Microbiology: Diseases Of The Urogenital System

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The urinary system consists of

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two kidneys, two ureters, a bladder, and a urethra

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Antimicrobial properties of urinary system

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Natural urine acidity

Flushing properties of urine

Valves to prevent black-flow

Semen contains lysozyme

low pH makes microbes inhospitable

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The female reproductive system consists of

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two ovaries, two uterine (fallopian tubes), a uterus, cervix, vagina, and external genitals

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The male reproductive system includes

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two testes, a system of ducts/glands, and a penis

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Normal urinary microbiota

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Lactobacilli in vagina/ opening of urethra

Streptococci

Candida albicans in vagina/opening of urethra

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Purpose of lactobacilli in vagina

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produce lactic acid to maintain normal vaginal pH to inhibit development of microbes

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Purpose of estrogen on vaginal microorganisms

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promote growth of lactobacilli

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Microbiota of bladder and male urethra

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None/ normally sterile

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Cystitis

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Inflammation of bladder/ side effect of urethritis/ UTI

Cause: Usually E. coli from rectum (also from Pseudomonas, Enterococcus, Klebsiella, and Staphylococcus)

Symptoms: painful/difficult urination

Dx: culturing CFUs

Treatment:Trimethoprim/Sulfamethoxazole

Prevention: ingestion of cranberry juice to eliminate E. coli

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Pyelonephritis

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inflammation of one or more kidneys

Symptoms: fever, dysuria, flank back pain

Dx: blood cultures or gram stain of >10,000 CFUs

Treatment: extended IV administration of cephalosporins

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Leptospirosis

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Domestic animal disease that can cause human liver damage (Weil's Disease)

Cause: spirochete Leptospira interrogans

Humans infected via contact with animal urine in water or soil through skin abrasion

Risk: animal occupations

Symptoms: headache, muscle aches, chills, fever within 2 weeks

Dx: serological test of blood or urine

Treatment: Doxycycline

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Weil's Disease

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liver damage caused by leptospirosis

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Gonorrhea

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Bacterial STD that can infect orally, rectally, or urethra/cervix

Anchor itself to urinary tract and release edotoxins

Cause: gram negative diplococcus Neisseria gonorrhea

Symptoms: men show painful urination/discharge in 2-3 days while women may not present with any

Dx: stain smear of pus for men/culture of cervix for women or ELISA test

Treatment: cephalosporins or fluoroquinolones for both partners

Prevention: newborns eyes treated immediately after birth

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Gonorrhea can cause a coinfection of both

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urethritis or chlamydia

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Nongonococcal Urethritis (NGU)

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urethritis not caused by gonorrhea

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Chlamydia

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Cause: C. trachomatis

Symptoms: women usually asymptomatic / men present with watery discharge and painful urination

Dx: 72 yr DNA cultivation/ NAAT/AMP urine tests

Treatment: tetracycline/ doxycycline

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Most cases of pelvic inflammatory disease are caused by

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Chlamydia

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Pelvic Inflammatory Disease (PID)

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collective term for extensive bacterial infection of female pelvic organs

Cause: often gonorrhea or chlamydia infections

Dx: combo of previous related infection and current symptoms

Treatment: cephalosporins

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Salpingitis

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microbes from bacterial infection attach to sperm and are carried to cervix

Can lead to sterility, ectopic pregnancy, and chronic pain

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Syphilis

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Cause: gram negative spirochete Treponema pallidum through sexual contact or saliva

Occurs in four stages

Dx: silver stains of fluid from lesions/ serological tests such as VDLR, RPR, FTA-ABS

Treatment: benzathine/ PCN or antibiotics to expecting mothers

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Syphilis Stages

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1. Chancre- painless sore, usually on genitals 10-90 days after infection

2. Secondary-varying skin rash usually on palms of hands, patchy hair loss, and mild fever

3. Latent- no symptoms for 2-4 years/ noninfectious

4. Tertiary-gummas appear on organs/ leads to CV/ Neuro symptoms

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Lymphogranuloma Venerum (LGV)

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Cause: serovar C. trachomatis in tropical regions

Symptoms: swollen lymph nodes/ genital enlargement

Dx: aspiration of pus from nodes stained with iodine

Treatment: doxycycline

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Chancroid

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Occurs in tropical areas/ associated with drug use

Cause: haemophilus ducreyi

Symptoms: swollen, painful ulcers on genitals lymph nodes (buboes)

Dx: aspiration of pus from nodes

Treatment: erythromycin or ceftriaxone but tissue destruction irreversible

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Bacterial vaginosis

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Inflammation of vagina

Cause: fungus Candida albicans or G. vaginalis which is normal in vagina but grows in excess under pH changes

Symptoms: vaginal pH above 4.5 with frothy and fishy d/c

Dx: fishy "whiff" test

Treatment: metronidazole, acetic acid gels, and yogurt

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Genital Herpes

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Cause: herpes simplex virus 2

Symptoms: painful urination, genital irritation, and fluid-filled vesicles for 2-3 weeks then latent period

Stress, menses, and fever may trigger relapse

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Glomerulonephritis

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Immune complex disease causing inflammation and damage of glomeruli of kidneys

Cause: strep/virus infections

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Bacterial Vaginitis

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Normal microflora of vagina (usually Gardnarella vaginalis) have opportunity to multiply due to pH change

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Balantitis

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Male equivalent to vaginitis

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Toxic Shock Syndrome (TSS)

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Cause: toxogenic strains of Staphylococcus aureus

Symptoms: fever, low blood pressure, red rash on trunk, shock

Organisms release toxins into bloodstream

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Trichomoniasis

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STD which infects urogenital tract and feeds on other bacteria

Cause: protozoan parasite T. vaginalis

Symptoms: itching, white d/c

Treatment: metronidazole (unless pregnant)

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Risk factors of contracting Gonorrhea

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oral contraceptives (alters vaginal conditions in favor of microbial growth)

condom/spermicide reuse

arthritis

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Over the past 20 years chlamydial infections have

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risen

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Genital herpes is related to increased risk of

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HIV
Miscarriage
C-Section (required to prevent fatal neonatal herpes)

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Other HPV infections include

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lip infections
gingivostomatitis
Herpes pneumonia
Skin/wounds
Corneal infections

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Condomylas

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aka genital warts caused by HPV

Symptoms: asymptomatic in men

Prevention: condoms not useful/ new vaccine available

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whitlow

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herpatic infection on finger that can result in oral, ocular, or genital herpes

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neurosyphilis

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Neurological damage, including thickening of the meninges, alaxia, paralysis, and insanity

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inclusion blennorrhea

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mild chlamydial infection in the eyes of infants

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keratoconjunctivitis

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herpatic vesicles of cornea or eyelid

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Herpes pneumonia

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rare form of herpes seen in burn patients, AIDs patients, and alcoholics

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Gumma

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granulomatous inflammation

symptomatic of syphilis that destroys tissues

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Elementary body

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infectious stage in the life cycle of chlamydia

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Opportunistic circumstances of bacterial vaginitis includes

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pregnancy

antibiotic use

prengancy

menopause

douching

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Cause of AIDS

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human immunodeficiency retrovirus which release transcriptase

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reverse transcriptase

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reverse enzyme found in AIDs used to make DNA from its RNA

Becomes integrated into host's chromosomes

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Symptoms of AIDs

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flu-like symptoms followed by asymptomatic period of months or years

Kaposi's sarcoma