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Genitourinary Infection

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Abstract

The genitourinary system, including the lower and upper renal tracts, is another interface between the inside and outside worlds. The urinary tract and vaginal microbiome play major roles in health and disease. Diagnosing genitourinary infections can be challenging as it is important to distinguish infection versus asymptomatic presence of bacteria to spare patients unnecessary and potentially harmful courses of antibiotics.

Sexually transmitted infections that affect the genitourinary system are a public health concern. There have been increasing rates of resistance among these organisms and changing patterns of prevalence. Sexually transmitted infections are an entire subfield within ID. Physicians specializing in this area work in clinics where their main practice is diagnosing and treating patients with sexually transmitted infections. Given the breadth of sexually transmitted infections, it is outside the scope of this text to cover the topic in great detail, but we will review several examples of related inpatient consult questions.

In this chapter, we will discuss diagnosis of urinary tract infections (UTIs), duration of treatment, management of recurrence, unusual cases of pyelonephritis, and a few examples of consult questions involving sexually transmitted infections.

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References

  1. Nicolle LE. The paradigm shift to non-treatment of asymptomatic bacteriuria. Pathogens. 2016;5:38. https://doi.org/10.3390/pathogens5020038.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE, Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625–63. https://doi.org/10.1086/650482.

    Article  PubMed  Google Scholar 

  3. Hooton TM, Scholes D, Stapleton AE, Roberts PL, Winter C, Gupta K, Samadpour M, Stamm WE. A prospective study of asymptomatic bacteriuria in sexually active young women. N Engl J Med. 2000;343:992–7. https://doi.org/10.1056/NEJM200010053431402.

    Article  CAS  PubMed  Google Scholar 

  4. Abrutyn E, Mossey J, Levison M, Boscia J, Pitsakis P, Kaye D. Epidemiology of asymptomatic bacteriuria in elderly women. J Am Geriatr Soc. 1991;39:388–93. https://doi.org/10.1111/j.1532-5415.1991.tb02905.x.

    Article  CAS  PubMed  Google Scholar 

  5. Mims AD, Norman DC, Yamamura RH, Yoshikawa TT. Clinically inapparent (asymptomatic) bacteriuria in ambulatory elderly men: epidemiological, clinical, and microbiological findings. J Am Geriatr Soc. 1990;38:1209–14. https://doi.org/10.1111/j.1532-5415.1990.tb01501.x.

    Article  CAS  PubMed  Google Scholar 

  6. Harding GKM, Zhanel GG, Nicolle LE, Cheang M, Manitoba Diabetes Urinary Tract Infection Study Group. Antimicrobial treatment in diabetic women with asymptomatic bacteriuria. N Engl J Med. 2002;347:1576–83. https://doi.org/10.1056/NEJMoa021042.

    Article  Google Scholar 

  7. Köves B, Cai T, Veeratterapillay R, Pickard R, Seisen T, Lam TB, Yuan CY, Bruyere F, Wagenlehner F, Bartoletti R, Geerlings SE, Pilatz A, Pradere B, Hofmann F, Bonkat G, Wullt B. Benefits and harms of treatment of asymptomatic bacteriuria: a systematic review and meta-analysis by the European Association of Urology urological infection guidelines panel. Eur Urol. 2017;72:865–8. https://doi.org/10.1016/j.eururo.2017.07.014.

    Article  PubMed  Google Scholar 

  8. Cai T, Mazzoli S, Mondaini N, Meacci F, Nesi G, D’Elia C, Malossini G, Boddi V, Bartoletti R. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Clin Infect Dis. 2012;55:771–7. https://doi.org/10.1093/cid/cis534.

    Article  PubMed  Google Scholar 

  9. Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, Eckert LO, Geerlings SE, Köves B, Hooton TM, Juthani-Mehta M, Knight SL, Saint S, Schaeffer AJ, Trautner B, Wullt B, Siemieniuk R. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68:e83–e110. https://doi.org/10.1093/cid/ciy1121.

    Article  PubMed  Google Scholar 

  10. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE, Infectious Diseases Society of America, European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103–20. https://doi.org/10.1093/cid/ciq257.

    Article  PubMed  Google Scholar 

  11. Talan DA, Stamm WE, Hooton TM, Moran GJ, Burke T, Iravani A, Reuning-Scherer J, Church DA. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis in women: a randomized trial. JAMA. 2000;283:1583–90. https://doi.org/10.1001/jama.283.12.1583.

