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Microbiology: A Systems Approach, 2 nd ed. Chapter 23: Infectious Diseases Affecting the Genitourinary System. 23.1 The Genitourinary Tract and Its Defenses.

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microbiology a systems approach 2 nd ed

Microbiology: A Systems Approach, 2nd ed.

Chapter 23: Infectious Diseases Affecting the Genitourinary System

23 1 the genitourinary tract and its defenses
23.1 The Genitourinary Tract and Its Defenses
  • Urinary tract: removes substances from the blood, regulates certain body processes, and forms urine and transports it out of the body
    • Includes the kidneys, ureters, bladder, and urethra
    • Defenses
      • Flushing action of urine
      • Desquamation of the epithelial cells
      • Acidity of urine
      • Antibacterial proteins in urine
      • SecretoryIgA
genital system
Genital System
  • Genital system: reproduction , aka the reproductive system
    • Male reproductive system includes the testes, epididymis, vas deferens, prostate gland, scrotum, and penis
      • Defenses: flushing action of urine
    • Female reproductive system includes the uterus, fallopian tubes, ovaries, and vagina
      • Defenses vary over the lifetime of the woman
        • Childhood and after menopause: mucous is the major defense with secretoryIgA antibodies
        • During reproductive years: changes in pH
23 2 normal biota of the urinary tract
23.2 Normal Biota of the Urinary Tract
  • Outer region of the urethra harbors some normal biota
  • Nonhemolytic streptococci, staphylocci, corynebacteria, and some lactobacilli
  • Normal Biota of the Male Genital Tract
    • Same as described for urethra, since the urethra is the terminal “tube”
  • Normal Biota of the Female Genital Tract
    • The vagina harbors a normal population of microbes
      • Lactobacillusi species
      • Candida albicans at low levels
23 3 urinary tract diseases caused by microorganisms
23.3 Urinary Tract Diseases Caused by Microorganisms
  • Urinary Tract Infections (UTIs)
    • Urine is a good growth medium for many microorganisms
    • Reduced urine flow or accidental introduction of bacteria into the bladder can result in cystitis
    • If the infection also affects the kidneys it is called pyelonephritis
    • An infection only in the urethra: urethritis
  • Cystitis: sudden onset of symptoms
    • Pain in the pubic area
    • Frequent urges to urinate even when the bladder is empty
    • Burning pain accompanying urination (dysuria)
    • Cloudy urine
    • Orange tinge to the urine (hematuria)
    • Fever and nausea
    • Back pain indicates kidneys may also be involved
  • Zoonosis associated with wild animals and domesticated animals
  • Can affect the kidneys, liver, brain, and eyes
  • Major effects on the kidneys and is shed into the environment through animal urine
  • Two phases
    • Early (leptospiremic) phase
      • Sudden high fever, chills, headache, muscle aches, conjunctivitis, and vomiting
    • Second phase (immune phase)
      • Milder fever, headache, Weil’s syndrome (kidney invasion, hepatic disease, jaundice, anemia, and neurological disturbances)
urinary schistosomiasis
Urinary Schistosomiasis
  • Schistosomahaematobium lodges in to the blood vessels of the bladder
  • May or may not result in symptoms
  • If symptoms occur: itchiness in the area where the worm enters the body, fever, chills, diarrhea, and cough
  • Urinary tract symptoms occur later which may include blood in the urine and bladder obstruction
23 4 reproductive tract diseases caused by microorganisms
23.4 Reproductive Tract Diseases Caused by Microorganisms
  • Many are transmitted through sexual contact, but not all are
  • Three broad categories of sexually transmitted diseases
    • Discharge diseases
    • Ulcer diseases
    • Wart diseases
vaginitis and vaginosis
Vaginitis and Vaginosis
  • Inflammation of the vagina
  • Vaginal itching to some degree
  • Burning and sometimes a discharge occurs
  • Symptoms depend on the etiologic agent
candida albicans
Candida albicans
  • Normal biota living in low numbers
  • If grows rapidly and causes a yeast infection, white vaginal discharge occurs
gardnerella species
Gardnerella species
  • Infection called vaginosis rather than vaginitis because inflammation in the vagina does not occur
  • Vaginal discharge with a very fishy odor, especially fater sex
  • Itching is common
trichomonas vaginalis
Trichomonas vaginalis
  • Asymptomatic infections in approximately 50% of females and males
  • Some people experience long-term negative effects
  • Inflammation of the prostate gland
  • Acute or chronic
  • Pain in the pelvic area, lower back, or genital area; frequent urge to urinate; blood in the urine; and/or painful ejaculation
discharge diseases with major manifestation in the genitourinary tract
Discharge Diseases with Major Manifestation in the Genitourinary Tract
  • Increase in fluid discharge in male and female reproductive tracts
  • Includes trichomoniasis, HIV, gonorrhea, and Chlamydia infection
  • N. gonorrhoeae is the etiologic agent- also known as the gonococcus
  • Symptoms in the male
    • Urethritis, painful urination and a yellowish discharge
    • Can occasionally spread from the urethra to the prostate gland and epididymis
    • Scar tissue in the spermatic ducts during healing can render a man infertile (rare)
symptoms in the female
Symptoms in the Female
  • Likely that both urinary and genital tracts will be infected
  • Mucopurulent or bloody vaginal discharge
  • Painful urination if urethra is affected
  • Major complications occur when the infection ascends from the vagina and cervix to higher reproductive structures
    • Salpingitis
    • Pelvic inflammatory disease
  • Most common reportable infectious disease in the U.S.
  • Majority of cases are asymptomatic
  • Symptoms in males
    • Inflammation of the urethra
    • Symptoms mimicking gonorrhea
    • Untreated infections may lead to epididymitis
  • Symptoms in females
    • Cervicitis
    • Discharge
    • Salpingitis
    • May lead to PID

