Urology/Sexually transmitted diseases
70 important questions on Urology/Sexually transmitted diseases
Diagnostic method glomeruloneprhitis
urine test, blood tests, imaging tests, kidney biopsy
Chlamydia trachomatis infection/trachoma (with PID), treatment/therapy
Chlamydia can be effectively treated by use of antibiotics. The two most commonly prescribed antibiotics are azithromycin and doxycycline. These will cure more than 95% of all infections
Symptoms gonorrhoeal disease
in men: causing dysuria and/or urethral discharge
complications leading to ascending infection involving epididymis or prostate leading to chronic infection. In MSM (men who have sex with men) rectal infection may cause proctitis with pain, discharge and itching
in women: infection of endocervical canal → increased or unusual vaginal discharge, pelvic pain due to ascending infection, dysuria and intermenstrual bleeding
can cause infertility, rectal infection, neonates of infected mother can have conjunctival infection
complications: perihepatitis and Bartholin’s abscesses (accumulation of pus due to infected bartholin’s glands)
disseminated GC can lead to arthritis
complications leading to ascending infection involving epididymis or prostate leading to chronic infection. In MSM (men who have sex with men) rectal infection may cause proctitis with pain, discharge and itching
in women: infection of endocervical canal → increased or unusual vaginal discharge, pelvic pain due to ascending infection, dysuria and intermenstrual bleeding
can cause infertility, rectal infection, neonates of infected mother can have conjunctival infection
complications: perihepatitis and Bartholin’s abscesses (accumulation of pus due to infected bartholin’s glands)
disseminated GC can lead to arthritis
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Diagnostic methods gonorrhoeal disease
●identified from infected areas by culture on selective media
●nucleic acid amplification tests (NAATs) using urine specimen are non-invasvie but can give false positive results.
●microscopy of gram-stained secretions
●in disseminated GC blood test can be used
●nucleic acid amplification tests (NAATs) using urine specimen are non-invasvie but can give false positive results.
●microscopy of gram-stained secretions
●in disseminated GC blood test can be used
Glomerulonephritis, therapy/treatment
Mild cases:
Severe cases:
Treat complications resulting from glomerulonephritis such as high blood pressure and high cholesterol
- change diet
- stop smoking
Severe cases:
- immunosuppressants
- corticosteroids to reduce swelling
Treat complications resulting from glomerulonephritis such as high blood pressure and high cholesterol
Treatment gonorrhoeal disease
antibiotic choice influenced by travel history or details known from contact (some antibiotic-resistant strains can be present)
Gonorrhoeal disease (with PID), explanation
is a bacterial infection of the urogenital tract, rectum, pharynx and conjunctivae( mucous membrane that covers the and lines the inside of the eyelids
Herpes Simplex Virus Infection
is a viral infection that persists for the whole life when infected once.
HSV type 1 and 2
type 2 often causing genital infection
HSV type 1 and 2
type 2 often causing genital infection
Gonorrhoeal disease (with PID), underlying cause
spread by intimate physical contact.
humans are the only host.
humans are the only host.
Cause herpes simplex virus infection
viral infection which is transmitted through close contact with a person who is shedding.
can cause infections in mouth, genital, cold sore or systemic infection (affecting entire body)
activated by: stress, trauma, febrile(fever) illness, ultraviolet radiation
immunosuppressed people (HIV) are prone to Herpes
can cause infections in mouth, genital, cold sore or systemic infection (affecting entire body)
activated by: stress, trauma, febrile(fever) illness, ultraviolet radiation
immunosuppressed people (HIV) are prone to Herpes
Diagnostic method herpes simplex virus infection
painful ulcers
tingling or pricking sensation before outbreak
genital herpes: pain in groin, buttocks, upper thighs, fever, headache, myalgia (pain in muscle), lymphadenopathy (disease of lymph nodes)
complications can cause: encephalitis (inflammation of brain)
for HSV-2:
asymptomatic primary infection occur but rare
tingling or pricking sensation before outbreak
genital herpes: pain in groin, buttocks, upper thighs, fever, headache, myalgia (pain in muscle), lymphadenopathy (disease of lymph nodes)
complications can cause: encephalitis (inflammation of brain)
for HSV-2:
asymptomatic primary infection occur but rare
Treatment herpes simplex virus infection
detection of lesions caused by virus
culture of virus from lesions
HSV DNA detection by PCR
culture of virus from lesions
HSV DNA detection by PCR
HIV (Human immunodeficiency virus) infection
is a viral infection often transmitted due to the sexual act.
