1. Urinary Tract Infection and Sexually Transmitted Diseases
Prof. R. K. Dixit
Pharmacology and Therapeutics
K.G.M.U. Lucknow

3. Urinary Tract Infection
Vesico-ureteral Reflux
Pyelonephritis
Upper UTI
Ureteritis
Cystitis
Lower UTI
Urethritis

4. 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

5. 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)

6. Symptoms

7. 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)
Incontinence of urine

8. 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,

9. 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)

10. Urinary analgesics (Local)- Urinary antiseptics-
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

11. Quinolones -(Nalidixic acid, Norfloxacin……)
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……..

12. 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

13. V V V

15. 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. )

16. 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

17. Clean HAND With Soap To Loose Germs Chancroid Herpes genitalis
Hepatitis B
AIDS (HIV)
Non-gonococcal urethritis
Donovaniasis
Wart (genital)
Syphilis
Trichomoniasis
Lymphogranuloma inguinalae
Lice
Gonorrhea
Clean
HAND
With
Soap To
Loose
Germs

18. Types of Sexually Transmitted Infections
Bacterial
Viral
Parasitic
Chlamydia
Gonorrhea
Syphilis
HPV (Genital Warts)
HIV
Herpes
Hepatitis B
Pubic Lice
(“crabs”)
Trichomoniasis

19. DISEASES DRUG OF CHOICE Neisseria gonorrhoea 2. Syphillis
( gonococcus)
Ceftriaxone 250 mg I.M/ Azithromycin/ Doxycycline
Amoxicillin/ Cefixime/Ciprofoxacin (Single dose)
2. Syphillis
-Primary( chancre)
Early Secondary (Condeloma Lata)
-Latent (< 1 yr)
Procaine Penicillin-G 2.4 M.U. daily for 10 to 14 days or
Benzathine penicillin G 2.4 M.U Once
- Latent (>1 yr) or
-cardiovascular syphillis
-Tertiary
-Neurosyphillis
Benzathine penicillin G 2.4 M.U. weekly for 3 weeks
Procaine Penicillin G 2.4 M.U. for 3 weeks

20. DISEASES
DRUG OF CHOICE
3. Herpes simplex
Acyclovir/ Valacyclovir
4. Chalmydiae trachomatis (Non specific urethritis)
Lymphogranuloma venereum
Doxycycline 100 mg BD for three weeks or
Azithromycin 1 gm oral per week for three weeks
5. Donovanosis (Calymmatobacterium granulomatis)
Granuloma Inguinale
Azithromycin 1g per week for 3 weeks
Doxycycline 100mg BD for 3 weeks
6. Chancroids
(Haemophilus ducreyi)
Azithromycin 1g oral single dose Or
Ceftriaxone 250 mg I.M sing dose
Erythromycin 500 mg QID for one week

21. Remember it ‘s different: To Condyloma lata- Secondary Syphilis
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

22. 8. Hepatitis B- Lamivudine 9. HIV- Zidovudine and other ART

23. STDs are Very BAD
Valacyclovir (Acyclovir) - Herpes genitalis, Genital Warts
Betalactams
Penicillins- Syphilis
Ceftriaxone - Gonorrhea
Azithromycin - Chancroid
Doxycycline- Chlamydia, Donovanosis, Gonorrhea