Urogenital System Infections Flashcards

Urogenital System Infections

The urogenital system includes the urinary tract and reproductive system.
It is prone to infection due to openings to the external environment and the presence of normal flora on the skin.
Infections often result from dysbiosis of the microbiota.
Common UTIs are the most common bacterial infection worldwide, with millions of cases each year.
Sexually transmitted infections (STIs) are also significant, with approximately 20 million new cases reported annually in the United States, half of which occur in the 15-24 age group.
Infections may affect males and females differently due to anatomical differences.

Anatomy and Normal Microbiota of the Urogenital Tract

Key features include the urethra, bladder, ureters, and kidneys.
Infections higher up in the urinary tract are more serious.
The nephron is the functional unit, filtering blood and removing water and dissolved compounds.
Filtrate enters the glomerulus, goes to the proximal convoluted tubules, and passes into urine flow in the ureters.
Constant flow decreases the likelihood of infections.

Reproduction System

Women have a shorter urethra, increasing susceptibility to UTIs due to close proximity to the anal area.
The lower urethra contains normal skin microbiota.
Ureters and Kidneys are sterile
Urine contains antibacterial components but is nutrient-rich, allowing bacterial growth.
Hydration is key to preventing UTIs by flushing the system.

Normal Microbiota of the Vagina

Lactobacillus predominates (90% or greater), along with Bifidobacterium (about 9%) and conditionally pathogenic microorganisms (about 1%).
Dysbiosis can lead to vaginal infections, STDs, and UTIs.
Lactobacillus produces antibacterial peptides and lactic acid, maintaining an acidic environment.
Lactic acid production relies on glycogen from vaginal epithelial cells and is regulated by estrogen.
Increased estrogen leads to increased glycogen and lactic acid, lowering vaginal pH.
Changes in estrogen levels (menstrual cycle, menopause) alter the microbiota population, potentially diminishing Lactobacillus and increasing infection risk.

Signs and Symptoms of Urogenital Infections

UTIs commonly cause inflammation (cystitis in the bladder, urethritis in the urethra).
Men may experience burning during urination, penile discharge, and blood in semen or urine.
Women may experience painful, frequent urination, vaginal discharge, fever, chills, and abdominal pain.
Frequent leakage and potent urine odor may occur.
Pyelonephritis (kidney infection) can develop from a UTI, leading to systemic symptoms like fever, chills, nausea, vomiting, and lower back pain.
Predisposing conditions and anatomical features (short urethra in women) increase UTI risk.
Glomerulonephritis involves inflammation of the glomeruli, causing proteinuria (excessive protein in urine) and hematuria (blood in urine).
Red blood cell casts may be present in urine.
Kidney dysfunction can lead to fluid retention and edema in the face, hands, and feet.
In males, epididymitis, orchitis, and prostatitis involve inflammation of the epididymis, testicles, and prostate gland, respectively, causing pain, swelling, and urinary symptoms.
In women, vaginitis is inflammation of the vagina due to overgrowth of bacteria or fungi.

Degrees of Purity in the Vagina:

First degree: pH less than 6, 95% lactobacillus.
Second degree: pH 6-7, lactobacillus decreases to about 60%, increase in gram-positive cocci.
Third degree: pH around 7, random lactobacilli, large number of white blood cells.
Fourth degree: pH greater than 7, virtually no lactobacillus, proliferation of pathogenic flora, high white blood cell count.
Bacterial vaginosis causes a thin, gray discharge with a fishy odor.
Yeast infections cause intense itching and a cottage cheese-like discharge, possibly with a bready smell.

Symptom Checker

Yeast infections and bacterial vaginosis typically lack fever, chills, lower abdominal pain, nausea, or vomiting.
Yeast infections: Intense itchiness, rash around vagina/vulva.
Bacterial vaginosis: Pain/burning during urination, strong fishy odor.

Pelvic Inflammatory Disease (PID)

Infection of female reproductive organs (uterus, cervix, fallopian tubes, ovaries) can lead to infertility. Common pathogens are Neisseria gonorrhoeae and Chlamydia trachomatis.
Salpingitis is inflammation of the fallopian tubes with lower abdominal pain, fever, chills, nausea, vomiting, vaginal discharge, and painful urination.
Untreated PID can cause infertility due to abscesses and pus buildup.
Severe cervical motion tenderness (chandelier sign) indicates PID.
Elevated C-reactive protein and erythrocyte sedimentation rates indicate inflammation.
Hormonal changes during the menstrual cycle, pregnancy, and menopause affect vaginal health.

Estrogen's Role

Estrogen regulates glycogen availability and lactic acid production by Lactobacillus.
Low estrogen levels increase vaginal pH and risk of bacterial and yeast infections.
Thinning of the vaginal wall increases susceptibility to tears and abrasion.
Estrogen therapy may help maintain vaginal health.