Diagnostic method HIV
laboratory abnormalities:
atypical reactive lymphocytes on blood film,
raised liver enzymes, CD4 lymphocytes markedly depleted, level of circulating viral RNA high, p24 protein may be detectable,
identification of anti-HIV antibodies or direct virus material
using ELISA techniques
→ Detection of IgG antibodies
however in babies detection of IgG not reliable because IgG cross placenta and thus babies will have the antibody but may be still not actively infected because antibodies will be lost over first 18 month when uninfected.
atypical reactive lymphocytes on blood film,
raised liver enzymes, CD4 lymphocytes markedly depleted, level of circulating viral RNA high, p24 protein may be detectable,
identification of anti-HIV antibodies or direct virus material
using ELISA techniques
→ Detection of IgG antibodies
however in babies detection of IgG not reliable because IgG cross placenta and thus babies will have the antibody but may be still not actively infected because antibodies will be lost over first 18 month when uninfected.
Herpes Simplex Virus, therapy/treatment
using ointment against cold sore
for genital HSV: saltwater bathing or sitting in a warm bath is soothing and allow patient to pass urine with some degree of comfort, rest , medications to relieve the pain
when encephalitis present antiviral medication and hospital visit prescribed
for genital HSV: saltwater bathing or sitting in a warm bath is soothing and allow patient to pass urine with some degree of comfort, rest , medications to relieve the pain
when encephalitis present antiviral medication and hospital visit prescribed
HIV (human immunodeficiency virus) infection, underlying cause
sexually transmitted especially due to MSM.
virus infections leads to shut down of immune system of host.
transmitted via semen, cervical secretions and blood.
contaminated needles (heroin)
vertical transmission: mother → child
virus attacks CD4+ T cells which are normally responsible in fighting against antigens and preventing infections and in general are responsible for the immune system.
virus infections leads to shut down of immune system of host.
transmitted via semen, cervical secretions and blood.
contaminated needles (heroin)
vertical transmission: mother → child
virus attacks CD4+ T cells which are normally responsible in fighting against antigens and preventing infections and in general are responsible for the immune system.
HIV (Human Immunodefiency Virus), main symptoms
due to the shutdown of immune system patients are more prone to infections and even malignant tumors
often asymptomatic
fever, myalgia, arthralgia (pain in joint), lethargy (lack of energy and enthusiasm), lymphadenopathy, sore throat, mucosal ulcers, faint pink maculopapular rash
neurological symptoms are common:
headache, photophobia (pain in eyes), myelopathy, neuropathy and in rare cases encephalopathy → recovery complete.
advanced HIV infection:
dry skin and thin hair, neurological disorders, eye disorders, weight loss, diarrhoea, anorexia,
→ in general almost everything starts to shut down in the body and body gets very prone to infectious diseases.
often asymptomatic
fever, myalgia, arthralgia (pain in joint), lethargy (lack of energy and enthusiasm), lymphadenopathy, sore throat, mucosal ulcers, faint pink maculopapular rash
neurological symptoms are common:
headache, photophobia (pain in eyes), myelopathy, neuropathy and in rare cases encephalopathy → recovery complete.
advanced HIV infection:
dry skin and thin hair, neurological disorders, eye disorders, weight loss, diarrhoea, anorexia,
→ in general almost everything starts to shut down in the body and body gets very prone to infectious diseases.
