CHAPTER 5 -UROGENITAL AND SEXUAL TRANSMITTED DISEASES

1. CHAPTER 5 -UROGENITAL AND SEXUAL TRANSMITTED DISEASES By Miss RashidahbintiHjIberahim

2. Content • Urogenital Diseases • Sexually transmitted disease (STD) • - Gonorrhear • - Syphilis • - Herpesvirus infection

3. Bacterial Urogenital Infections

4. Bacterial infection • Urinary tract infections (UTIs) • Prostatitis • Pyelonephritis • Glomerulonephritis • Leptospirosis • Vaginitis • Toxic shock syndrome (TSS)

5. 1. Urinary Tract Infections (UTIs) • burning with urination (dysuria), frequency of urination, an urge to urinate, no vaginal discharge, and no significant pain. • An upper urinary tract infection or pyelonephritis may also present with flank pain and a fever. Healthy women have an average of 5 days of symptoms. • In young children, urinary tract infection symptoms may include diarrhea, loss of appetite, nausea and vomiting, fever, and excessive crying that cannot be resolved by typical measures. • Older children on the other hand may experience abdominal pain, or incontinence. • Lower urinary tract infections in adults may manifest with symptoms including hematuria (blood in the urine), inability to urinate despite the urge, and malaise.

6. Symptoms • foul-smelling urine and urine that appears cloudy. • Urethritis, meaning only the urethra has been affected, does not usually cause any other symptoms besides dysuria. • However, if the bladder is affected (cystitis), the patient is likely to experience more symptoms, including lower abdomen discomfort, low-grade fever, pelvic pressure, and frequent urination, all together with dysuria. • Whereas in newborns the condition may cause jaundice and hypothermia, in the elderly, symptoms of urinary tract infections may includelethargy and a change in mental status, signs that are otherwise nonspecific.

7. What is this?

8. Hematuria

9. Causes Intercourse • In young sexually active women, sex is the cause of 75–90% of bladder infections, with the risk of infection related to the frequency of sex.The term "honeymoon cystitis" has been applied to this phenomenon of frequent UTIs during early marriage. • In post menopausal women sexual activity does not affect the risk of developing a UTI. Spermicide use, independent of sexual frequency, increases the risk of UTIs. Sex • Among the elderly, UTI frequency is roughly equal proportions in women and men. This is due, in part, to an enlarged prostate in older men. As the gland grows, it obstructs the urethra, leading to increased difficulty in micturition. Because there is less urine flushing the urethra, there is a higher incidence of colonization.

10. Causes Urinary catheters • Urinary catheters are a risk factor for urinary tract infections. The risk of an associated infection can be decreased by only catheterizing when necessary, using aseptic technique for insertion, and maintaining unobstructed closed drainage of the catheter. Genetics • A predisposition for bladder infections may run in families. Others • Other risk factors include diabetes,sickle-cell disease, or anatomical malformations of the urinary tract such as prostate enlargement. • While ascending infections are, in general, the rule for lower urinary tract infections and cystitis, the same is not necessarily true for upper urinary tract infections like pyelonephritis, which may originate from a blood-born infection.

11. Catheterization

12. General prevention • A prolonged course (six months to a year) of low-dose antibiotics (usually nitrofurantoin or TMP/SMX) is effective in reducing the frequency of UTIs in those with recurrent UTIs. • Cranberry (juice or capsules) may decrease the incidence of UTI in those with frequent infections. Long-term tolerance, however, is an issue. Subsequent research has questioned these findings.  • For post-menopausal women intravaginal application of topical estrogen cream can prevent recurrent cystitis.This however is not as useful as low dose antibiotics. • Studies have shown that breastfeeding can reduce the risk of UTIs in infants.

13. Cont. • the use of birth control pills or condoms, voiding after sex, the type of underwear used, personal hygiene methods used after voiding or defecating, and whether one takes a bath instead of a shower

14. Microbial causing infections • E.coli • Proteus mirabilis • Klebsiellapneumoniae • Chlamydia / Ureaplasma • Staphylococcus epidermidis • Staphylococcus saprophyticus

15. Diagnosis • Make sure that the sample should be ‘ clean catch urine’ and ‘mid stream urine’ • In straight-forward cases, a diagnosis may be made and treatment given based on symptoms alone without further laboratory confirmation.  • In complicated or questionable cases, confirmation via urinalysis, looking for the presence of nitrites, leukocytes, or leukocyte esterase, or via urine microscopy, looking for the presence of red blood cells, white blood cells, and bacteria, may be useful.

