Chapter26.
- 1. Chapter 26: Diseases of the Urinary and Reproductive System The urinary system Regulates the composition and volume of the blood Excretes nitrogenous waste products and water Prone to infection since there is an opening to the external environment and the mucosal membranes are supportive of bacterial growth
- 2. Structure and function of the urinary tract The urinary tract consists of: 2 ureters 1 bladder 1 urethra 2 kidneys Urine (waste products) are removed from the blood as it moves though the kidney The urine then moves through the ureters into the bladder and exits the body through the urethra a. The male urethra also transports the seminal fluid
- 3. Normal microbiota of the urinary tract The kidney, ureters, bladder, and upper urethra are kept sterile by the flow of urine a. Normal urine is acidic which has antimicrobial properties 2. The outer region of the urethra harbors the following microbiota: nonhemolytic streptococci, staphylococci, corynebacteria, and some lactobacillus
- 4. Urinary tract infections (UTIs) Women have a short urethra which is close to the anus allowing bacteria from the GI tract into the bladder Cystitis = common inflammation of the urinary bladder Pathogen = most common – E. coli – gram negative rod Sxs: dysuria = difficult, painful urination and pyuria = pus in the urine, fever and nausea may be present
- 5. Urinary tract infections (UTIs) 3. Virulence = E. coli have adhesions at the ends of their long fimbriae that they use to attach to epithelial lining of the urinary tract 4. Prevention – empty bladder frequently and sanitary practices 5. Tx is antibiotics
- 6. Urinary tract infections (UTIs) Pyelonephritis = inflammation of 1 or both kidneys usually caused by E. coli Untreated cystitis may lead to pyelonephritis which can then lead to bacteremia Sxs = fever, flank and back pain If the disease becomes chronic, scar tissue can form in the kidney leading to dysfunction Can be life threatening so treatment begins with IV antibiotics
- 7. Urinary tract infections (UTIs) Leptospirosis Pathogen = the spirochete Leptospira interrogans Infection is a zoonosis associated with wild and domesticated animals Mode of transmission – vehicle – urine or urine contaminated soil or water from an infected animal enters the mucous membranes of the eyes, nose or through a skin abrasion
- 8. Urinary tract infections (UTIs) Leptospirosis 4. Sxs: Leptospirosis has 2 phases a. during the early phase the pathogen appears in the blood and CSF causing sudden high fever, chills, HA, muscle aches, conjunctivitis, vomiting b. 2 nd phase the blood infection is cleared by body defenses and the fever is milder, HA due to leptospiral meningitis and Weil’s syndrome 1) Weil’s syndrome – kidney invasion, hepatic disease, jaundice, anemia, neurological disturbances 5. Dx is made by serological tests, or testing fluids for the organism or it’s DNA 6. Tx is doxycycline (a tetracycline)
- 9. The reproductive tract The reproductive system in males and females is involved in the production of gametes – sperm and eggs These tracts are normally sterile except for the female vagina that is colonized by several types of resident microbiota
- 10. Diseases of the Reproductive tract Gonorrhea – is the most common reportable disease in the US, aka “the clap” from the French clappoir which means brothel Neisseria gonorrhoeae – Gram neg diplococcus aka gonococcus a. Attaches to mucosal cells by fimbriae
- 11. Gonorrhea 2. A single unprotected exposure results in infection a. in men – 20-35% of the time b. in women – 60 -90% of the time 3. Females – gonococci invade the cervix, urethra, and may spread to the fallopian tubes (salpingitis) causing adhesions which make it difficult for the passage of eggs a. sxs = may be asymptomatic or have abdominal pain, burning on urination 1) can lead to PID – bacterial disease affecting the pelvic organs
- 12. Gonorrhea 4. Males – primarily affects the urethra a. onset accompanied by tingling in the penis followed by painful urination b. also 1 st a watery discharge, later white, thick fluid – resembles semen 5. Untreated males and female may become sterile 6. Pregnant women with untreated gonorrhea can transmit the disease to the eyes of the newborn during delivery = opthalmia neonatorum a. prevent with Ag nitrate or antibiotics in eyes
- 13. Gonorrhea 7. Pharyngeal gonorrhea a. pharynx affected b. sx = septic sore throat c. transmitted during oral sex with infected partner 8. Dx in men is a smear of pus with the gonococcus 9. Tx = penicillin