Diagnostic method prostatitis
digital rectal exam to look if prostate enlarged or tender
tests for signs of infection (prostate fluid analysis)
tests for signs of infection (prostate fluid analysis)
HIV (human immunodefiency virus) infection, therapy/treatment
vertical transmission can be reduced by using antiretroviral agents and avoiding breast feeding
Highly active antiretroviral therapy (HAART) started before severe immunosuppression
→ however still no absolute cure for HIV infection
in general aiming for healthy life and trying to improve immune system and quality of life
Highly active antiretroviral therapy (HAART) started before severe immunosuppression
→ however still no absolute cure for HIV infection
in general aiming for healthy life and trying to improve immune system and quality of life
Diagnostic method pyelonephritis
small renal cortical abscesses and streaks of pus in the renal medulla often present
infiltration of polymorphonuclear leucocytes and many polymorphs in tubular lamina
CT scan can show wedge-shaped area of inflammation in renal cortex and can damage renal function
infiltration of polymorphonuclear leucocytes and many polymorphs in tubular lamina
CT scan can show wedge-shaped area of inflammation in renal cortex and can damage renal function
Prostatitis, therapy/treatment
drugs that penetrate prostate
long-term low dose treatment may be required
antibiotics
long-term low dose treatment may be required
antibiotics
Diagnostic method renal disease
-Examination of the urine (appearance, volume, blood, gravity, osmolality, microalbuminuria, glucose, bacteriuria, microscopy)
-Imaging techniques
Blood and quantitative tests (serum urea, GFR)
-Imaging techniques
Blood and quantitative tests (serum urea, GFR)
Cause renal calculi/ nephorlithiasis/ urolithiasis
Dehydration
Hypercalcaemia
Hypercalciuria
Hyperoxaluria
Hyperuricaemia and hyperuricosuria
Infection
Cystinuria
Renal tubular acidosis
Primary renal disease (polycystic kidneys, medullary sponge
kidneys)
Drugs
Hypercalcaemia
Hypercalciuria
Hyperoxaluria
Hyperuricaemia and hyperuricosuria
Infection
Cystinuria
Renal tubular acidosis
Primary renal disease (polycystic kidneys, medullary sponge
kidneys)
Drugs
Symptoms renal calculi/ nephorlithiasis/ urolithiasis
-Asymptomatic
-Pain: renal colic
-Haematuria
-Urinary tract infection
-Urinary tract obstruction
-pain back may occur
-Pain: renal colic
-Haematuria
-Urinary tract infection
-Urinary tract obstruction
-pain back may occur
Diagnostic methods renal calculi/ nephorlithiasis/ urolithiasis
-A mid-stream specimen of urine for culture
-Serum urea, electrolyte, creatinine and calcium levels
-Plain abdominal x-ray
-CT-KUB (CT of kidney, ureter and bladder)
Cause of stone formation:
-renal imaging
- Significant bacteriuria
-Serum urea, electrolyte, creatinine and calcium levels
-Plain abdominal x-ray
-CT-KUB (CT of kidney, ureter and bladder)
Cause of stone formation:
-renal imaging
- Significant bacteriuria
Renal disease, explanation
Collective name for all kinds of diseases of the kidneys.
Treatment renal calculi/ nephorlithiasis/ urolithiasis
Adequate analgesia.
Stones less than 0.5 cm usually pass spontaneously. Stones greater than 1 cm require urological or radiological intervention. Extracorporeal shock wave lithotripsy (ESWL) will fragment most stones.
Ureteroscopy with a Yag laser can be used for larger stones.
Stones less than 0.5 cm usually pass spontaneously. Stones greater than 1 cm require urological or radiological intervention. Extracorporeal shock wave lithotripsy (ESWL) will fragment most stones.
Ureteroscopy with a Yag laser can be used for larger stones.
Renal disease, underlying cause
Depends on the type of renal disease.
Sexually transmitted disease
Also called sexually transmitted infection (STI). It is a collective name for diverse sexually transmittable diseases.
Renal disease, main symptoms
Depends on the type of renal disease.
Diagnostic methods syphilis
Dark -ground microscopy (The bacterium is not amenable to in vitro culture) or EIA screening test.