16. Agar used for urine diagnosis Oxoid clarity agar Chromogenic Urine Agar

17. Diagnosis Dip the strip Compare with table

18. 2. Prostatitis 4 routes of infections: • By ascent thru the urethra • By back-flow of contaminated urine • By passage of fecal organisms from rectum thru lymphatic and to the prostate • By descent of blood-borne organism

19. Harmful effects • Usually occur in male • Cause infertility • 2nd infection to prostate infection • Attacking at least age 40 above • Causing urgent and frequent urination, low fever, back pain and sometimes muscles / joint pain

20. 3. Pyelonephritis • Caused by Candida sp. or E.coli • Inflammation of kidney • Usually caused by anatomical defects / lower UT blockage • Especially children (infant) faced back up urination • Symptoms similar to cytitis but this illness feels chills, fever, diluted urine (frequent and nocturia) • difficult to treat compared UTIs • Limited drugs used as precaution of kidney failure

21. 4. Glomerulonephritis • Also known as Bright’s disease • Inflammation of glomeruli of kidney • Caused either by staphylococcus / viral infection • Along wt Rheumatic fever – Staphylococcus pyogenes • Initiate antibodies production that enhance the immune systems to activated but false distruction – against cell wall of glomeruli

22. Cont. • Phagocytic cell leak out from b.v plus production of hydrolytic enzymes – causing damage • Appropriate antibiotic needed • Cause infection in throat and additional infection of streptococcal • Heal either 3-12 months/ permanent damage of kidney/die

23. 5. Leptospirosis • Caused by Leptospirainterrogans • Acquired from contact wt contaminated urine • Diagnosis from microscopic observation of blood • Treated by antibiotics and treated vaccination of pets (as source of infection)

24. 6. Toxic Shock Syndrome (TSS) • Arises from superabsorbent tampon usage • Treated by nafcilin • Prevent such tampons

25. Fungal Urogenital Infection

26. Candidiasis • Caused by Candida albicans • About 75% woman experience it once in life • Less common in girls before puberty and after menopause • Yeasty and white urine • Treated by clotrimazole and fluconazole

27. Diagnosis • Culturation • Microscopic observation - hyphae

28. Treatment • Topical antifungal • Oral fluconazole • Gentian violet can be used for breastfeeding thrush

29. Sexually transmitted diseases (std)

30. Bacterial STD • Gonorrhea* • Syphilis* • Chancroid • Nongonococcal Urethritis • Lyphogranuloma Venereum • Granuloma Inguinale

31. 1. Gonorrhea • Caused by gram negative diplococcus Neisseria gonorrheae • Confused between semen and pus • Area of infection – heart, eyes, pharynx, anal and ophthalmic

33. Diagnosis Using the discharge sample: • Gram-negative diplococci • Culturation • ELISA • Nucleic acid amplification test

34. 2. Syphilis • Caused by Gram negative spirochete, Treponema pallidum • The m/org loses effectiveness outside the host body • Grow slowly (rabbit) about 30hrs • Culture in low oxygen concentration for few generation • Cork-screw motility, no toxin but contain lipoprotein that induce inflammatory immune response

35. Syphilis

36. Stages • Primary • Secondary • Tertiary • Congenital

37. Diagnosis Primary stage – microscopic observation Secondary stage • using serological test – nontreponemal (that had distributed generally) • So called as reagin-type antibiotics • Slide agglutination – Venereal Disease Research Laboratory (VDRL) test, rapid plasma reagin (RPR) test, ELISA • Treponemal-type serological test (direct to the m/org) • Such as enzyme immunoassay (EIA), simple Rapid diagnostic tests (RDTs) • For confirmation – flourescent treponemal antibody absorption test (FTA-ABS)

38. Treatment • Benzathine penicillin act after 2 weeks • In serum, m/org concentration low but sensitive towards antibiotic • For penicillin-sensitive people, use azithromycin, doxycycline and tetracycline

39. 3. Chancroid

40. 4. Lymphogranuloma venereum (LGV) and 5. Granuloma inguinale

41. Other diseases

42. Bacterial vaginitis • Bacteria from vagina contaminating UT • Gardnerella vaginalis identify via present of clue cell • Best treated by metronidazole

43. Trichomoniasis • Caused by Trichomonas vaginalis (protozoan) • Transmitted sexually • Diagnosis thru discharge smear • Antibiotic - metronidazole • The urine – foul, greenish-yellow

44. Viral STD • Herpesvirus Infection* • Genital Warts • Laryngeal Papillomas • Cytomegalovirus (CMV) infections

45. Herpes • Caused by herpes simplex type 1 / 2 • Forming cold sore and fever blisters • Incubation period about 1 month and causing burning sensation • More in male than in female • Transfer to infant – congenital herpes • The virus either grow in amniotic fluid or in birth canal