A Pathophysiologic Approach, seventh edition)... 

Lower tract infections include cystitis (bladder), urethritis (urethra), prostatitis (prostate gland), and epididymitis. Upper tract infections (such as pyelonephritis) involve the kidney and are referred to as pyelonephritis. 

The exact mechanism of bacterial infection of the prostate is not well understood. The possible routes of infection include ascending infection of the urethra, reflux of infected urine into prostatic ducts, invasion by rectal bacteria through direct extension or lymphatic spread, and by hematogenous spread. 

First void your bladder as you would with injection. Run a thin plastic tube to the bladder. (Males must insert the tube into the opening of the penis, go through the urethra and into the bladder.) Catheterization done on females is not as unpleasant as it is for males. Then inject the clean urine into the bladder via catheter. Catheterization is less painful, safer, and more effective. Infection is still possible. 

Reactive arthritis (ReA) develops 1-3 weeks after a bacterial infection in the intestinal tract (diarrhea) and/or urethra (urethritis) or elsewhere due to immune responses. HLA-B27 positive individuals may develop ReA. ReA is an autoimmune disease and consists of sterile axial and/or peripheral articular inflammation, enthesitis and extra-articular manifestations. 

Sexual intercourse may precipitate an episode of cystitis due to minor trauma or infection arising from bacteria being pushed along the urethra (so-called honeymoon cystitis ). Post-coital voiding of urine has been suggested as a means of reducing the risk of cystitis but again this is not evidence-based. 

Lower tract infections include cystitis (bladder), urethritis (urethra), prostatitis (prostate gland), and epididymitis. Upper tract infections (such as pyelonephritis) involve the kidney and are referred to as pyelonephritis. Uncomplicated UTIs are not associated with structural or neurologic abnormalities that may interfere with the normal flow of urine or the voiding mechanism. Complicated UTIs are the result of a predisposing lesion of the urinary tract such as a congenital abnormality or distortion of the urinary tract, a stone, indwelling catheter, prostatic hypertrophy, obstruction, or neurologic deficit that interferes with the normal flow of urine and urinary tract defenses. 

Cystitis is an inflammation of the bladder and urethra. Microbial infection is the cause... 

The use of an indwelling catheter frequently is associated with infection of the urinary tract and represents the most common cause of hospital-acquired infection. The incidence of catheter-associated infection is related to a variety of factors, including method and duration of catheterization, the catheter system (open or closed), the care of the system, the susceptibility of the patient, and the technique of the health care personnel inserting the catheter. The incidence of infection from a single catheterization in a healthy ambulatory patient is 1%. Bacteria may enter the bladder in a number of ways. During the catheterization, bacteria may be introduced directly into the bladder from the urethra. Once the catheter is in place, bacteria may pass up the lumen of the catheter via the movement of air bubbles, by motility of the bacteria, or by capillary action. In addition, bacteria may reach the bladder from around the exudative sheath that surrounds... 

Culture is considered the most reliable means of diagnosing gonococcal infections. Anatomic sites to be cultured depend on the individual s sexual preferences and body areas exposed. In women, because the urethra and other sites are rarely the sole locus of infection, cervical cultures produce the highest yield and frequently are performed in conjunction with rectal cultures. Urethral cultures are recommended in women who have had hysterectomies and heterosexual men. In MSM, anorectal cultures generally produce the highest yields, and pharyngeal and urethral cultures are considered optional. ° " ... 

Humans are the sole known reservoir for HS V. Infection is transmitted via inoculation of virus from infected secretions onto mucosal surfaces (e.g., urethra, oropharynx, cervix, and conjunctivae) or through abraded skin. Evidence that the virus survives for a limited time on environmental surfaces suggests the possibihty of fomitic transfer as a nonvenereal route of transmission." " ... 

Trichomonads typically can be isolated from the vagina, urethra, and paraurethral ducts and glands in the majority of infected women. 

Trichomonal infections are reported more commonly in women than in men. In part this may be due to the smaller number of organisms found in the male urethra making detection more difficult, greater disease transmission rates from males to females, and the nature of male infections, which have a high spontaneous cure rate even in the absence of treatment. The typical clinical presentation of trichomoniasis in males and females is presented in Table 115-11. 

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