Cause trichomonoas vaginalis infection
Caused by the one-celled protozoan organism Trichomonas vaginalis
Genital contact during sex
Risk factors:
-multiple sexual partners
-a history of other STI”s
-previous trichomoniasis infections
unprotected sex
Genital contact during sex
Risk factors:
-multiple sexual partners
-a history of other STI”s
-previous trichomoniasis infections
unprotected sex
Symptoms trichomanoas vaginalis infection
Symptoms often begin 5-28 days after infection
-vaginal discharge (white/gray/yellow/green/unpleasant smell)
-vaginal spotting or bleeding
-genital burning or itching
-genital redness or swelling
-frequent urge to urinate
pain during urination or sexual intercourse.
-vaginal discharge (white/gray/yellow/green/unpleasant smell)
-vaginal spotting or bleeding
-genital burning or itching
-genital redness or swelling
-frequent urge to urinate
pain during urination or sexual intercourse.
Diagnostic methods trichomanas vaginalis infection
Symptoms are similar to those of other STI’s, a physical exam and laboratory tests are necessary for diagnosis:
Cell cultures
antigen test
examining samples of vaginal fluid (for women) or urethral discharge (for men) under a microscope
Cell cultures
antigen test
examining samples of vaginal fluid (for women) or urethral discharge (for men) under a microscope
Diagnostic methods trichomonas vaginalis infection
Antibiotics
Partners should be tested
Partners should be tested
Sexually transmitted disease, diagnostic methods
Depends on type of STI
Breast cancer/ ovarian cancer
There are many factors that help to cause breast or ovary cancer;
-Age
-Smoking
-obesity
-alcohol
-radiation
-family history
-hormone replacement therapy
exposure to oestrogen, contraceptive pill (breast cancer)
-Age
-Smoking
-obesity
-alcohol
-radiation
-family history
-hormone replacement therapy
exposure to oestrogen, contraceptive pill (breast cancer)
Sexually transmitted disease, therapy/treatment
Dependent on type of STI, often treatable with antibiotics.
Prevention is very important (education for example).
Prevention is very important (education for example).
Symptoms breast/ ovarian cancer
breast cancer;
Lumps or thickened tissue in the breast area, change in size or shape of the breast, bloodstained discharge from the nipples, Lumps in the armpits, dimpling on the skin of the breast, rash around the nipple, change of nipple appearance
ovarian cancer;
feeling bloated, swollen stomach, discomfort in stomach or pelvic area, loss of appetite, urge to urinate more frequently than usual
Lumps or thickened tissue in the breast area, change in size or shape of the breast, bloodstained discharge from the nipples, Lumps in the armpits, dimpling on the skin of the breast, rash around the nipple, change of nipple appearance
ovarian cancer;
feeling bloated, swollen stomach, discomfort in stomach or pelvic area, loss of appetite, urge to urinate more frequently than usual
Diagnostic methods breast/ovarian cancer
breast cancer;
mammogram and breast ultrasound can help to identify cancer. A biopsy from the breast can identify cancerous tissues
ovarian cancer;
by analysis of the symptoms, a blood test, ultrasound scan, biopsy, CT scan, X-ray and ovary visual examination can be used to identify ovarian cancer
mammogram and breast ultrasound can help to identify cancer. A biopsy from the breast can identify cancerous tissues
ovarian cancer;
by analysis of the symptoms, a blood test, ultrasound scan, biopsy, CT scan, X-ray and ovary visual examination can be used to identify ovarian cancer
Treatment breast/ ovarian cancer
breast cancer;
main treatment methods are surgery, radiotherapy, chemotherapy and hormone therapy. These may be combined for better effects
Ovarian cancer;
Therapy is dependent on the stage of the cancer and the ability to have children. Main treatment methods are surgery, chemotherapy and radiotherapy.
main treatment methods are surgery, radiotherapy, chemotherapy and hormone therapy. These may be combined for better effects
Ovarian cancer;
Therapy is dependent on the stage of the cancer and the ability to have children. Main treatment methods are surgery, chemotherapy and radiotherapy.
Syphillis, therapy/treatment
Late stage syphilis can cause complex sequelae in many organs and eventually leading to death.