    Article  CAS  PubMed  Google Scholar 

  12. Eliakim-Raz N, Yahav D, Paul M, Leibovici L. Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection—7 days or less versus longer treatment: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2013;68:2183–91. https://doi.org/10.1093/jac/dkt177.

    Article  CAS  PubMed  Google Scholar 

  13. van Nieuwkoop C, van der Starre WE, Stalenhoef JE, van Aartrijk AM, van der Reijden TJK, Vollaard AM, Delfos NM, van’t Wout JW, Blom JW, Spelt IC, Leyten EMS, Koster T, Ablij HC, van der Beek MT, Knol MJ, van Dissel JT. Treatment duration of febrile urinary tract infection: a pragmatic randomized, double-blind, placebo-controlled non-inferiority trial in men and women. BMC Med. 2017;15:70. https://doi.org/10.1186/s12916-017-0835-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Drekonja DM, Trautner B, Amundson C, Kuskowski M, Johnson JR. Effect of 7 vs 14 days of antibiotic therapy on resolution of symptoms among afebrile men with urinary tract infection: a randomized clinical trial. JAMA. 2021;326:324–31. https://doi.org/10.1001/jama.2021.9899.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Franco AVM. Recurrent urinary tract infections. Best Pract Res Clin Obstet Gynaecol. 2005;19:861–73. https://doi.org/10.1016/j.bpobgyn.2005.08.003.

    Article  PubMed  Google Scholar 

  16. Bartoletti R, Cai T, Wagenlehner FM, Naber K, Bjerklund Johansen TE. Treatment of urinary tract infections and antibiotic stewardship. Eur Urol Suppl. 2016;15:81–7. https://doi.org/10.1016/j.eursup.2016.04.003.

    Article  Google Scholar 

  17. Ahmed H, Davies F, Francis N, Farewell D, Butler C, Paranjothy S. Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials. BMJ Open. 2017;7:e015233. https://doi.org/10.1136/bmjopen-2016-015233.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Beerepoot MAJ, ter Riet G, Nys S, van der Wal WM, de Borgie CAJM, de Reijke TM, Prins JM, Koeijers J, Verbon A, Stobberingh E, Geerlings SE. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012;172:704–12. https://doi.org/10.1001/archinternmed.2012.777.

    Article  CAS  PubMed  Google Scholar 

  19. Dinh A, Hallouin-Bernard M-C, Davido B, Lemaignen A, Bouchand F, Duran C, Even A, Denys P, Perrouin-Verbe B, Sotto A, Lavigne J-P, Bruyère F, Grall N, Tavernier E, Bernard L. Weekly sequential antibioprophylaxis for recurrent urinary tract infections among patients with neurogenic bladder: a randomized controlled trial. Clin Infect Dis. 2020;71:3128–35. https://doi.org/10.1093/cid/ciz1207.

    Article  CAS  PubMed  Google Scholar 

  20. Beerepoot MJ, Geerlings SE, van Haarst EP, van Charante NM, ter Riet G. Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2013;190:1981–9. https://doi.org/10.1016/j.juro.2013.04.142.

    Article  CAS  PubMed  Google Scholar 

  21. Lenger SM, Bradley MS, Thomas DA, Bertolet MH, Lowder JL, Sutcliffe S. D-mannose vs other agents for recurrent urinary tract infection prevention in adult women: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020;223:265.e1–265.e13. https://doi.org/10.1016/j.ajog.2020.05.048.

    Article  CAS  PubMed  Google Scholar 

  22. Lo TS, Hammer KDP, Zegarra M, Cho WCS. Methenamine: a forgotten drug for preventing recurrent urinary tract infection in a multidrug resistance era. Expert Rev Anti-Infect Ther. 2014;12:549–54. https://doi.org/10.1586/14787210.2014.904202.

    Article  CAS  PubMed  Google Scholar 

  23. Kinnear N, Barnett D, O’Callaghan M, Horsell K, Gani J, Hennessey D. The impact of catheter-based bladder drainage method on urinary tract infection risk in spinal cord injury and neurogenic bladder: a systematic review. Neurourol Urodyn. 2020;39:854–62. https://doi.org/10.1002/nau.24253.

