Lecture 7: Diseases Affecting Urinary and Reproductive System Flashcards
Urinary system
- removes waste from blood, helps maintain homeostasis
- infections influenced by system’s anatomy
- 50% UTIs are sexually transmitted
Females most at rx for infections
opening of urethra close to anus
Known colonizers of urethra in males and females
common (4)
lesser (3)
Main
- corynobacterium
- streptococcus
- staphylococcus
- bacteroides
Lesser
- peptostreptococcus
- prevotella
- porphyromonas
female susceptibility to kidney infection
urethra shorter, bacteria does not have to travel as far to reach kidneys
Kidneys and ureter microbiota?
usually sterile
Antimicrobial defenses of urinary system (7)
- shedding outermost cells of mucosa
- mucous secretion
- flushing action of urine
- pH (acidic)
- urea content
- antimicrobial proteins
- zinc secretion- inhibits E..coli
UTIs characterization
characterized by presence of significant number of bacteria in urinary tract
UTI sx (4)
- persistent urinary urgency
- persisten dysuria
- hematuria
- cloudy and strong smelling urine
Most common cause of UTI (pathogen)
e. coli
Infections of lower urinary tract
involve what 3 organs (3)
most common infections (3)
Involve
- urethra
- bladder
- prostate
Most common lower infections
- urethritis
- cystisis (inflam. bladder)
- prostitis
Infections of upper urinary tract
involve kidneys and pyelonephritis
Urethritis
def.
2 pathogen
sx (2)
- bacteria from lower intestine and anus reach the vagina
- neisseria gonorrhaea and chalmydia
- can be asymptomatic
- sx: dysuria and purulent discharge
Cysitis
def
pathogen
high rx population
sx (4 rsh)
- infection of bladder
- e coli most common
- higher rx during pregnancy
- urinary catheter can cause hospital-acquired cystitis
- sx similar to urethritis; clinically distinguished by acute onset, more severe symptoms, bacterial cells in urine, hematuria
prostitis
special pop.
2 types
inflammation and infection of protstate
- develops in young and older men following placement of indwelling catheter
- acute: sudden onset fever chills, increased urinary urgency and frequency
- chronic: signs and sx develop gradually and are less severe
Pyelonephritis
definition
commonly caused by
UTI involving one or both kidneys
- more common in women
- 90% of cases caused by e. coli
- can lead to permanent damage of kidneys and can spread systemically
Leptospirosis
- zoonotic disease affecting kidneys and other tissues
- hook at one end, resembles question mark
- spread by direct or indirect contact with urine of infected animal
- spirochetes found in contaminated waters, soil etc.
- bacteria enter via mucous membranes od eyes, nose, mouth
Leptospitosis pathogen
thin, aerobic, gram-negatie mossige spirochete
Clinical presentation leptospirosis
- incubation
- transmission
- sx (5)
- compilation
- rapid onset after 10 day incubation
- enters host through membranes od eyes, nose, mouth, and abrasions on feet
- 90% patients present with flu-like sx (chills, myalgia, HA, conjuctivitis), nausea/vomiting/diarrhea
- weil Syndrome: severe form leptospirosis: meningitis, liver, lung, and kidney damage
Weil syndrome
complications (3)
severe form leptospirosis
meningitis
liver
and kidney damage
tx leptospirosis/weil syndrom
DCN, PROMPT
Vaginal mirobiota
lactobacillus thrive in acidic pH of vagina, and convert lactic acid which further contributes to low pH
-susceptible to significant alterations (dysbiosis) that lead to common infections
Non-sexually transmitted infections of female reproductive system (2)
- bacterial vaginosis
2. vaginal candidiases
Bacterial vaginosis
caused by what pathogens (3)
tx
non-sexually transmitted infection of female reproductive system
garnerella vaginalis rods, prevotella, mobiluncus
tx: metronidazole or clindamysin (oral or vaginal, less rx c. diff)
most common vaginal infection in women of child-bearing age
-40-50% all gynecologic conditions
Vaginal candidasis
pathogen
sx (2)
tx (3)
“yeast infection”
c. albicans responsible agent for non-sexually transmitted infection of reproductive system
