Microbial Diseases of the Urinary and Reproductive Systems

Microbes enter the urinary system through the urethra.
Microbes enter the reproductive system through the vagina (females) or urethra (males).

Female Urinary Organs: Includes kidneys, ureters, urinary bladder, and urethra.
Male Reproductive & Urinary: Includes urinary bladder, urethra, penis, scrotum, testis, epididymis, vas deferens, seminal vesicle, prostate gland.

Urinary bladder and upper urinary tract should be sterile.
Urethra has low normal flora.
Vagina: Low pH due to estrogen stimulating glycogen production. Lactobacilli digest glycogen, producing acid and inhibiting unwanted growth. Pre-menstrual and post-menopause, low estrogen levels result in altered flora.
Males: Normally sterile.

Causative Agent: Neisseria gonorrhoeae
Incubation: 2-5 days
Infects: Columnar epithelial cells.
Males: 90% symptomatic, painful urination, pus discharge.
Females: 60% asymptomatic, may lead to PID.
Systemic infections: Gonorrheal endocarditis, meningitis, arthritis, ophthalmia neonatorum.
Treatment: Ceftriaxone.
Attaches to oral or urogenital mucosa via fimbriae; can "catch a ride" on sperm.
Transmission rates: Female to male (30%), Male to female (60-90%).
Untreated gonorrhea can result in Pelvic Inflammatory Disease (PID), abdominal infection, pain, and scarring.
PID can lead to ectopic pregnancy, reduced fertility, and sterility (approximately 25%).
Ophthalmia neonatorum is a concern in newborns.

Causative Agents: Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis
Symptoms: Painful urination, watery discharge.
Most common STDs in the USA.
Often mild symptoms in males; 60-70% asymptomatic in females.
Can cause pelvic inflammatory disease in women and sterility.
May lead to eye infection and pneumonia in infants.

Both N. gonorrhoeae and C. trachomatis can block uterine tubes.
Can result in chronic abdominal pain and salpingitis (inflammation of fallopian tubes).
Symptoms include lower abdominal pain and abnormal vaginal discharge.
Other symptoms: fever, right upper abdominal pain, painful intercourse, irregular menstrual bleeding.
Chlamydial infection may present with minor or no symptoms, leading to severe reproductive organ damage.

Causative Agent: Treponema pallidum
Invades mucosa or skin breaks.
Incubation: 3 weeks
Stages:
- Primary: Chancre
- Secondary: Skin rashes, hair loss, mild fever
- Latency: No symptoms
- Tertiary: Gummas; complications of the cardiovascular system, seizures, blindness.
- Congenital syphilis.
Diagnosis: Darkfield microscopy, staining with fluorescent-labeled monoclonal antibodies.
Primary & secondary stages treated with penicillin
Tertiary Stage: Gummas (degenerative lesions) form on the skin, bone, and nervous system due to hypersensitivity reactions.

Causative Agent: Chlamydia trachomatis
Invasive, infects the lymphoid system, leading to node enlargement and suppuration.
In males, causes enlargement of genitals; in females, rectal narrowing.
Treatment: Doxycycline.

Causative Agent: Haemophilus ducreyi
Prevalent in tropical regions.
Affects sexual organs, tongue, and lips.
Painful ulcer with granular base, not indurated, infectious lymph nodes, suppuration.
Incubation: 4-10 days.

Causative Agent: Gardnerella vaginalis
Infection of the vagina without signs of inflammation, due to imbalance of normal microbiota and higher pH.
Characterized by fishy odor, frothy vaginal discharge, and microscopic observation of clue cells.
Can lead to premature births and low-birth-weight infants.
No corresponding disease in males.

Causative Agent: Herpes simplex virus Type 2 (HSV-2)
Causes genital ulcers.
Incubation: 1 week.
In both males and females, causes painful urination and discomfort during walking.
Vesicles are highly infectious and heal in two weeks.
Disease can be transmitted even when no lesions or symptoms are present.
Recurrences in 88% of patients.
Neonatal herpes can cause fetal damage, mental retardation, and defective vision and hearing.
Treatment: Acyclovir.

Causative Agent: Human papillomavirus (HPV)
Extremely large, warty, fingerlike projections, others smooth or flat.
Some serotypes are associated with cancer (HPV 16 causes cervical and penile cancer).
DNA test to detect cancer-causing strains.
Vaccination (Gardasil) available against HPV strains.
Treatment: Imiquimod to stimulate interferon.

Causative Agent: Candida albicans
Often grows on mucous membranes; opportunistic overgrowth.
In females, causes vulvovaginal candidiasis.
In males, occasional cases of NGU.
Symptoms include severe itching, thick, yellow, cheesy discharge, and yeasty or no odor.
Treatment: Clotrimazole, miconazole.

Used to screen for infections that can be transmitted from a pregnant woman to her fetus.
TORCH stands for:
- Toxoplasmosis
- Other (syphilis, hepatitis B, enterovirus, Epstein-Barr virus, varicella-zoster virus)
- Rubella
- Cytomegalovirus
- Herpes simplex virus

Human herpes virus 1 (HHV1) / herpes simplex virus 1 (HSV1): cold sores around the mouth.
Human herpes virus 2 (HHV2) / herpes simplex virus 2 (HSV2): genital herpes.
Human herpes virus 3 (HHV3) / varicella-zoster virus: chickenpox.
Human herpes virus 4 (HHV4) / Epstein-Barr virus: infectious mononucleosis ("mono", the "kissing disease"). Transmitted through saliva.