Genitourinary Infections & STIs ch 27

Reference from 1 Corinthians 6:18: "Flee from sexual immorality…"
- Important biblical context related to sexual morality.

Syphilis Characteristics:
- Ancient disease, common historically.
- Severity reduced over time; initially led to many deaths.
- Treatments like mercury and plant products were not effective.
Microbial Findings:
- Fritz Schaudinn (1905): Discovered motile, corkscrew-shaped organisms in fluid from syphilitic sores.
- First identified as spirochetes.
- Named Treponema pallidum ("the pale spirochete") despite challenges in culturing it in the lab.

General Overview:
- Commonly uncomfortable with serious consequences.
Urinary Tract Infections (UTIs):
- Most frequent healthcare-associated infections.
- Primary cause of fatal bacterial bloodstream infections.
Statistics in the U.S:
- Highest reported incidence of STIs among developed countries.
- Approximately 85% of students report sexual intercourse; about 30% have >6 partners.
- 70% of sexually active students rarely or never use condoms.

Components:
- Kidneys, ureters, bladder, urethra.
- Function: Filter waste from blood, reabsorb substances, store urine.
Urine Composition:
- Acidic, contains organic acids and antimicrobial substances.
- Flow of urine rinses the urinary tract.
UTI Risk Factors:
- Women have shorter urethras, increasing likelihood of UTIs.

Components:
- Ovaries, fallopian tubes, uterus, vagina.
- Egg (ovum) released monthly; fertilization leads to embryo development.
Infection Risks:
- Vagina as entry point for pathogens; menstruation increases susceptibility to infections.
- Often leads to pelvic inflammatory disease (PID) if untreated, can cause infertility.

Components:
- Testes, sperm ducts, glands, penis.
Function:
- Sperm produced in testes, transported through epididymis and vas deferens to prostate gland.
Health Risks:
- Prostate enlargement can slow urine flow, increase risk of infections.

Resident Flora:
- Normal microbiota includes Lactobacillus, which helps maintain acidic environment and inhibits pathogens.
- Female microbiota is influenced by hormonal changes; glycogen in the vagina is converted to lactic acid.

Signs and Symptoms:
- Often sudden onset; can be asymptomatic.
- Symptoms include burning urination, urgent need to urinate, cloudy urine, possible blood, and abdominal pain.
Complications:
- Pyelonephritis may occur, leading to kidney damage (fever, chills, vomiting).

Most Commonly:
- Uropathogenic strains of Escherichia coli (over 80% of cases).
- Other pathogens include Klebsiella, Proteus, and Staphylococcus saprophyticus.
- Hospitalized patients may have multiple resistant species.

Mechanism:
- Pathogens ascend the urethra to the bladder to establish infection.
- UPEC (Uropathogenic E. coli) utilize fimbriae for adhesion and form biofilms within the bladder lining.

Prevalence:
- 30% of women may develop cystitis at some point.
- Factors include short urethra, sexual activity, and birth control methods.

Management:
- Antimicrobials for a short duration; hospitalization may be required for severe cases.
- Preventive measures include hydration, post-sex urination, and good hygiene practices.

Risk Factors:
- Increase in risk with multiple partners and unprotected sex.
Common STIs:
- Many are asymptomatic; require clinical evaluation.

Chlamydial Infections:
- Causative agent: Chlamydia trachomatis.
- Symptoms vary by gender; often asymptomatic in women.
Gonorrhea:
- Causative agent: Neisseria gonorrhoeae.
- Symptoms include painful urination, discharge.
Syphilis:
- Causative agent: Treponema pallidum.
- Presents in stages; initial painless sore, followed by systemic rash, and potential systemic damage (tertiary).