    Article  PubMed  Google Scholar 

  24. Pannek J, Wöllner J. Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions. Res Rep Urol. 2017;9:121–7. https://doi.org/10.2147/RRU.S113610.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Banovac K, Wade N, Gonzalez F, Walsh B, Rhamy RK. Decreased incidence of urinary tract infections in patients with spinal cord injury: effect of methenamine. J Am Paraplegia Soc. 1991;14:52–4. https://doi.org/10.1080/01952307.1991.11735835.

    Article  CAS  PubMed  Google Scholar 

  26. Bakhit M, Krzyzaniak N, Hilder J, Clark J, Scott AM, Mar CD. Use of methenamine hippurate to prevent urinary tract infections in community adult women: a systematic review and meta-analysis. Br J Gen Pract. 2021;71:e528–37. https://doi.org/10.3399/BJGP.2020.0833.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Musher DM, Griffith DP, Tyler M, Woelfel A. Potentiation of the antibacterial effect of methenamine by acetohydroxamic acid. Antimicrob Agents Chemother. 1974;5:101–5. https://doi.org/10.1128/AAC.5.2.101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Del Popolo G, Nelli F. Recurrent bacterial symptomatic cystitis: a pilot study on a new natural option for treatment. Arch Ital Urol Androl. 2018;90:101–3. https://doi.org/10.4081/aiua.2018.2.101.

    Article  CAS  PubMed  Google Scholar 

  29. Hess MJ, Hess PE, Sullivan MR, Nee M, Yalla SV. Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder. Spinal Cord. 2008;46:622–6. https://doi.org/10.1038/sc.2008.25.

    Article  CAS  PubMed  Google Scholar 

  30. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321. https://doi.org/10.1002/14651858.CD001321.pub5.

    Article  PubMed  Google Scholar 

  31. Havranova J, Cardio S, Krinock M, Widawski M, Sluder R, Kumar A, Hippen J, Goel H. Cranberry extract for preventing recurrent urinary tract infections: an outcome-specific meta-analysis of prospective trials. J Womens Health Dev. 2020;3:222–42.

    Article  Google Scholar 

  32. Toh S-L, Lee BB, Ryan S, Simpson JM, Clezy K, Bossa L, Rice SA, Marial O, Weber GH, Kaur J, Boswell-Ruys CL, Goodall S, Middleton JW, Tuderhope M, Kotsiou G. Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a randomised controlled trial. Spinal Cord. 2019;57:550–61. https://doi.org/10.1038/s41393-019-0251-y.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Groah SL, Tractenberg RE. Intravesical lactobacillus rhamnosus GG versus saline bladder wash: protocol for a randomized, controlled, comparative effectiveness clinical trial. Top Spinal Cord Inj Rehabil. 2022;28:12–21. https://doi.org/10.46292/sci22-00005.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cattoir V, Kobal A, Legrand P. Aerococcus urinae and Aerococcus sanguinicola, two frequently misidentified uropathogens. Scand J Infect Dis. 2010;42:775. https://doi.org/10.3109/00365548.2010.485576.

    Article  CAS  PubMed  Google Scholar 

  35. Senneby E, Petersson AC, Rasmussen M. Clinical and microbiological features of bacteraemia with Aerococcus urinae. Clin Microbiol Infect. 2012;18:546. https://doi.org/10.1111/j.1469-0691.2011.03609.x.

    Article  CAS  PubMed  Google Scholar 

  36. Zhang Q, Kwoh C, Attorri S, Clarridge JE. Aerococcus urinae in urinary tract infections. J Clin Microbiol. 2000;38:1703. https://doi.org/10.1128/jcm.38.4.1703-1705.2000.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Kass M, Toye B, Veinot JP. Fatal infective endocarditis due to Aerococcus urinae-case report and review of literature. Cardiovasc Pathol. 2008;17:410. https://doi.org/10.1016/j.carpath.2008.06.001.

    Article  PubMed  Google Scholar 

  38. Humphries RM, Hindler JA. In vitro antimicrobial susceptibility of aerococcus urinae. J Clin Microbiol. 2014;52:2177. https://doi.org/10.1128/JCM.00418-14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Li L, Parwani AV. Xanthogranulomatous pyelonephritis. Arch Pathol Lab Med. 2011;135:671–4. https://doi.org/10.5858/2009-0769-RSR.1.