- decreased lactobacilli allow c.albicans to grow
sx: itching, white discharge
tx: nystatin, clotrimazole, fluconazole
3 key changes leading to bacterial vaginosis
- dysbiosis
- production volatile amines
- pH > 4.5
chlamydial urethritis
pathogen
transmission
- most frequently reported STD
- chlamydia trachoma’s
- one of several non-gonococcal urethritis
- sexually transmitted by contact with mucous membrane secretion of semen of infected person
* more common in men t
chlamydia lifecyle
characteristics pathogen
2 phases
c. trachomatis: small, round/ovoid-shaped organism, obligate, intracellular parasite
1. two phases
a. elementary body (EB): non-replicating, extracellular, infectious
b. reticulate body (RB): replicating, intracellular, non-infectious
chlamydia disease
transmission
sx (male/female)
complication
t: vaginal, anal, oral sex
- silent disease, 85-90% have no symptoms
sx: slight vaginal discharge and inflammation of the cervix
- burning pain during urination possible if urethra is infected
- males: painful urination and water/milky discharge
- can cause infertility in males
can cause pelvic inflammatory disease
Salpingitis
spreading of disease to the fallopian tubes
-blockage and inflammation of fallopian tubes can cause infertility
chalmydia other facts
dx test
tx
- can occur in parynx or anus
- newborns can contract chlamydial ophthalmia during delivery
- lab text=sample of urethra in men or cerix in women and using PCR ro detect chalmydial DNA
4: tx: tetracyclines (DCN), or macrocodes (azithromycin)
Gonorrhea
pathogen
shape
susceptibility
transmission
- can be an infection in any sexually active person
- caused by Neisseria Gornorrheae “the clap”
- double bean shape
- susceptible to most antiseptics and disinfectants, sensitive to dehydration
- survives only a brief period outside the body - transmission: sexual contact, newborn during birth
Neisseria gonorrhoeae
5 characteristicns
- small
- nonencapsulated
- nonmotile
- gram (-)
- diplococcus
Gonorrhea
incubation
affects what organs
special population
- incubation: 2-6 days
- affects: reproductive organs, female: cervix/urethra/fallopian tubes, male: infects urethra, pharynx, rectum, eyes
- rarely can disseminate and cause arthritis or dermatitis
- infant can contract gonoccal ophthalmia while passing through birth canal
Gonorrhea females
Major complication
Other complications (3)
tx
many infected females are asymptomatic and contribute to the spread of the disease, may present with PID
- can spread to fallopian tubes/salpingitis
- can lead to sterility
- can lead to ectopic pregnancy
tx: high dose ceftriaxone IM x1 dose
Gonorrhea Males
sx/complications (6)
tx
- tingling penis
- pain when urinating
- penile dischrge
- swollen lymph nodes
- painful testicles
- infertility
tx: high dose ceftriaxone IM x1 dose
PID
pathogens (3)
complications
sx
pelvic inflammatory disease
- polymicrobail infection
- neisseria gonorrhoeae
- chlamydia trachomatis
- anaerobes - salpingitis- infection fallopian tube
- scarring blocks passage of ova from ovary to uterus, causing sterility
- blocked uterine tube may cause fertilized ovum to be implanted in the tube rather than uterus (ectopic pregnancy) - sx: chronic abdominal pain; pain during or after menses particularly suggestive
- preventing PID is main reason for treating STD
Syphilis
caused by what patogen
- chronic, infectious disease
- top 5 most reported microbial disease in US
- treponema palladium, spirochete for which humans are only host
Syphilis
incubation period
sx
- I: 3 weeks avg, can vary
- chancre where bacteria entered body
- painless circular small raised edges
- persists 3-6 weeks, healthcares spontaneously
secondly syphilis
def sx
- occurs when spirochete spreads through blood and lymph to other organs
- sx: fever, skin rash, swollen nodes, transmission can occur through lesions
- chornic latent stage of 3-30 years follows in which relapses of secondary syphilis can occur, will be infectious at this point
