Infections of the Urinary and Reproductive Tracts

what do kidneys do

filter and eliminate unwanted small molecules from the blood, while maintaining plasma electrolytes and blood pH in the normal range

urinary tract

removes the fluid waste and any excess water and electrolytes from the bloodstream and then expels the product (urine) - urine is not sterile

urinary system

2 kidneys, 2 ureters, 1 bladder, 1 urethra

infection prevented by

valves that prevent back flow to kidneys, pH of urine (6-7.5), mechanical flushing

gram negative rods thrive in urine and cause UTIs

development of infections in urinary tract

infection from urethra to bladder: urogenital membranes ascend into bladder, more common in women

ascending infection to kidney: organisms form an established infection in the bladder, ascend along ureter to infect kidney

descending infection from kidney: infected kidney sheds bacteria that descend into bladder, kidney infections may arise when microbes are deposited in the kidneys from the blood

anatomy and infections of urinary tract

women have more than 50% chance of getting UTI in their lifetime, 20-40% of those infected will have recurrent infections (2 or more in 6 months or 3 or more per year), female urethra is near vaginal and rectal openings

infections of urinary tract

cystitis, pyelonephritis

cystitis (bladder infection)

pathogen: 75-90% E. coli, other gram negative species

symptoms: dysuria (difficult or painful urination), burning upon urination, inflammation of urethra, increased frequency and urgency of urination

complications: kidney infection, bacteremia, sepsis

treatment: antibiotics to prevent transition to kidney infection

bladder infection in hospital setting

most common developed nosocomial infection, associated with urinary catheterization because of biofilm production

urinalysis

determines color and clarity of sample, microscopic examination, biochemical studies performed with a dipstick (dry reagent strip)

dry reagent strip analysis: urine is collected in sterile cup, dipstick is then inserted into urine and color changes on strip indicate diagnosis

pyelonephritis (kidney infection)

pathogen: commonly E. coli, other gram negative species

symptoms: fever, back pain and tenderness, chills, nausea, decreased urine production

complications: kidney necrosis, sepsis, septic shock, death

female reproductive system

2 ovaries, 2 uterine/fallopian tubes, uterus, cervix, vagina, external genitals (vulva)

external male reproductive system

penis, scrotum, testes inside scrotum, epididymis

spermatozoa (sperm) are produced in testes and mature as they wind their way through epididymides where they’re stored

internal male reproductive system

vas deferens (long tube), seminal vesicle, prostate

vas deferens transfers mature sperm from epididymides to penis

bacterial infections of reproductive tract

gonorrhea, syphilis, chlamydia

gonorrhea

pathogen: neisseria gonorrhoeae - gram negative cocci

transmission: sexual contact, spread to child during birth

symptoms: males have painful urination, discharge of pus, urethral itching. 80% of females have no symptoms, if present they have vaginal discharge, pain when having vaginal intercourse, vaginal bleeding after sex

complications: males have epididymitis, disseminated infection. females have pelvic inflammatory disease

what can happen when gonorrhea is spread to child during birth

ophthalmia neonatorum (infant blindness), children are given antibiotic eyedrops

syphilis

pathogen: treponema pallidum - gram negative spirochete

transmission: sexual contact - invades mucosa or through skin breaks and enters the bloodstream

symptoms:

primary stage - chancre (painless ulcer) at site of infection, highly infectious, resolves on its own in 2 weeks

secondary stage - generalized rash including palms of hands and soles of feet, enlarged lymph nodes, fatigue, fever

tertiary stage (complications) - loss of coordination of movement, progressive dementia, personality changes, stroke and other CNS abnormalities, abnormal pupillary reaction to light, noncancerous tumors, aneurysm

congenital: neurological damage to fetus

Belmont report for human research

respect for persons, beneficence, justice

chlamydia

pathogen: chlamydia trachomatis

symptoms: painful urination, discharge, urethral itching

complications: males - urethral and testicular infections. females - pelvic inflammatory disease

nongonococcal urethritis

chlamydia life cycle

1 - elementary bodies (infectious particles) bind and enter

2 - elementary body differentiates into larger reticulate body (replicative particle)

3 - reticulate bodies replicate

4 - reticulate bodies differentiate into elementary bodies and form inclusions

5 - elementary bodies are released

viral infections of reproductive tract

genital herpes, genital warts

genital herpes

pathogen: herpes simplex virus type 2 (HSV-2), and HSV-1

transmission: sexual contact

symptoms: painful vesicles on the genitals (heals in 2 weeks), burning sensation, pain, itching

complications: neonatal herpes (infection of child during birth or pregnancy), untreated mortality of 60%

genital warts

pathogen: human papillomaviruses (HPV)

transmission: sexual contact

symptoms: cauliflower shaped, soft, flesh colored lesions on an infected patient’s genitals or rectum - itching, pain, or tenderness

visible warts caused by serotypes 6 and 11, serotypes 16 and 18 cause cancer

complications: cancer (cervical for females, penile for males), throat

prevention: HPV vaccine (protects against serotypes 6, 11, 16, 18)

most common STI

genital warts