Antibiotics can be used for at least 7 days in early syphilis.
Antibiotics can be used for at least 7 days in early syphilis.
Symptoms extra uterine pregnancy
Sharp, stabbing pain in the pelvis, abdomen or even in the shoulder or neck.
Weakness, dizziness, lightheadedness, sense of passing out.
Weakness, dizziness, lightheadedness, sense of passing out.
Diagnostic methods extra uterine pregnancy
Pelvic exam to test for pain
Laboratory test: hCG (in ectopic pregnancy the hCG rise slower than in a normal pregnancy)
Ultrasound
Laboratory test: hCG (in ectopic pregnancy the hCG rise slower than in a normal pregnancy)
Ultrasound
Treatment extra uterine pregnancy
Laparoscopy to remove the ill-fated pregnancy
Cause Acute back problem (lumbago/disk hernia/spondylodiscitis/spondolisthesis)
spondylodiscitis; a bone in the spine slipping out of position
spondylolisthesis; displacement of vertebral bone in relation to the spine curve
disk hernia; the intervertebral disc bulges out.
spondylolisthesis; displacement of vertebral bone in relation to the spine curve
disk hernia; the intervertebral disc bulges out.
Symptoms Acute back problem (lumbago/disk hernia/spondylodiscitis/spondolisthesis)
Pain in the lower back or spine. It may be felt anywhere from the neck down to the hips
Acute back problem (lumbago/disk hernia/spondylodiscitis/spondolisthesis)
The pain usually resolves from itself. Otherwise a physiotherapist can help to restore the natural spinal form to aid the pain.
Other treatments are to stay active, do back exercises and to take painkillers in extreme cases surgery can help
Other treatments are to stay active, do back exercises and to take painkillers in extreme cases surgery can help
Renal insufficiency/chronic renal failure as a result of diabetes our hypertension
Renal insufficiency is poor function of the kidneys.
chronic kidney disease is a long term condition where the kidneys do not function as they should
chronic kidney disease is a long term condition where the kidneys do not function as they should
Cause Renal insufficiency/chronic renal failure as a result of diabetes our hypertension
-older age
-gender
-family history
-diabetes
-smoking
-obesity
-high blood pressure
-kidney inflammation
-kidney stones
-high cholesterol
certain medicines
-gender
-family history
-diabetes
-smoking
-obesity
-high blood pressure
-kidney inflammation
-kidney stones
-high cholesterol
certain medicines
Symptoms Renal insufficiency/chronic renal failure as a result of diabetes our hypertension
CKD (chronic kidney disease, A.K.A renal failure)
tiredness, swollen ankles hand or feet, shortness of breath, feeling sick, blood in the urine
Renal insufficiency can have no symptoms or experience severe hypertension.
tiredness, swollen ankles hand or feet, shortness of breath, feeling sick, blood in the urine
Renal insufficiency can have no symptoms or experience severe hypertension.
Pregnancy (extra uterine pregnancy), explanation
A pregnancy that is not in the usual place and is located outside the inner lining of the uterus. Also called ectopic pregnancy.
Diagnostic methods Renal insufficiency/chronic renal failure as a result of diabetes our hypertension
CKD is usually only picked up during a routine blood test or urine test
Renal insufficiency is diagnosed from renal artery disease. Renal artery disease is diagnosed via ultrasound scanning, CT angiography and MR angiography
Renal insufficiency is diagnosed from renal artery disease. Renal artery disease is diagnosed via ultrasound scanning, CT angiography and MR angiography
Pregnancy (extra uterine pregnancy), underlying cause
Pelvic inflammatory disease
Surgery on a fallopian tube
prior ectopic pregnancy
history of abortions
history of infertility problems
abnormalities in the shape of the fallopian tube
Surgery on a fallopian tube
prior ectopic pregnancy
history of abortions
history of infertility problems
abnormalities in the shape of the fallopian tube
Treatment Renal insufficiency/chronic renal failure as a result of diabetes our hypertension
CKD can be treated with lifestyle changes to eat healthy, exercise and stop smoking, medication to control blood pressure or cholesterol, dialysis or kidney transplants
Renal insufficiency is treated with medication and are regulary tested for blood pressure and kidney function
Renal insufficiency is treated with medication and are regulary tested for blood pressure and kidney function
Symptoms renal stones
blood in the urine (red, pink, brown urine), vomiting, nausea, discolored or foul-smelling urine, chills, fever, frequent need to urinate, urinating small amounts of urine.
