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1.Describe urinary tract infection, causes, symptoms and treatment
- A urinary tract infection encompasses multiple causes of urethral, bladder, or kidney inflammation. This inflammation is typically caused by yeast, bacteria, or chemical irritants.
- Women are 30x as likely as men to have a urinary tract infection. Women’s urethras are shorter than men’s, meaning there is less distance for bacteria to travel and the woman’s urethra is much closer to the anus than that of men, posing the risk of cross-contamination when wiping or during sexual intercourse. In men, the most common causes of urinary tract infections include having anal sex, the partner inserting their penis into another’s anus, and having an uncircumcised penis, as it traps bacteria.
- The most common symptoms associated with a urinary tract infection include urinary frequency, urinary urgency, and difficult or painful urination. Patients may also experience back or suprapubic pain. In patients with kidney infections, they may also experience flank pain, fever, nausea, and vomiting.
- Although around a quarter of uncomplicated urinary tract infections can resolve on their own, antibiotics are the treatment of choice. Antibiotics used to treat urinary tract infections include Bactrim, Trimpex, Macrobid, Cipro, Floxin, Levaquin, Noroxin, and Suprax. Urinary analgesics may also be prescribed to reduce pain, frequency, and urgency. These include Urised, Pyridium, and Urispas (Arcangelo, et al., 2017, pp. 1503-1522).
- Discuss treatment for benign prostatic hyperplasia
- There are three main drug classes used to treat benign prostatic hyperplasia: A-Adrenergic antagonists, 5-A-reductase inhibitors, and PDE type 5 inhibitors.
- A-adrenergic antagonists relax the prostate and bladder’s smooth muscle fibers. These drugs include tamsulosin, doxazosin, terazosin, alfuzosin and silodosin.
- 5-A-reductase inhibitors, like finasteride and dutasteride, reduce the size of the prostate by up to 20-30% by decreasing intracellular DHT, which is the hormone that promotes prostate cell growth.
- PDE5 inhibitors (tadalafil) is used when A-adrenergic antagonist use is unsuccessful or in men who also have erectile dysfunction. This drug regulates the prostate’s smooth muscle tone.
- Alternative therapies can also be considered for benign prostatic hyperplasia even though there is no scientific proof to back them. Some men are choosing to take saw palmetto, Pygeum, and zinc to treat their BPH (Virginia Poole Arcangelo, Et Al., 2017, pp. 1543-1563)
- Describe overactive bladder, causes, symptoms and treatment
- Overactive bladder is a broad term, it encompasses urinary urgency, nocturia, frequency, and possibly incontinence, not caused by a UTI (Scarneciu et al., 2021).
- Pinpointing the cause of overactive bladder is not always possible. Many physiologic, anatomic, and comorbidity-related factors can contribute to the development of overactive bladder. In most cases, the cause is idiopathic, while other causes are typically neurogenic or myogenic related.
- Symptoms typically include urinary frequency, urinary urgency, nocturia, and incontinence. Patients may experience some or all of these symptoms.
- Treatment includes non-pharmacological and pharmacological interventions. Pelvic floor muscle exercises, bladder training, and weight loss are important treatments to aid in the reduction of symptoms. Medications used to treat overactive bladder include anticholinergics/antimuscarinics like oxybutynin or trospium, beta-3-adrenoreceptor agonists like Myrbetriq, OnabotulinumtoxinA better known as botox, serotonin norepinephrine reuptake inhibitors like duloxetine, alpha-adrenergic antagonists like tamsulosin or doxazosin, estradiol vaginal suppositories, estrogen ring, or desmopressin oral or intranasal spray (Virginia Poole Arcangelo, Et Al., 2017, pp. 1587-1626)
- Treatment options and recommendations for different STIs (Chlamydia, Gonorrhea and Syphilis)
- For chlamydia, the treatment of choice is a one-time 1g dose of PO azithromycin or a 7-day 100mg BID regiment of doxycycline. If the patient is pregnant, they should not be prescribed doxycycline.
- For gonorrhea, the treatment of choice is a one-time 250mg IM injection of ceftriaxone and either a one-time 1g PO dose of azithromycin or a 7-day 100mg BID regiment of doxycycline.
- For genital herpes, the initial outbreak should be treated with acyclovir 400mg PO TID, acyclovir 200mg PO 5x daily, or valacyclovir 1g PO BID for 7-10 days. Recurrent treatments should be treated with acyclovir 400mg PO TID for 5 days, acyclovir 800mg BID for 5 days, acyclovir 800mg TID for 2 days, famciclovir 125mg PO BID for 5 days, famciclovir 100mg BID for 1 day, valacyclovir 500mg PO BID for 3 days or Valacyclovir 1g QD for 5 days. Suppressive treatment is also an option with acyclovir 400mg BID, famciclovir 250mg BID, Valacyclovir 500mg QD, or valacyclovir 1g QD.
- For Syphilis, treatment depends on when it is caught. If caught within the first year, regardless of it being primary, secondary, or latent syphilis, the adult dose is a one-time benzathine penicillin G 2.4 million U IM injection, child doses are weight based. For latent disease > one year, the same medication is given to adults, but instead of a one-time dose, they receive three doses one week apart. For children, the dose is weight based, but also done in 3 doses one week apart. If a patient is allergic to penicillin and not pregnant, they can be prescribed 14 days of 100mg PO doxycycline BID or tetracycline 500mg PO BID (Virginia Poole Arcangelo, Et Al., 2017, pp. 1630-1631).
