Download Genitourinary Infections

Diseases of the Urinary &
Reproductive Systems
Chapter 24
Structures of Urinary System
– Kidneys
• Nephrons are functional unit (1.25 million per kidney)
– Ureters
– Urinary bladder
– Urethra
• Much longer in males
Structures of Reproductive System
• Females
– Urinary and reproductive systems
are distinct
• Males
– Urinary and reproductive systems
share components
• Normally urine and urinary tract above
bladder are sterile
– Urethra contains normal resident flora
• Lactobacillus, Staphylococcus, Corynebacterium
and Streptococcus
• Normal flora varies in female genital tract
– Depends on hormones
• Lactobacillus
• Non-venereal diseases of urinary tract
– Affect males and females
– Urinary tract infections
– Leptospirosis
Urinary Tract Infections
• 8 million cases annually in US
– 600,000 nosocomial
– May include any or all of the organs
•
•
•
•
Urethritis – inflammation of urethra
Cystits – inflammation of the urinary bladder
Ureteritis –inflammation of the ureters
Pyelonephritis – inflammation of the kidneys
• Causative agents:
– Usually intestinal flora
• E. coli – most common
• Proteus and Klebsiella
• Psudomonas
– Typically nosocomial
– Non-enteric bacteria
– Non-invasive and opportunistic
• Signs and Symptoms
– Dysuria – frequent, painful urination
– cloudy urine with foul odor; may have pale red color
9due to blood in urine)
– Tenderness of pelvic area
– May have slight fever
– Pathogens typically ascend urethra and attach
to receptors on bladder lining
– May form biofilm
– Pyelonephritis
• Sudden elevation of temperature, chills, vomiting
and back pain, bacteremia (may result in septicemia
if bacteria gain entrance into the blood stream)
• Epidemiology
– Typically results from auto-inoculation (except for
nosocomial infections)
– 30% of women develop UTI
– Risk factors include:
• short urethra; sex; use of diaphragm; pregnancy,
catheterization
– Infections less common in men
• More common after age 50
• Prostatitis – inflammation of the prostate gland
which decreases urine flow
• Prevention
–
–
–
–
Adequate fluid intake (2-4 liters daily)
Cranberry juice may help prevent attachment of bacteria
Void urine immediately after sex
Proper personal hygiene
• Treatment
– Sulfonamides or cephalosporins
Leptospirosis
• Zoonotic disease
• Causative agent
– Leptospira interrogans
• Gram -, Spirochete
• Double axial filaments
• Over 200 antigenic types
• Signs & Symptoms
– Abrupt onset of headache, spiking fever, chills and
severe myalgia
– Eye redness
• Due to dilation of small blood vessels
– ½ of patients develop nausea, vomiting and diarrhea
• Requires direct contact with urine or urine
contaminated waters or soil
• Bacteria enter body through mucous membranes
and breaks in skin
– Organism multiplies and travels to kidneys in blood
stream
• Epidemiology
– Worldwide distribution
– Infects many wild and domestic animals
• Asymptomatic carriers
– Organism is excreted in urine
• Survives in water or moist soil for weeks
– Farmers, ranchers, butchers, vets at high risk
– Rarely fatal
• Prevention
– Avoid water contaminated with animal urine
• Swimming accounts for a large number of cases
– Maintain sanitary conditions for animals
– Vaccine available for livestock and pets
– Rodent control
• Treatment
– Oral doxycycline, chloramphenicol, erythromycin
– IV penicillin in severe cases
• Non-venereal diseases of reproductive tract
– Toxic Shock Syndrome
• May affect males and females
– Bacterial Vaginosis
– Vaginal Candidiasis
Staphylococcal Toxic Shock Syndrome
• Causative agent: Staphylococcus aureus
• Virulent strains produce Toxic Shock Syndrome
Toxin (TSST1 or TSST2)
– binds cells of immune system and triggers excess
immune related chemicals be released
• Signs & Symptoms
– Sudden onset fever, chills, vomiting, diarrhea,
extremely low blood pressure, mental confusion and
a severe red rash
– 50% mortality if untreated
• Most cases involve menstruating women
– 25% of cases involved wound infection
– New mothers and surgical patients also at risk
• Prevention
– Avoid highly absorbent tampons, diaphragms,
contraceptive sponges or use them for shorter
periods of time
• Treatment
– Remove foreign matter or drain infected wound
immediately
– IV fluids to support blood pressure
– Vancomycin and anti-TSST immunoglobulin
Bacterial Vaginosis
• Causative agent:
– May be caused by multiple anaerobic bacteria
– Gardnerella vaginalis
• Change in vaginal flora
– pH increases and allows
overgrowth of pathogen
• Signs & Symptoms
– Thin, grayish-white vaginal discharge
• Can be slightly bubbly
– Pungent ‘fishy’ odor
– Some itching and irritation
– 50% asymptomatic
• Prevention
– No proven prevention
– Associated with multiple sexual partners, vaginal
douching, anti-microbial therapy
• Treatment
– Metronidazole
– Vinegar douche
– Reestablishment of lactobacilli
Vaginal Candidiasis
• Causative agent
– Candida albicans
• Normal flora for up to 80%
of women
• Opportunistic pathogen
• Dimorphic
• Signs & Symptoms
– White mucoid colonies on vaginal mucus membranes
and labia
– Severe itching and burning
– White curd-like discharge
• Epidemiology
– Can be spread person to person
• Mother to newborn
• Rarely sexually transmitted
– Antibacterial medications increases risk
– Other risk factors include birth control, hormone
therapy, AIDS, diabetes, invasive hospital procedures
and cancers
– Changes in vaginal flora and pH
• Prevention
– minimizing risk factors
• Treatment
– Intra-vaginal treatment with nystatin and
clotrimazole
• Cream azoles may weaken latex condoms
– Oral fluconazole