Diagnostic methods renal stones
Blood tests for calcium, phosphorus, uric acid and electrolytes
Blood urea nitrogen (BUN) and creatinine to assess kidney functioning
urinalysis to check for crystals, blood and white cells
The following tests can rule out obstruction:
-abdominal Xrays
-Intravenous pyelogram
-Retrograde pyelogram
-Ultrasount kidney
-MRI
Abdominal CT
Blood urea nitrogen (BUN) and creatinine to assess kidney functioning
urinalysis to check for crystals, blood and white cells
The following tests can rule out obstruction:
-abdominal Xrays
-Intravenous pyelogram
-Retrograde pyelogram
-Ultrasount kidney
-MRI
Abdominal CT
Treatment renal stones
Medication,
Lithotripsy (extracorporeal shock wave to break up large stones so they can more easily pass down the ureters into your bladder)
Tunnel surgery
Ureteroscopy
Lithotripsy (extracorporeal shock wave to break up large stones so they can more easily pass down the ureters into your bladder)
Tunnel surgery
Ureteroscopy
Symptoms renal tumour
Mostly asymptomatic
Haematuria, loin pain and a mass in the flank.
Malaise, anorexia and weight loss. Hypertension (due to secretion of renin by the tumour), anaemia. Pyrexia.
Haematuria, loin pain and a mass in the flank.
Malaise, anorexia and weight loss. Hypertension (due to secretion of renin by the tumour), anaemia. Pyrexia.
Diagnostic methods renal tumour
Ultrasonography
CT scan
MRI (better than CT for tumour staging)
ESR is usually raised
CT scan
MRI (better than CT for tumour staging)
ESR is usually raised
Treatment renal tumour
Nephrectomy
Medorxyprogesterone acetate
Newer therapies
Antibodies
Medorxyprogesterone acetate
Newer therapies
Antibodies
Ulcus pepticum (with perforation)
Also known as peptic ulcer, is a break in the lining of the stomach, first part of the small intestine or lower esophagus
Cause Ulcus pepticum (with perforation)
Chronic inflammation due to H. pylori can increase acidity and cause ulcers.
-stress
-diet
NSAIDS (painkillers)
-stress
-diet
NSAIDS (painkillers)
Sypmtoms Ulcus pepticum (with perforation)
-abdominal pain
-bloating
-nausea
-loss of aRppetite
vomiting of blood
-bloating
-nausea
-loss of aRppetite
vomiting of blood
Renal stones, explanation
Renal stones or kidney stones are solid masses made of crystals. Usually originate in your kidneys but can develop anywhere along your urinary tract.
Not all kidney stones are made up of the same crystals. Different types:
Not all kidney stones are made up of the same crystals. Different types:
- calcium
- uric acid
- Struvite
- Cystine
Diagnostic methods ulcus pepticum (with perforation)
Mainly diagnosed based on symptoms. By use of an endoscopy or x-ray the diagnosis may be confirmed
Renal stones, underlying cause
dehydration, obesity, high-protein, salt or glucose diet, hyperparathyroid condition, gastric bypass surgery, IBS, medication (diuretics, anti-seizure drugs and calcium based antacids)
Treatment ulcus pepticum (with perforation)
Medication to reduce stomach acidity, surgery to repair the perforation
Renal tumour, explanation
Renal tumours or renal cell carcinoma (RCC) arise from proximal tubular epithelium.
Renal tumour, underlying cause
Male: Female 2:1
Adults
autosomal dominant disorder
bilateral renal cell carcinomas
Adults
autosomal dominant disorder
bilateral renal cell carcinomas
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