- 14. Syphilis – A STD that progresses through several stages Treponema pallidum - gram neg spirochete Stages: Primary stage syphilis A hard chancre (sore) appears at the site of infection 10 – 90 days after exposure The chancre is painless and fluid ( teaming with the spirochete) forms in the center The chancre disappears in 2 - 6 weeks Bacteria enter the bloodstream and lymphatic system
- 15. Syphilis 2. Secondary stage syphilis a. several weeks after the chancre disappears a red or brown rash develops on the skin including the palms and soles b. these lesions of the rash have viable spirochetes and disappear spontaneously c. sxs = fever, HA, sore throat, hair loss, lymphadenopathy d. can run a VDRL test (Venereal Disease Research Laboratory) at this stage - detects 99% syphilis cases
- 16. Syphilis 3. Latent period a. no sxs b. after 2 – 4 years of latency the disease is not infectious except from mother to fetus 4. Tertiary stage period – years from onset of latent stage a. this stage is relatively rare today because of antibiotics b. gummas develop in tissue = soft, granular lesions that weaken blood vessels causing them to bulge and burst
- 17. Syphilis 4. c. cardiovascular syphilis results in weakening of the aorta d. neurosyphilis can involve any part of the nervous system 1) gummas in the nervous system lead to paralysis and insanity 5. Tx = penicillin in primary and secondary stages, not effective in tertiary stage 6. Spirochetes can cross the placental barrier in pregnant women and cause congenital syphilis to the fetus
- 18. Nongonococcal Urethritis (NGU) - STD 1. Chlamydia trachomatis is the most common cause of NGU 2. Other causes of NGU = The mycoplasmas Ureaplasma urealyticum and Mycoplasma hominis infect the vagina of females and the urethra in females and males 3. sxs: a. female = vaginal discharge, inflammation of the cervix, burning pain with urination, may spread to the fallopian tubes, may lead to PID and possible sterility 1) increased risk of cervical cancer
- 19. Nongonococcal Urethritis 3. sxs: b. male = painful urination, watery discharge, tingling sensation of the penis and inflammation of the epididymis ( an organ that lies along the posterior border of the testis), possible sterility 4. Newborns can contact the disease from an infected mother causing chlamydial ophthalmia or chlamydial pneumonia
- 20. Viral diseases of the reproductive system Genital Herpes – STD 1. Herpes simplex virus type 2 (also type 1) 2. Affects the external genitalia causing painful lesions in about 1 week after exposure 3. Fluid filled vesicles appear that rupture into painful ulcers a. the vesicles contain the virus b. the virus can be shed with no apparent lesions
- 21. Viral diseases of the reproductive system Genital Herpes 4. The virus has a lifetime latent period on nerve cells and can be re-activated by stress, illness, menstruation 5. Neonatal herpes can be passed to the fetus by an infected mother via the placenta or during childbirth a. can cause neurological problems or mental impairment to the newborn b. if mother has active lesions at the time of birth a C-section is advised
- 22. Viral diseases of the reproductive system Genital warts aka condylomata acuminata Human papilloma viruses – DNA virus Sexually transmitted papillomaviruses can cause growths on the penis or vagina a. Warts are pink and moist Linked to cervical cancer In 2006 Gardasil vaccine protects against 70% of cancer causing papilloma viral strains
- 23. Fungal diseases of the Reproductive system Candidiasis Candida albicans – an opportunistic dimorphic fungus Held in check by Lactobacillus which produces lactic acid- acidic conditions make an inhospitable environment for Candida albicans grows on mucous membranes of the mouth, GI tract and genitourinary tract
- 24. Fungal diseases of the Reproductive system Candidiasis 3. Oral candidiasis = thrush – newborns, AIDS pxs 4. Vulvovaginal candidiasis – most common cause of vaginitis a. sx = severe itching, thick yellow cheesy discharge b. predisposing factors = diabetes, antibiotic therapy, pg, BC pill
- 25. Protozoan diseases of the Reproductive Tract Trichomoniasis – non reportable STD 1. The flagellated protozoan Trichomonas vaginalis is a normal inhabitant in the vagina of females and urethra of males (rarely have sxs) 2. Trichomoniasis results when the acidity of the vagina is disturbed and the protozoa outgrows the normal microbiota a. female – profuse greenish, yellow discharge with a foul odor accompanied by irritation and itching b. male – asymptomatic or urethritis and burning urination
- 26. Protozoan diseases of the Reproductive Tract Trichomoniasis May cause preterm labor and low birth weight Dx = microscopic exam of discharge Tx = Metronidazole