Chapter 26: Microbial Diseases of the Urinary and Reproductive Systems

1. Chapter 26: Microbial Diseases of the Urinary and Reproductive Systems Spirochetes: Leptospira interrogans & Treponema pallidum

2. Urinary System The urinary bladder and upper urinary tract are sterile under normal conditions. Infection prevented by: Valves prevent backflow to kidneys Acidity of urine Mechanical flushing Females have a Predisposition to infection Short urethra Proximity to anus

3. Normal Microbiota Urinary bladder and upper urinary tract are sterile Lactobacilli are predominant in the vagina during reproductive years Produce H2O2 Grow on glycogen secretions Infection is indicated by: >10,000 bacteria/ml 100 coliforms/ml Positive urine leukocyte esterase (LE) test

4. Urinary System Infections Cystitis An inflammation of the urinary bladder Urethritis An inflammation of the urethra Pyelonephritis An inflammation of one or both kidneys

5. Cystitis Opportunistic gram-negative bacteria from the intestines often cause urinary tract infections. Usual causative agents: E. coli Staphylococcus saprophyticus Symptoms: Dysuria (difficult or painful urination) Pyuria (pus in urine) Causes: careless personal hygiene and sexual intercourse

6. Pyelonephritis Inflammation of the kidneys Usually from untreated UTI Causative agent: Usually E. coli (common in elderly) Symptoms: Fever; back or flank pain Urination problems Blood in the urine Cloudy or abnormal urine color Foul or strong urine odor Increased urinary frequency or urgency

7. Leptospirosis Causative agent: Leptospira interrogans (a spirochete) Reservoir: Dogs and rats Transmission: Skin/mucosal contact from urine-contaminated water Symptoms: Headaches, muscular aches, fever, kidney failure a possible complication

8. Sexually Transmitted Infections (STIs) Prevented by condoms & having a monogomous relationship Bacterial infections are treated with antibiotics

9. Gonorrhea Caused by Neisseria gonorrhoeae (gram negative diplococcus�anaerobe) One of the most common reportable communicable diseases reported in the US Attaches to oral or urogenital mucosa by fimbriae Symptoms: Men: Painful urination and discharge of pus Women: Few symptoms but possible complications, such as PID Anal gonorrhea, pharyngeal gonorrhea If left untreated, may result in Endocarditis Meningitis Arthritis Ophthalmia neonatorum

10. Geographical Distribution of Gonorrhea

11. Nongonococcal Urethritis (NGU) Nonspecific urethritis Chlamydia trachomatis (most common) Mycoplasma hominis Ureaplasma urealyticum Symptoms: Painful urination and watery discharge; in women, possible complications, such as PID Diagnosis: Culturing, PCR Treatment: Doxycycline, azithromycin

12. Pelvic Inflammatory Disease (PID) Neisseria gonorrhoeae & Chlamydia trachomatis In the United States, nearly 1 million women develop PID each year. About 1 in 8 sexually active adolescent girls will develop PID before age 20. Causes salpingitis (infection of uterine tubes) Symptoms: Chronic abdominal pain Most common cause of PID is through sexual contact. Bacteria may also enter the body after gynecological procedures such as: Childbirth Endometrial biopsy Insertion of an intrauterine device (IUD) Miscarriage Therapeutic or elective abortion

13. Syphilis Caused by Treponema pallidum Invades mucosa or through skin breaks Primary stage: Chancre at site of infection Secondary stage: Skin and mucosal rashes Latent period: No symptoms Tertiary stage: Gummas on many organs Late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, dementia, death. Congenital: Neurological damage

14. Geographical Distribution of Syphilis

15. Lesions of Secondary Stage Syphilis

16. Lesions of Tertiary Stage Syphilis

17. Lymphogranuloma Venereum (LGV) Causative agent: Chlamydia trachomatis (a bacteria) Some women are asymptomatic & do not seek treatment This leads to damage in the fallopian tubes And can cause sterility Initial lesion on genitals will heal Bacteria spread through lymph Symptoms: Swelling in lymph nodes in groin Diagnosis: Microscopic and culture

18. Chancroid (Soft Chancre) Causative agent: Haemophilus ducreyi (Gram-negative coccobacilli) Symptoms: Painful ulcers of genitals swollen lymph nodes in groin Diagnosis: Culture

19. Bacterial Vaginosis Causative agent: Gardnerella vaginalis (gram positive rods) Most common vaginal infection in women of childbearing age. Symptoms: Copious fishy, gray-white, thin, frothy discharge pH: >4.5 Diagnosis: Clue cells

20. Herpes Herpes simplex viruses (HSV-1 on face & HSV-2 on genitals) Symptoms: painful urination, genital irritation, and fluid-filled vesicles The virus can enter a latent stage in nerve cells Vesicles reappear following trauma and hormonal changes Neonatal herpes is contracted during fetal development or birth. It can result in neurological damage or infant fatalities.

21. Genital Warts Human papillomaviruses Warts in genital area HPV 16 causes cervical cancer and cancer of the penis Prevention: Vaccination (GARDASIL)against HPV strains 3 separate IM injections

22. Candidiasis Causative agent: Candida albicans Normally grows on mucosa of mouth, intestinal tract, and genitourinary tract NonGonococcal Urethritis in males Vulvovaginal candidiasis, yeasty discharge pH: <4 Symptoms: itching, cheesy discharge Diagnosis: microscopic

23. Trichomoniasis Causative agent: Trichomonas vaginalis: an anaerobic, parasitic flagellated protozoan Found in semen or urine of male carriers Vaginal infection causes irritation and profuse foul, greenish yellow frothy discharge pH: 5�8 Diagnosis: Microscopic identification

24. The TORCH Panel of Tests The blood test can determine if the person has had a recent infection, a past infection, or has never been exposed.� Toxoplasmosis Other (such as syphilis, hepatitis B, enterovirus, Epstein-Barr virus, varicella-zoster virus) Rubella Cytomegalovirus Herpes simplex virus