Ch. 21 Infectious Diseases Affecting the Genitourinary System

Uncomplicated UTI

Occurs in otherwise normal urinary tract Usually involves only the bladder

common modes of transmission of UTI

Opportunism: transfer from GI tract (community-acquired) or environment or GI tract (via catheter)

Diagnosis of Chlamydia

PCR or ELISA. Direct fluorescent antibody detection is also used. Serology is not always reliable; urine test is available but slightly less accurate for females

cystitis

inflammation of the bladder; When urine flow is reduced, or bacteria are accidentally introduced into the bladder

vaginitis

inflammation of the vagina

Leptospirosis

spirochete-caused disease transmitted by contact of broken skin or mucous membranes with contaminated animal urine.

Normal Biota of the Urinary Tract

varies between men and women and individuals

symptoms of chlamydia in men

vast majority asymptomatic; penile discharge and pain with urination

community-acquired UTIs more common in

woman; due to proximity of the female urethral opening to the anus

Diagnosis of Gonorrhea

-PCR test of secretions -Males: gram stain of secretions -females: ELISA and PCR tests -bacterium can be cultured on Thayer-Martin agar -enzymes used for identification: cytochrome oxidase and Gonococci, catalase

Pyridium

(Phenazopyridine) Urinary tract analgesic; an azo dye and causes the urine to turn a dark orange to red color

virulence of gonococci

-Gonococci use specific chemical groups on the tips of fimbriae to anchor themselves to mucosal epithelial cells. Once the bacterium attaches, it invades the cells and multiplies within the basement membrane. -Fimbriae are capable of phase variation -also can rearrange genes (antigenic variation)- confuse immune system -IgA protease: cleaves IgA molecules on mucus wall

Virulence of Chlamydia

-ability to grow intracellularly (escapes part of the host's immune response) -unique cell wall that prevents the phagosome from fusing with the lysosome inside phagocytes -The presence of the bacteria inside cells causes the release of cytokines that provoke intense inflammation

Discharge diseases

-infectious agent causes an increase in fluid discharge in the male and female reproductive tract (ex. trichomoniasis, gonorrhea, and Chlamydia infection) -The causative agents are transferred to new hosts when the fluids in which they live contact the mucosal surfaces of the receiving partner

Chlamydia pathogenesis

1. The infectious stage of Chlamydia is the elementary body (EB), which is taken into a phagocyte and ends up in its phagosome 2. In the phagosome, each elementary body develops into a reticulate body (RB) 3. RBs multiply by binary fission 4. Mature RBs become reorganized into EBs 5. Completed EBs are released from the host cell

Phases of Leptospirosis

2: During the early, or leptospiremic, phase and the second phase,

prostate gland

A gland in males that contributes to the seminal fluid.

causative agent of Vaginitis

Candida albicans

fungus present at low levels in the healthy female reproductive tract

Candida albicans

Causative agent of Chlamydia

Chlamydia trachomatis, very small gram-negative bacterium. It lives inside host cells as an obligate intracellular parasite. All Chlamydia species alternate between two distinct stages,

treatment of chlamydia and gonorrhea

Coinfection with gonorrhea and C. trachomatis should be assumed; treat with doxycycline or azithromycin. Be on alert for multidrug-resistant N. gonorrhoeae, which is in Urgent Threat category in CDC Antibiotic Resistance Report.

treatment of Leptospirosis

Early treatment with doxycycline, penicillin G, or ceftriazone rapidly reduces symptoms and shortens the course of disease, but delayed therapy is less effective

Bladder

Elastic, hollow, muscular organ that provides temporary storage for urine and empties it into the urethra

defenses of the urinary tract

Flushing action of urine Desquamation of epithelial cells lining the urinary tract Most bacteria adapted to adhere to the cells of the GI tract cannot gain a foothold in the urinary tract Acidic pH of urine Lysozyme and lactoferrin Secretory IgA

most common reportable infectious disease in the United States

Genital Chlamydia

complication of gonorrhea for males

In most cases, infection is limited to the distal urogenital tract, but it can occasionally spread from the urethra to the prostate gland and epididymis. Scar tissue formed in the spermatic ducts during healing of an invasive infection can render a man infertile.

complications of gonorrhea in women

Inflammation and/or pelvic inflammatory disease leads to scarred fallopian tubes and infertility

causative agent of Leptospirosis

Leptospira interrogans (spirochete); Leptospires are typical spirochete bacteria marked by tight, regular, individual coils with a bend or hook at one or both ends

possible affects of Leptospirosis

Long-term disability and even death can result from damage to the kidneys and liver, but they occur primarily with the most virulent strains and in elderly persons.

