Urinary and Reproductive System

Normal Microbiota of Vagina

• Lactobacilli

  • Growth promoted by estrogen

• Streptococci

• Candida albicans

Normal Microbiota of Male Urethra

Introduces bacteria into semen ; Propionibacterium, Prevotella, Lactobacillus

Urethritis

An inflammation of the urethra

Cystitis

An inflammation of the urinary bladder ; cause dysuria and pyuria

• Eight times more common in women than men

• Commonly caused by E. coli; also Staphylococcus saprophyticus

Ureteritis

Infection of the ureters

Pyelonephritis

An inflammation of one or both kidneys ; 75% of cases caused by E. coli

• Fever and back or flank pain

• Can form scar tissue in kidneys and become life-
  threatening

What causes most urinary tract infections?

Escherichia coli

Gonorrhea

• Caused by Neisseria gonorrhoeae ; Gram-negative diplococcus

• Attaches to the epithelial mucosa by the fimbriae

  • Invades the spaces between the columnar epithelial cells (pharynx, eyes, rectum, urethra, cervix, external genitalia of prepubertal females)

Gonorrhea Symptoms

• Men : painful urination and discharge of pus; epididymitis

• Women : maybe some inflammation and abdominal pain from complications, few symptoms ; most are unaware

Ophthalmia neonatorum

Infant eye infection due to a gonorrheal infection of the eye ; Acquired at birth if mother has a genital infection

Gonorrhea Treatment and Diagnosis

• Treatment : ceftriaxone

• Diagnosis : gram stain, culture, or NAATs

Chlamydia

• Chlamydia trachomatis

• Painful urination and watery discharge; but often asymptomatic

  • May result in pelvic inflammatory disease (PID) in women

Chlamydia Treatment and Diagnosis

• Treatment : azithromycin and doxycycline

• Diagnosis: NAATs

Pelvic Inflammatory Disease (PID)

• Polymicrobial infection, usually : N. gonorrhoeae and C. trachomatis

• Extensive bacterial infection of the female pelvic organs

• Consequences may include infertility and chronic abdominal pain

Salpingitis

Infection of the uterine tubes ; Most serious form of PID. Scarring can cause infertility or ectopic pregnancy

Pelvic Inflammatory Disease (PID) Treatment

Simultaneous administration of doxycycline, ceftriaxone, and metronidazole

Syphilis

• Caused by Treponema pallidum ; Gram-negative spirochete

  • Invades the mucosa or through skin breaks and enters the bloodstream

• Induces an inflammatory response

Primary Stage of Syphilis

• Chancre (firm ulcer) at the site of infection about 3 weeks after exposure

  • Painless and highly infectious ; Disappears after 2 weeks

• Bacteria enter the bloodstream and lymphatic system

Secondary Stage of Syphilis

• Skin and mucosal rashes, especially on the palms and soles

  • Due to an inflammatory response

  • Rash lesions are infectious

Tertiary Stage of Syphilis

• Appear years after latency

• Gummatous syphilis: gummas (tumour) on many organs

• Cardiovascular syphilis: weakens the aorta

• Neurosyphilis: affects the CNS

Congenital Syphilis

• Transmitted across placenta to fetus

• Neurological damage

• Prevented by treating pregnant patient with antibiotics during first two trimesters

Syphilis Treatment

Treatment with benzathine penicillin

Bacterial Vaginosis

• Caused by Gardnerella vaginalis or Candida albicans

• Often precipitated by a decrease in the number of Lactobacillus

• pH above 4.5, fishy odor, copious frothy discharge

• Clue cells in discharge

Bacterial Vaginosis Treatment

Treatment with metronidazole

Genital Herpes

• Caused by Simplexvirus HSV-1 and HSV-2

• Painful vesicles on the genitals; painful urination ; Heals within 2 weeks

• May be transmitted even when there are no lesions or apparent symptoms

• No cure

Neonatal Herpes

• Herpesvirus crosses the placental barrier and infects the fetus; causes spontaneous abortion or serious damage

• Newborns infected from HSV exposure during delivery

  • Caesarian delivery recommended if mother has active lesions at the time of delivery

  • may cause developmental delays, blindness, hearing loss

Neonatal Herpes Treatment

Intravenous acyclovir

Genital Warts

• Caused by human papillomaviruses

• Visible warts caused by species 6 and 11

• Species 7 and 9 cause cervical cancer

Genital Warts Treatment and Prevention

• Treatment via removal of warts; podofilox and imiquimod

• Prevention with HPV vaccine (Gardasil)