Urethritis  Inflammation or infection of the urethra, usually from a sexually transmitted infection (STI). Most common pathogens: Chlamydia trachomatis and Neisseria gonorrhoeae. Can also result from chemical irritation or catheter use.  

Urethritis 
<ul> 
<li>Inflammation or infection of the urethra, usually from a sexually transmitted infection (STI).</li> 
<li>Most common pathogens: Chlamydia trachomatis and Neisseria gonorrhoeae.</li> 
<li>Can also result from chemical irritation or catheter use.</li> 
</ul> 
Risk Factors 
<ul> 
<li>Multiple or new sexual partners</li> 
<li>Unprotected intercourse</li> 
<li>Prior STI history</li> 
<li>Men under 35 years old</li> 
</ul> 
Clinical Presentation 
<ul> 
<li>Dysuria, burning, or itching at urethral meatus</li> 
<li>Urethral discharge: 
<ul> 
<li>Clear or mucoid → Chlamydia</li> 
<li>Thick yellow-green → Gonorrhea</li> 
</ul> 
</li> 
<li>Urethral redness or irritation</li> 
<li>The question stem would likely describe a young sexually active man with dysuria and discharge after unprotected sex.</li> 
</ul> 
Diagnostics 
<ul> 
<li>NAAT (nucleic acid amplification test): Urethral swab or first-catch urine → most sensitive for Chlamydia and Gonorrhea.</li> 
<li>Urinalysis: Pyuria without bacteriuria (“sterile pyuria”) — WBCs in urine but no bacterial growth due to intracellular organisms like Chlamydia.</li> 
<li>Consider Trichomonas vaginalis or Mycoplasma genitalium if persistent symptoms.</li> 
<li>Screen for HIV and syphilis.</li> 
</ul> 
Treatment 
<ul> 
<li>Empiric therapy for both C. trachomatis and N. gonorrhoeae: 
<ul> 
<li>Ceftriaxone 500 mg IM single dose</li> 
<li>plus Doxycycline 100 mg PO twice daily for 7 days</li> 
</ul> 
</li> 
<li>If doxycycline contraindicated → Azithromycin 1 g PO single dose</li> 
<li>Treat all sexual partners.</li> 
<li>Abstain from sexual activity for 7 days after treatment.</li> 
<li>Retest at 3 months due to high reinfection rate.</li> 
</ul> 
Exam Keys 
<ul> 
<li>Dysuria + urethral discharge = Urethritis (STI until proven otherwise).</li> 
<li>Gonorrhea: Purulent yellow-green discharge.</li> 
<li>Chlamydia: Clear or mucoid discharge.</li> 
<li>Sterile pyuria: WBCs present but no bacterial growth → Chlamydia.</li> 
<li>Always treat both pathogens empirically.</li> 
</ul> 
Urinary Tract Infection (Cystitis) 
<ul> 
<li>Infection of the bladder (lower urinary tract) most often caused by Escherichia coli.</li> 
<li>Common in women due to short urethra and proximity to anus.</li> 
<li>Classified as uncomplicated (healthy, nonpregnant women) or complicated (men, pregnancy, diabetes, obstruction, catheters).</li> 
</ul> 
Risk Factors 
<ul> 
<li>Female sex, sexual activity, diaphragm or spermicide use.</li> 
<li>Postmenopausal estrogen loss, pregnancy, diabetes.</li> 
<li>Indwelling catheters or urinary obstruction (BPH, stones).</li> 
</ul> 
Clinical Presentation 
<ul> 
<li>Dysuria, frequency, urgency, suprapubic pain, hematuria, cloudy urine.</li> 
<li>No systemic symptoms (no fever, chills, or flank pain).</li> 
<li>If fever or costovertebral tenderness → think pyelonephritis.</li> 
<li>The question stem would likely describe a young woman with burning urination, frequency, and no fever.</li> 
</ul> 
Diagnostics 
<ul> 
<li>Urinalysis: Pyuria, positive leukocyte esterase, and nitrites (Gram-negative organisms).</li> 
<li>Urine culture: >100,000 CFU/mL of a single organism confirms diagnosis.</li> 
<li>Urine dipstick: Often sufficient in uncomplicated cases.</li> 
<li>Men or recurrent infections: Consider ultrasound to assess for obstruction or stones.</li> 
</ul> 
Treatment 
<ul> 
<li>Uncomplicated: Nitrofurantoin, Trimethoprim-Sulfamethoxazole (TMP-SMX), or Fosfomycin.</li>

Physician Assistant Exam Review

144 GU Infectious disease and getting more questions right

144 GU Infectious disease and getting more questions right

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