Trichomonas vaginalis

Many cases are asymptomatic, and men seldom have symptoms. Women often have vaginitis symptoms, which can include a white to green frothy discharge. Chronic infection can make a person more susceptible to other infections, including HIV. Also, women who become infected during pregnancy are predisposed to premature labor and low-birth-weight infants. Chronic infection may also lead to infertility.

causative agent of Gonorrhea

Neisseria gonorrhea; a pyogenic (pus-forming) gram-negative diplococcus. It appears as pairs of kidney bean-shaped bacteria, with their flat sides touching

Gonorrhea symptoms in males

Painful urination, pus discharge from urethra (90% have symptoms)

C. albicans is super serious (T. or F.)

Possibly: In otherwise healthy people, the fungus is not invasive and limits itself to this surface infection; however, that Candida infections of the bloodstream do occur and they have high mortality rates

biota on outside of penis

Pseudomonas and Staphylococcus species—aerobic bacteria

Transmission of Chlamydia

Sexual contact, mother to child

Prevalence of vaginosis

Thirty percent of women between the ages of 15 and 44 in the United States are estimated to have bacterial vaginosis. Rates are noticeably greater in non-White women:

how does estrogen alter pH of vagina?

This hormone stimulates the vaginal mucosa to secrete glycogen, which certain bacteria can ferment into acid, lowering the pH of the vagina to between 4.2 and 5.0 (from about 7 pre-puberty)

Treatment for vaginal candidiasis

Topical and oral azole drugs

Trichomonads:

Trichomonas Species; small, pear-shaped protozoa with four anterior flagella and an undulating membrane

symptoms of chlamydia in women

Up to 75% of Chlamydia infections are asymptomatic; others: cervicitis, a discharge, and often salpingitis. Pelvic inflammatory disease is a frequent sequela of female chlamydial infection. A woman is even more likely to experience PID as a result of a Chlamydia infection than as a result of gonorrhea.

Difference between vaginitis and vaginosis

Vaginosis does not include significant inflammation

symptomatic yeast infection occurs...

When the normal vaginal microbiota is altered and is unable to keep Candida albicans in check, an overgrowth of the fungus may occur

yeast infection

a vaginal infection caused by a fungal organism (Candida albicans)

People most susceptible to chlamydia

adolescent women (prefers to infect cells that are particularly prevalent on the adolescent cervix)

Treatment of UTI

antibiotics Sulfa drugs such as trimethoprim-sulfamethoxazole are most often used; another nonantibiotic drug called phenazopyridine (Pyridium)

UTIs contracted in healthcare setting

catheter-associated UTIs (CA-UTIs) (because they are almost always a result of catheterization)

Vaginosis is also called

bacterial vaginosis

Vaginosis causative agent

bacterium Gardnerella; Vaginosis is most likely a result of a shift from a predominance of "good" bacteria (lactobacilli) in the vagina to a predominance of "bad" bacteria, and one of those is Gardnerella vaginalis. This genus of bacteria is a facultative anaerobe and gram-positive, although in a Gram stain it usually appears gram-negative. (Some texts refer to it as gram-variable for this reason.

Babies born to mothers with Chlamydia

can develop eye infections and also pneumonia if they become infected during passage through the birth canal. Infant conjunctivitis caused by contact with maternal Chlamydia infection is the most prevalent form of conjunctivitis in the United States (100,000 cases per year)

Lymphogranuloma venereum

caused by chlamydia. (specifically C. trachomatis) headache, fever, and muscle aches. The lymph nodes near the lesion begin to fill with granuloma cells and become enlarged and tender. These "nodes" can cause long-term lymphatic obstruction that leads to chronic, deforming edema of the genitalia or anus

symptoms of vaginitis

characterized by some degree of vaginal itching, depending on the etiologic agent. Symptoms may also include burning and sometimes a discharge, which may take different forms as well

Epididymis

coiled tubes leading out of the testes

mucopurulent

containing both mucus and pus; discharge that occurs in some cases of gonorrhea in women

C. albicans

dimorphic fungus that is normal biota in the majority of humans, living in low numbers on many mucosal surfaces such as the mouth, gastrointestinal tract, vagina, and so on

Diagnosis of C. albicans

easily detectable on a wet prep or a Gram stain of material obtained during a pelvic exam. The presence of pseudohyphae in the smear is a clear indication that the yeast is growing rapidly and causing a yeast infection

Untreated chlamydia in males may lead to

epididymitis

Defenses of female reproductive system

ever changing throughout life childhood/after menopause: mucus, secretory IgA reproductive years: changes in the pH of the vagina (more acidic) brought about by release of estrogen childbearing years: normal biota prevent establishment/invasion of microbes

male reproductive system defenses

flushing action of urine

urethritis

infection of the urethra

sexually transmitted infections (STIs)

infections caused by sexual contact with infected people; signs and symptoms are not always apparent

salpingitis

inflammation of a fallopian tube

pelvic inflammatory disease (PID)

inflammation of organs in the pelvic cavity; usually includes the fallopian tubes, ovaries, and endometrium; most often caused by bacteria

urinary tract infections result from...

invasion of the urinary system by bacteria or other microorganisms

If back pain is present and fever is high with cystitis...

