Urogenital Infections in Humans

 

Male urethritis:

The definition is cytological: ≥ 10 PNN on the review of the first urine stream at a magnification of 400 and at least 5 PNN mile magnification; serous or purulent urethral discharge; ductal pruritus; burning on urination; urinary frequency; dysuria.

Gonococcal urethritis:

– The transmission is still sexual; Incubation is short (always <5 days)

– The symptoms are usually noisy with a purulent urethral discharge; marked dysuria (clap, gonorrhea)

– There is neither ADP nor fever

– The diagnosis is easily made by direct examination of smears flow

– There is no reliable serology of gonococcal infections

– NB: gonococcal cervicitis (in women) are frequently asymptomatic; smear-positive in only 20% of cases.

– Complications: epididymoorchitis; prostatitis; sepsis; conjunctivitis

– Antibiotics: ceftriaxone, cefixime, ciprofloxacin, spectinomycin. (Gonococcal pharyngitis should be treated with ceftriaxone)

– An anti-chlamydial therapy should be systematically deputy anti-gonococcal treatment

SEPTICEMIA GONOCOCCAL:

– Low-grade fever; arthralgia; tenosynovitis; skin lesions (pustules)

– After a few days -> arthritis (infectious oligoarthritis)

– More rarely: SPM; hepatitis; meningitis; myocarditis; endocarditis

Chlamydia trachomatis urethritis:

– The C. trachomatis is the most common bacterium urethritis gono non-coccal; it is also the leading cause of urethritis

– Incubation lasts 10 to 15 days

– In the majority of cases the infection is asymptomatic

– Urethritis with clear discharge, moderate or no symptoms urethral discharge.

– This is the only seed in the charge of serious complications UNG

– The diagnosis is difficult; direct examination slide is impossible. The gold standard is the cell culture media (HeLa cell); rapid reviews (immunofluorescence) are less sensitive and less specific

– The serology of C. trachomatis have no interest in uncomplicated forms (poor sensitivity, cross-reactions with C. trachomatis)

– NB: C. trachomatis is the leading cause of mucopurulent cervicitis; is completely identical to gonococcal cervicitis

– Complication: epididymoorchitis; prostatitis; Fiessenger Reiter syndrome

– NB: For women -> salpingitis; Fitz-Hugh-Curtis syndrome (perihepatitis) with acute cholecystitis table with peritoneal involvement (-> Dc: laparoscopy)

NB: C. trachomatis is the primary etiology of neonatal pneumonia

Fiessenger syndrome Reiter:

– Reactive arthritis after urethritis with sex ratio = 50/1 (man )

– And combining bilateral conjunctivitis

– Asymmetric arthritis (especially the large joints of MI) with heel pain; axial involvement and tendonitis. Inflammatory joint fluid is sterile.

– Mucocutaneous signs (common): balanitis; psoriasiform lesions

HLA B27 in 70% of cases

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