    Article  PubMed  Google Scholar 

  40. Fallatah A, Tarakji M, Amuesi J. Xanthogranulomatous pyelonephritis: a retrospective study of 10 cases and review of the literature. Saudi J Kidney Dis Transpl. 2001;12:520–4.

    CAS  PubMed  Google Scholar 

  41. Malek RS, Greene LF, DeWeerd JH, Farrow GM. Xanthogranulomatous pyelonephritis. Br J Urol. 1972;44:296–308. https://doi.org/10.1111/j.1464-410x.1972.tb10080.x.

    Article  CAS  PubMed  Google Scholar 

  42. Xie L, Tapiero S, Flores AR, Armas-Phan M, Limfueco L, Karani R, Jiang P, Cobb KD, Sur RL, Chi T, Landman J, Kaler KS, Clayman RV. Long-term antibiotic treatment prior to laparoscopic nephrectomy for xanthogranulomatous pyelonephritis improves postoperative outcomes: results from a multicenter study. J Urol. 2021;205:820–5. https://doi.org/10.1097/JU.0000000000001429.

    Article  PubMed  Google Scholar 

  43. Nandwani R, Evans DT. Are you sure it’s syphilis? A review of false positive serology. Int J STD AIDS. 1995;6:241–8. https://doi.org/10.1177/095646249500600404.

    Article  CAS  PubMed  Google Scholar 

  44. Ortiz DA, Shukla MR, Loeffelholz MJ. The traditional or reverse algorithm for diagnosis of syphilis: pros and cons. Clin Infect Dis. 2020;71:S43–51. https://doi.org/10.1093/cid/ciaa307.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Clement ME, Okeke NL, Hicks CB. Treatment of syphilis a systematic review. JAMA. 2014;312:1905–17. https://doi.org/10.1001/jama.2014.13259.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Berger S, Kunerl A, Wasmuth S, Tierno P, Wagner K, Brügger J. Menstrual toxic shock syndrome: case report and systematic review of the literature. Lancet Infect Dis. 2019;19:e313–21. https://doi.org/10.1016/S1473-3099(19)30041-6.

    Article  PubMed  Google Scholar 

  47. Toxic Shock Syndrome (Other Than Streptococcal) (TSS) 2011 Case Definition | CDC; 2021. https://ndc.services.cdc.gov/case-definitions/toxic-shock-syndrome-2011/. Accessed 11 Apr 2023.

  48. Hodille E, Badiou C, Bouveyron C, Bes M, Tristan A, Vandenesch F, Lina G, Dumitrescu O. Clindamycin suppresses virulence expression in inducible clindamycin-resistant Staphylococcus aureus strains. Ann Clin Microbiol Antimicrob. 2018;17:38. https://doi.org/10.1186/s12941-018-0291-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Stevens DL, Wallace RJ, Hamilton SM, Bryant AE. Successful treatment of staphylococcal toxic shock syndrome with linezolid: a case report and in vitro evaluation of the production of toxic shock syndrome toxin type 1 in the presence of antibiotics. Clin Infect Dis. 2006;42:729–30. https://doi.org/10.1086/500265.

    Article  PubMed  Google Scholar 

  50. Beigi RH, Austin MN, Meyn LA, Krohn MA, Hillier SL. Antimicrobial resistance associated with the treatment of bacterial vaginosis. Am J Obstet Gynecol. 2004;191:1124–9. https://doi.org/10.1016/j.ajog.2004.05.033.

    Article  PubMed  Google Scholar 

  51. Wiesenfeld HC, Manhart LE. Mycoplasma genitalium in women: current knowledge and research priorities for this recently emerged pathogen. J Infect Dis. 2017;216:S389–95. https://doi.org/10.1093/infdis/jix198.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Wiesenfeld HC, Meyn LA, Darville T, Macio IS, Hillier SL. A randomized controlled trial of ceftriaxone and doxycycline, with or without metronidazole, for the treatment of acute pelvic inflammatory disease. Clin Infect Dis. 2021;72:1181–9. https://doi.org/10.1093/cid/ciaa101.

    Article  CAS  PubMed  Google Scholar 

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  1. Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA

    Alexander M. Tatara

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Tatara, A.M. (2023). Genitourinary Infection. In: The Infectious Diseases Consult Handbook. Springer, Cham. https://doi.org/10.1007/978-3-031-39474-4_15

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  • DOI: https://doi.org/10.1007/978-3-031-39474-4_15

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