it is an indication that the kidneys may also be involved (pyelonephritis)

pyelonephritis

kidney infection; also can occur when urine flow is reduced or bacteria are accidentally introduced; can result in permanent damage to the kidneys if improperly or inadequately treated

Weil's syndrome

kidney invasion, hepatic disease, jaundice, anemia, neurological disturbances

Leptospirosis can affect...

kidneys, liver, brain, and eyes

parts of the urinary tract

kidneys, ureters, bladder, urethra

Cervix

lower one-third of the uterus and the part that connects to the vagina. The cervix serves as the opening to the uterus. The cervix is a common site of infection in the female reproductive tract

antibacterial proteins in urine (and jobs)

lysozome (an enzyme that breaks down peptidoglycan) Lactoferrin (an iron-binding protein that inhibits bacterial growth)

Gonococcal Isolate Surveillance Project (GISP)

monitor the growing prevalence of antibiotic-resistant strains of N. gonorrhoeae; The CDC has this bacterium in its Urgent Threat category for antibiotic resistance because it has developed resistance to nearly every drug that could be used for treatment.

Symptoms of Vaginosis

no significant inflammation of vagina; a vaginal discharge is associated with the condition, which often has a fishy odor. Itching is also common, but it is also true that many women have this condition with no noticeable symptoms.

cause of 95% of UTIs

normal bioto in gastrointestinal tract; Escherichia coli is by far the most common of these, accounting for approximately 80% of community-acquired urinary tract infections. Staphylococcus saprophyticus and other members of the bacterial family that contains E. coli, Enterobacteriaceae, especially Klebsiella pneumoniae, and Proteus mirablis are also common culprits.

Transmission of vaginosis

not fully understood; higher rate with sexually active women though not transmitted sexually; The low pH typical of the vagina is usually higher in vaginosis. It is not clear whether this causes or is caused by the change in bacterial biota.

Gonoccal eye infections in neonates

often result in keratitis, ophthalmia neonatorum, and even blindness

Transmission of yeast infections

opportunistic: Disruptions (ex. mechanical or chemical) of the normal bacterial biota or even minor damage to the mucosal epithelium in the vagina can lead to overgrowth by this fungus.; can also be transmitted sexually

treatment for vaginosis

oral or topical metronidazole or clindamycin

Parts of the female reproductive system

ovaries, fallopian tubes, uterus, vagina

Cystitis symptoms

pain, frequent urges to urinate even when the bladder is empty, and burning pain accompanying urination (called dysuria); possible hematuria; low grade fever and nausea

dysuria

painful urination

Leptospiremic Phase of Leptospirosis

pathogen appears in the blood and cerebrospinal fluid; Symptoms are sudden high fever, chills, headache, muscle aches, conjunctivitis, and vomiting.

complications of vaginosis

pelvic inflammatory disease, infertility, and, more rarely, ectopic pregnancies. Babies born to some mothers with vaginosis have low birth weights.

hematuria

presence of blood in the urine; causes an orange tinge

Testes

produce sperm cells and hormones

Kidneys

remove metabolic wastes from the blood, acting as a sophisticated filtration system; produce urine as waste

job of the urinary tract

removing substances from the blood, regulating certain body processes, and forming urine and transporting it out of the body

Transmission of Gonorrhea

sexual contact (and vertically to neonates)

Diagnosis of vaginosis

simple stain of vaginal secretions is used to examine sloughed vaginal epithelial cells. In vaginosis, some cells will appear to be nearly covered with adherent bacteria. In normal times, vaginal epithelial cells are sparsely covered with bacteria. These cells are called clue cells

Parts of the male reproductive system:

testes, epididymis, vas deferens, prostate gland

uncircumcised penis biota also includes

the area under the foreskin is colonized by anaerobic gram-negatives

Second phase of Leptospirosis

the blood infection is cleared by natural defenses. This period is marked by milder fever; headache due to leptospiral meningitis; and, in rare cases, Weil's syndrome

Rare complications of gonorrhea

the gonococcus enters the bloodstream and is disseminated to the joints and skin. Involvement of the wrist and ankle can lead to chronic arthritis and a painful, sporadic, papular rash on the limbs. Rare complications of gonococcal bacteremia are meningitis and endocarditis.

which part of the urethra has a larger normal biota?

the lower end, upper has fewer types and lower abundance

external male genitalia

the penis and the scrotum, which contains two testicles

Lactobacillus species

thrive in the acidic environment and contribute to it, converting sugars to acid. Their predominance in the vagina, combined with the acidic environment, discourages the growth of many microorganisms

community-acquired UTIs

transmitted from one organ system to another

Ureters function

transport urine from the kidneys to the bladder

Urethra

tube leading from the urinary bladder to the outside of the body

vas deferens

tube that carries sperm from the epididymis to the ejaculatory duct (which empties into urethra)

Gonorrhea symptoms in women

vaginal discharge, painful urination, vaginal bleeding, abdominal pain, pelvic pain, urethritis