tertiary syphillis
complications
- formation of non-infectious gammas
- weakenig or bursting of blood vessels
- degeneration spinal chord tissues
- brain damage leading to personality and judgement changes
congenital syphillis
complications
tx
prevention
dx
can occur in fetus of pregnant women
- still birth
- birth defects: hutchinson’s triad: deafness, impaired vision, noted peg shaped teeth
- tx: penicillin G 2.4 million units IM x 1 dose
- P: safe sex partners
- d: observation spirochetes by microscopy, antibody tests
Diagnosis syphilis
- RPR: rapid plasma regain
- antbodies to damaged cell components, not actual treponems - t. palladium enzyme immunoassay (TP-EIA)
- detects antibodies specific to t. pallidum
Genital Herpes
serotype
tx
- HSV-2
tx: acyclovir, famciclovir
signs of primary herpes infection
- itching or throbbing in genetical area
- reddening and appearance of blisters
- blisters crust over and disappear after 3 weeks
- 50% all infected individuals only experience one outbreak in lifetime
Human Papilomaviruses
- some cause genital warts and can cause cancer
2. condylomata tranmitted through sexual conduct
Condylomata
transmission
complications
prevention
genital warts
t: oral, vaginal, anal sex
- often asymptomatic
- can be transmitted to newborns during delivers
- can cause cervical cancer
- Gardisil vax
HPV (5 points)
- DNA virus, 200+ serotypes
- t sexual contact or microscopic abrasions
- disease depends on types
- P: vaccination against HPV strains
- can cause caner of anus, vagina/vulva, penis, mouth, throat
HPV types 16 & 18
cause 70% cervical cancer, assoc. with other cancers
Garasil 9
targets HPV 6, 11, 16, 18, 31, 33, 45, 52, 58
- only available in US
- protects against cervical, vulvar, vaginal, anal, oropharyngeal, and other head and neck cancers
Trichomoniasis
populations
transmission
parasitic protozoan, exists in only 1 morphological stage
- women > men
- can lead to infertility
- can lead to prostate cancer in meant - adherence factors allow cervicovaginal epithelium colonization in women
- t: direct skin-skin contact with infected individual, most often vaginal intercourse
Trichomoniasis
sx (3)
complication (6)
tx (3)
- common cause vaginitis in women
- intense itching and discomfort during urination and sexual intercourse, frothy, greenish vaginal discharge with musty malodorous smell
- complications: preterm delivers, low birth weight, increased mortality, predisposing HIV infection, AIDS, cervical cancer
- tx: metronidazole, tinidaole, secnidazole
Mild- Moderate PID tx (3)
- single dose long acting cephalosporin (ceftriazone) 500-1000 mg IM
- DCN 100 mg daily x14 days
- PLUS metronidazole 500 mg orally 2x daily for 14 days
inpatient tx for PID
option 1
a. cefoxitin 2 g IV every 6 hours
b. cefotetan 2 g IV every 12 hours
c. PLUS DCN 100 mg orally or IV every 12 hours
inpatient tx PID
option 2
clindamycin 900 mg IV Every 8 hours
PLUS gentamicin 3-5 mg/kg IV daily
Tx neonatal eye infection of Neisseria Gonorrhoeae
complications
prevention
tx
- acquired via passage through cervix/vagina or within the uterus
- can cause blindness if left untreated
- Px: maternal screening during pregnancy so mother can be treated if infected
- neonatal prophylaxis with erythromycin or tetracycline ointment applied up to 1 hour after birth
- rec. for all newborns by CDC and American Academy of Pediatrics
- tx neonatal infection
- ceftriaxone 25-50 mg/kg (MAX=125 mg) IV or IM x1 dose
- Cefotaxime or ceftrazidine alternatives
Neonatal eye infections: chlamydia trachomatis
- Aq. during birth in infants born vaginally to infected mothers
- causes neonatal conjunctivitis or pneumonia
- untreated conjunctivitis scan cause corneal and conjunctiontival scarring
- px: maternal screening during pregnancy for all women < 25 years old
- neonatal prophylaxis is not effected for c. trachomatis - tx: erythromycin 50 mg/kg orally in 4 divided doses per day for 14 days
OR azithromycin 20 mg/kg given orally once daily x3 days
**Topical therapy NOT effective for c. trachomatis