References:
Virginia Poole Arcangelo, & Al, E. (2017). Pharmacotherapeutics for advanced practice : a practical approach (4th ed., pp. 1503-1522). Wolters Kluwer Health, Cop
Scarneciu, I., Lupu, S., Bratu, O., Teodorescu, A., Maxim, L., Brinza, A., Laculiceanu, A., Rotaru, R., Lupu, A.-M., & Scarneciu, C. (2021). Overactive bladder: A review and update. Experimental and Therapeutic Medicine, 22(6). https://doi.org/10.3892/etm.2021.10879
2.Describe urinary tract infection, causes, symptoms, and treatment
Urinary tract infection is a broad term encompassing a range of infectious syndromes, affecting areas from the urethra to the kidneys (Al Lawati et al., 2024). The infection occurs when bacteria colonize the urethra or periurethral space, migrate into the bladder, and trigger an inflammatory response (Al Lawati et al., 2024). The primary causative agents include Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. The classic symptoms are dysuria, urinary frequency, urinary urgency, or suprapubic pain without systemic illness such as fever, rigors, or vomiting. It is confirmed with two main laboratory tests, a urinalysis and urine cultures, which show the presence of white blood cells in the urine.
Treatment includes proper hygiene, adequate hydration, and antibiotics. The first-line agent commonly used is nitrofurantoin 100 mg twice daily for five days. If the first-line agents are contraindicated, amoxicillin-clavulanic acid can also be used.
- Discuss treatment for benign prostatic hyperplasia
Benign prostatic hyperplasia is a diagnosis that refers to the growth of glandular epithelial tissue and smooth muscle in the transitional zone of the prostate (Eitftu et al., 2024). The exact mechanism of BPH remains unclear; age-related changes leading to metabolic disturbances, hormonal changes, and chronic inflammation may play a role.
Some patients may choose conservative treatment methods, such as lifestyle modifications like losing weight, reducing evening fluid intake, and limiting overall fluid intake or the number of substances that irritate the bladder or have diuretic effects, including carbonated beverages like coffee, tea, and cola. Additionally, bladder management techniques should be considered, which include timed voiding every 2-3 hours and performing pelvic floor stretches or relaxation exercises. Pharmacotherapy includes alpha-blockers that relax the smooth muscles in the bladder neck and prostate, reduce constriction of the urinary channel, and lower resistance to urinary flow (Eitftu et al., 2024). These include second-generation terazosin and doxazosin and third-generation tamsulosin, alfuzosin, and silodosin.
- Describe overactive bladder, causes, symptoms, and treatment
Overactive bladder is a chronic condition that affects both men and women. It is characterized by a sudden, involuntary contraction of the bladder muscle, leading to an urgent need to urinate, frequent urination, and urge incontinence (Scarneciu et al., 2021). Common causes include neurological disorders, bladder abnormalities, and BPH.
The first line of treatment includes bladder training, which involves urinating at regular intervals, as well as control techniques, like pelvic floor muscle training, which can also be positive. Pharmacologic interventions include antimuscarinic drugs and beta-3 adrenergic agonists, which help relax the bladder muscle.
- Treatment options and recommendations for different STIs (Chlamydia, Gonorrhea, and Syphilis)
Chlamydia infections can spontaneously clear. However, people with positive test results should always be treated. The treatment for non-pregnant people is doxycycline, 100 mg, twice a day for seven days. Patients can also be treated with a single 1-g dose of azithromycin or an alternative amoxicillin, 500 mg orally three times per day for seven days. Treatment for Gonococcal Infection includes higher doses of ceftriaxone, as azithromycin is no longer a recommended therapy for nonpregnant individuals (Yonke et al., 2022). Syphilis is primarily treated with penicillin G administered intramuscularly. The dosage and duration are based on the stage of the disease.
References
Al Lawati, H., Blair, B. M., & Larnard, J. (2024). Urinary tract infections: Core curriculum 2024. American Journal of Kidney Diseases, 83(1), 90–100. https://doi.org/10.1053/j.ajkd.2023.08.009Links to an external site.
Eiftu S. Haile, MD, Ayodeji E. Sotimehin, MD and Bradley C. Gill, MD, MS
Cleveland Clinic Journal of Medicine March 2024, 91 (3) 163-170; DOI: https://doi.org/10.3949/ccjm.91a.23027
Scarneciu, I., Lupu, S., Bratu, O. G., Teodorescu, A., Maxim, L. S., Brinza, A., Laculiceanu, A. G., Rotaru, R. M., Lupu, A. M., & Scarneciu, C. C. (2021). Overactive bladder: A review and update. Experimental and therapeutic medicine, 22(6), 1444. https://doi.org/10.3892/etm.2021.10879Links to an external site.
Yonke, N., Aragón, M., & Phillips, J. K. (2022). Chlamydial and Gonococcal Infections: Screening, Diagnosis, and Treatment. American family physician, 105(4), 388–396.
