W12. Ch.14. MALE REPRODUCTIVE SYSTEM Flashcards
1
Q
Males and infertility
A
- 60% with female partner, 30% with male
- 1 in 6 couples infertile
2
Q
Most important congential condiditon of male reproductive system.
A
- cryptochidism
- this is congential malpositioning outside their normal scrotal location
- may be found in inguinal canal or abominal cavity
3
Q
Pathogenesis of cryptochidism
A
- fetal testes develop from the genital ridge, which are originally located in the abdominal caivty
- during intrauterine life, they descent from inguinal canal to the scrotum
- in 3-4%, the inguinal canal remains open, and the cremasteric muscle that is attached to the testes pulls them back into the inguinal canal or into the abdominal cavity. These are called retractile testes
- In most cases, the inguinal canal closes, and by the end of the 1st year of life, less than 1% of all male infants do not have one or both testes in the scrotum
- in this case, the testes must be fixed to the scrotum surgically and the inuinal canal closed to prevent hernia
- in most cases cause is unknown
4
Q
Clinical features or criptochidism
A
- atrophy, hypospermatogensis
- infertility if both involved
- 10x risk of malignancy
5
Q
In adult sexually active males, most reproductive system infection are…
A
-sexually acquired
6
Q
A
7
Q
Balanitis
A
- localized or diffuse
- redness, swelling, or ulceration of the glans penis
- usually caused by virus or bacteria
ex. Herpes- vesicles that rupture to ulcers
siphilitic cancre
HPV- warts (condyloma acuminatum)
8
Q
Male Reproductive System: Genital Herpes
A
- caused by HSV2
- invades the skin and mucosal cells, produces vesicles filled with clear fluid
- genital lesions are located on the glans or on the skin of the shaft of the penis or scrotum
- vesicles rupture and form painful ulcers which heal without scarring
- vesicles are enough to establish dx., but may be confirmed with sampling cells from vesicles
- genital herpes tend to re-occur. Following the acute disease, the HSV travels along the axons of the peripheral nerves and invades the ganglion cells that innervate the genital area. In the gangion cells, the virus remains in balance with the host, causing no clinical symptoms.
- Once balance is disturbed (ex. systemic disease), the virus is activated from its latent stage, and can produce new vesicle eruptions.
- individuals with herpatic lesions are contagious and asymptomatic carries can transmit disease.
- no cure, though asyclovir can provide releif
9
Q
Male: Gonnorhea
A
- caused by Neisseria gonorrhoeae (gonococcus) which results in purulent urethritis
- presents with burning with urination and yellow urethral discharge 2-5 days after exposure
- gonococcus invades the mucosa of the penile urethra and adjascent periurethral glands. Can be seen in the cytoplasm of inflammatory cells.
- inflamed mucosa is red, moist, and covered in purulent exudate (PMNs).
Dx. is made with molecular biology probes. Tx. with penicillin.
Complications:
Ascending infection can lead to prostatitis and epididymitis.
Strictures can narrow the urethra and obliterate the epididymis
Inadequately treated can cause pain with urination and infertility (blocked sperm outflow)
Gonoccoci can spread hematogenously - most common is gonococi arthritis.
10
Q
Clamydial infections
A
- Clamydia Trachomatis:
- gram negative bacteria, most common cause of bacterial uretitis in men
- in women can cause uretitis, endometritis, and pelvin inflammatory disease
- occurs most often in sexually active men
- often presents with urethral pain without discharge seen in gonorrhea. Many men have no symptoms, and can pass to their partner. In some men, can spread to the prostate and epididymis causing chronic inflammation and pain.
- dx. genital swab or cells from urine test
tx. broad spectrum abx.
11
Q
Syphyllis: Primary
A
caused by spirochete T. pallidum
Primary:
- painless indurated ulcer develops 1-12 weeks after exposure (primary chancre) most often on the glans penis, but can form on the prepuce in uncircomsized men, or around the anus in male homosexuals
- ulcer is accompanied by local lymph node enlargement (inguinal)
- swabbing is rarely done, and ulcer is considered syphilic until proven otherwise
- primary chancre heals in 4-6 weeks, with abx. in a few days
12
Q
Syphylis: secondary stage
A
- symptoms in secondary phase are manifestations of systemic spread of spirochetes and immune reaction to the pathogen
- occurs 2 months to 2 years after primary infection
- marked by systemic symptoms like malaise, fever, macular rash, lymph node enlargement, and slihtly elevated papules called condyloma latum (located on palms of hands and soles of feet)
- many other symptoms may be present such as mucosal ulcerations, CNS irritability, hepatitis, kidney symptoms
- all these symptoms have a self limited course and heal spontaneously
13
Q
Tertiary Syphilis
A
- after remission of secondary stage, the disease may enter a latent phase for an extended period
- occurs in a small number of untreated or incompletely treated, 2-20 years after primary infection
- most nb symptoms are related to the cardiovascular and CNS
- histologic hallmarks include perivasculitis involving the small blood vessels and syphilitic granulomas (gummas)
- lymphocytic and plasma cellular infiltrates around the vasa vasorum of the aorta (small nutrient arteries in the wall of the aorta) cause destruction of the arterial wall with widening of lumen (aneurism).
- Gummas of the cardiac valves, most often at the aortic orifice, cause destrucion and insufficiency of the valves
- Meningovascular syphilis causes poserior destruction of the spinal cord (tabes dorsalis). As a result of the destruction of the sensory nerve axons in the posterior collumns, these patients lose propriocepation and have difficulty coordinating movements.
- In the brain, the loss of neurons results in dementia (general paralysis of the insane). These patients loss all mental faculties and are often paralyzed because of destruction of motor neurons.
