Microbiology: A Systems Approach, 2 nd ed.

1. Microbiology: A Systems Approach, 2nd ed. Chapter 23: Infectious Diseases Affecting the Genitourinary System

2. 23.1 The Genitourinary Tract and Its Defenses • Urinary tract: removes substances from the blood, regulates certain body processes, and forms urine and transports it out of the body • Includes the kidneys, ureters, bladder, and urethra • Defenses • Flushing action of urine • Desquamation of the epithelial cells • Acidity of urine • Antibacterial proteins in urine • SecretoryIgA

3. Genital System • Genital system: reproduction , aka the reproductive system • Male reproductive system includes the testes, epididymis, vas deferens, prostate gland, scrotum, and penis • Defenses: flushing action of urine • Female reproductive system includes the uterus, fallopian tubes, ovaries, and vagina • Defenses vary over the lifetime of the woman • Childhood and after menopause: mucous is the major defense with secretoryIgA antibodies • During reproductive years: changes in pH

4. Figure 23.1

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7. 23.2 Normal Biota of the Urinary Tract • Outer region of the urethra harbors some normal biota • Nonhemolytic streptococci, staphylocci, corynebacteria, and some lactobacilli • Normal Biota of the Male Genital Tract • Same as described for urethra, since the urethra is the terminal “tube” • Normal Biota of the Female Genital Tract • The vagina harbors a normal population of microbes • Lactobacillusi species • Candida albicans at low levels

9. 23.3 Urinary Tract Diseases Caused by Microorganisms • Urinary Tract Infections (UTIs) • Urine is a good growth medium for many microorganisms • Reduced urine flow or accidental introduction of bacteria into the bladder can result in cystitis • If the infection also affects the kidneys it is called pyelonephritis • An infection only in the urethra: urethritis

10. Cystitis • Cystitis: sudden onset of symptoms • Pain in the pubic area • Frequent urges to urinate even when the bladder is empty • Burning pain accompanying urination (dysuria) • Cloudy urine • Orange tinge to the urine (hematuria) • Fever and nausea • Back pain indicates kidneys may also be involved

12. Leptospirosis • Zoonosis associated with wild animals and domesticated animals • Can affect the kidneys, liver, brain, and eyes • Major effects on the kidneys and is shed into the environment through animal urine • Two phases • Early (leptospiremic) phase • Sudden high fever, chills, headache, muscle aches, conjunctivitis, and vomiting • Second phase (immune phase) • Milder fever, headache, Weil’s syndrome (kidney invasion, hepatic disease, jaundice, anemia, and neurological disturbances)

13. Figure 23.4

15. Urinary Schistosomiasis • Schistosomahaematobium lodges in to the blood vessels of the bladder • May or may not result in symptoms • If symptoms occur: itchiness in the area where the worm enters the body, fever, chills, diarrhea, and cough • Urinary tract symptoms occur later which may include blood in the urine and bladder obstruction

17. 23.4 Reproductive Tract Diseases Caused by Microorganisms • Many are transmitted through sexual contact, but not all are • Three broad categories of sexually transmitted diseases • Discharge diseases • Ulcer diseases • Wart diseases

18. Vaginitis and Vaginosis • Inflammation of the vagina • Vaginal itching to some degree • Burning and sometimes a discharge occurs • Symptoms depend on the etiologic agent

19. Candida albicans • Normal biota living in low numbers • If grows rapidly and causes a yeast infection, white vaginal discharge occurs

20. Figure 23.5

21. Gardnerella species • Infection called vaginosis rather than vaginitis because inflammation in the vagina does not occur • Vaginal discharge with a very fishy odor, especially fater sex • Itching is common

23. Trichomonas vaginalis • Asymptomatic infections in approximately 50% of females and males • Some people experience long-term negative effects

24. Figure 23.7

26. Prostatitis • Inflammation of the prostate gland • Acute or chronic • Pain in the pelvic area, lower back, or genital area; frequent urge to urinate; blood in the urine; and/or painful ejaculation

28. Discharge Diseases with Major Manifestation in the Genitourinary Tract • Increase in fluid discharge in male and female reproductive tracts • Includes trichomoniasis, HIV, gonorrhea, and Chlamydia infection

29. Gonorrhea • N. gonorrhoeae is the etiologic agent- also known as the gonococcus • Symptoms in the male • Urethritis, painful urination and a yellowish discharge • Can occasionally spread from the urethra to the prostate gland and epididymis • Scar tissue in the spermatic ducts during healing can render a man infertile (rare)

30. Symptoms in the Female • Likely that both urinary and genital tracts will be infected • Mucopurulent or bloody vaginal discharge • Painful urination if urethra is affected • Major complications occur when the infection ascends from the vagina and cervix to higher reproductive structures • Salpingitis • Pelvic inflammatory disease

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35. Chlamydia • Most common reportable infectious disease in the U.S. • Majority of cases are asymptomatic • Symptoms in males • Inflammation of the urethra • Symptoms mimicking gonorrhea • Untreated infections may lead to epididymitis • Symptoms in females • Cervicitis • Discharge • Salpingitis • May lead to PID

36. Certain strains can invade the lymphatic tissues, resulting in lymphogranuloma venereum • Headache, fever, muscle aches • Lymph nodes fill with granuloma cells and become enlarged and tender • Babies born to mothers with infections can develop eye infections and pneumonia

37. Figure 23.12

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40. Genital Ulcer Diseases • Three common infectious conditions resulting in lesions on a person’s genitals • Syphilis, chancroid, and genital herpes • Having one of these diseases increases the chances of infection with HIV because of the open lesions

41. Syphilis • Three distinct clinical stages: primary, secondary, and tertiary • Latent periods of varying duration also occur • Transmissible during the primary and secondary stages, and the early latency period between secondary and tertiary • Largely nontransmissible during late latent and tertiary stages

42. Primary Syphilis • Appearance of a hard chancre at the site of entry of the pathogen (after an incubation period of 9 days to 3 months) • Lymph nodes draining the affected region become enlarged and firm • Chancre filled with spirochetes • Chancre heals spontaneously in 3 to 6 weeks but by then the spirochete has moved into the circulation

43. Secondary Syphilis • 3 weeks to 6 months after the chancre heals • Many systems have been invaded • Fever, headache, sore throat, followed by lymphadenopathy and a red or brown rash that breaks out on all skin surfaces • Hair often falls out • Lesions contain viable spirochetes and disappear spontaneously in a few weeks • Major complications occur in bones, hair follicles, joints, liver, eyes, and brain

44. Figure 23.14

45. Latency and Tertiary Syphilis • Highly varied latent period, can last for 20 years or longer • Tertiary syphilis is rare because of the use of antibiotics • Major complications occur by this stage • Cardiovascular syphilis- weakens the arteries in the aortic wall • Gummas develop in tissues such as the liver, skin, bone, and cartilage

46. Figure 23.15

47. Congenital Syphilis • From a pregnant woman’s circulation into the placenta and fetal tissues • Inhibits fetal growth • Disrupts critical periods of development

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50. Figure 23.18