Biofilms

Unusual growth and biofilms can occur due to hormonal changes.
Intracellular bacterial communities (IBCs) may form, causing infections.
Uropathogenic E. coli is a common cause.

Uropathogenic E. coli

E. coli proximity to the urethra and vagina often causes infections in women.
Detected on Eosin Methylene Blue (EMB) agar with purple colonies and a green metallic sheen.

UTI Prevention Tips

Good hygiene practices, appropriate wiping techniques, and keeping the area clean and dry.
UTIs in men are more associated with enlarged prostate, kidney stones, or catheter placement.

Sexually Transmitted Infections (STIs/STDs)

CDC prefers the term sexually transmitted disease, while WHO prefers sexually transmitted infection.
Physical contact can cause cross-contamination in the genital region.
Swollen lymph nodes may occur, with local or systemic effects, including liver damage or immunosuppression.
STIs are on the rise, especially among younger age groups.

Bacterial UTIs

Bacteria are the most common cause of UTIs, especially in the urethra and bladder.
Cystitis is bladder infection accompanied by dysuria (painful urination), hematuria (blood in urine), and pyuria (pus in urine).
Catheterization, prostatitis in men, and kidney stones increase bladder infection risk.
UTIs and bladder infections in the elderly present differently and are often more severe, with agitation, hallucinations, disorientation, and confusion.
Elderly individuals are more susceptible due to incomplete bladder emptying, weaker immune systems, immobility, and incontinence.

Urine Analysis

Urine analysis detects gram-positive and gram-negative bacteria using dipsticks or test strips for rapid screening.
High nitrate/nitrite levels indicate E. coli or Klebsiella pneumoniae due to nitrate reductase production.
Leukocyte esterase detects the presence of neutrophils, indicating infection.
Urine color variations, such as dark shades of yellows, greens, browns and reds may indicate infections or kidney stones.
- Red or pink: Blood, tumors in bladder of kidney
- Orange: mild dehydration or problems with the liver or bile ducts
- Brown: Diet medication
- Neon or dark yellow: Severe dehydration
Simple screenings are followed by urine cultures to confirm the organism.
Blood agar and MacConkey's agar are used to identify fecal pathogens.
Clean-catch samples require proper technique to reduce contamination.
A colony count above a million colonies per milliliter indicates infection.
Treatment involves antibiotics, such as sulfa drugs, fluoroquinolones, and cephalosporins.
Broad-spectrum antibiotics can cause collateral damage and select for drug-resistant strains.

UTI Prevention

Urinate after sexual activity.
Stay well-hydrated.
Take showers instead of baths.
Minimize douching sprays and powders in the genital area.
Teach young girls to wipe from front to back.

D-Mannose

D-mannose products target E. Coli-caused UTIs, binding to the bacteria and flushing them out.
It may not work for bacterial biofilms or when bacteria are in IBCs.

UTIs Antibiotic Prescription problems

A 2021 study found that doctors were treating nearly half the time with the incorrect antibiotics
Treat with narrow spectrum antibiotics for shorter durations and stop perscribing broad-spectrum and monitor treatment closely.

Kidney Infections

True kidney infections, pyelonephritis, (inflammation of the kidneys), are more acute, and the main culprit again is E. coli.
Back pain, fever, nausea, or vomiting, will be present along with gross hematureia 30 to 40 percent in women not men.

Glomerulonephritis

Glomerulonephritis is when the glomeruli of the nephrons are damaged from inflammation. This can be acute or chronic, and associated with Streptococcus pyogenes.
Antibodies are trying to clear the strep pyogenes which then clump, leading to an inflammatory response by neutrophils.
There's a ruffled appearance to them in the complex's.

Leptospirosis

Leptospirosis is a spirochete found in soil and various animals that can enter through mucous membranes or skin.
It causes fever, headache, chills, vomiting, diarrhea, rash, and muscle pain.
Infection associated with the kidneys and liver is referred to as Wheals disease
Associated diagnoses rely on PCR reactions and immunobase detection

Urethritis

There are two types which are Gonorrheal from Neisseria gonorrhoeae, and non gonococcal (NGUs) which are unrelated to Neisseria gonorrhoeae.
NGUs in Women may be asymptomatic and if men are asymptomatic can lead to pelvic inflammatory disease and Salpingitus can also lead to a chronic purulent discharge and painful urination (dysuria).

NON gonococcal urethritis

Chlamydia trachomatis is the most frequently reported STI (Often asymptomic)
Mycoplasms and uroplasms, are commonly found in healthy indiviuals can lack antigenic variation and be able to be established.
There NGUs can co infect and make the organisms very resistant to antiobotics even.
Diagnosis rely on urethral swabs, urine cultures, PCR tests and nucleic acid amplification test to then begin specific treatment.