Certain strains can invade the lymphatic tissues, resulting in lymphogranuloma venereum

    • Headache, fever, muscle aches
    • Lymph nodes fill with granuloma cells and become enlarged and tender
  • Babies born to mothers with infections can develop eye infections and pneumonia
genital ulcer diseases
Genital Ulcer Diseases
  • Three common infectious conditions resulting in lesions on a person’s genitals
  • Syphilis, chancroid, and genital herpes
  • Having one of these diseases increases the chances of infection with HIV because of the open lesions
  • Three distinct clinical stages: primary, secondary, and tertiary
  • Latent periods of varying duration also occur
  • Transmissible during the primary and secondary stages, and the early latency period between secondary and tertiary
  • Largely nontransmissible during late latent and tertiary stages
primary syphilis
Primary Syphilis
  • Appearance of a hard chancre at the site of entry of the pathogen (after an incubation period of 9 days to 3 months)
  • Lymph nodes draining the affected region become enlarged and firm
  • Chancre filled with spirochetes
  • Chancre heals spontaneously in 3 to 6 weeks but by then the spirochete has moved into the circulation
secondary syphilis
Secondary Syphilis
  • 3 weeks to 6 months after the chancre heals
  • Many systems have been invaded
  • Fever, headache, sore throat, followed by lymphadenopathy and a red or brown rash that breaks out on all skin surfaces
  • Hair often falls out
  • Lesions contain viable spirochetes and disappear spontaneously in a few weeks
  • Major complications occur in bones, hair follicles, joints, liver, eyes, and brain
latency and tertiary syphilis
Latency and Tertiary Syphilis
  • Highly varied latent period, can last for 20 years or longer
  • Tertiary syphilis is rare because of the use of antibiotics
  • Major complications occur by this stage
  • Cardiovascular syphilis- weakens the arteries in the aortic wall
  • Gummas develop in tissues such as the liver, skin, bone, and cartilage
congenital syphilis
Congenital Syphilis
  • From a pregnant woman’s circulation into the placenta and fetal tissues
  • Inhibits fetal growth
  • Disrupts critical periods of development
  • No systemwide effects
  • Infection usually begins as a soft papule at the point of contact
  • Develops into a soft chancre (painful in men, but may be unnoticed in women)
  • Inguinal lymph nodes can become swollen and tender
genital herpes
Genital Herpes
  • Caused by herpes simplex viruses (HSVs)
  • Multiple presentations
    • No symptoms, or single or multiple vesicles on the genitalia, perineum, thigh, and buttocks
    • Lesions from initial infection can be accompanied by malaise, anorexia, fever, and bilateral swelling and tenderness of the groin
    • Occasionally meningitis or encephalitis can develojp
  • After recovery from initial infection, may have recurrent episodes of lesions; generally less severe
  • In the neonate and fetus, HSV infections are very destructive and can be fatal
wart diseases
Wart Diseases
  • Human papillomavirus (HPV)
    • Causative agents of genital warts
    • An individual can be infected with HPV without having warts, however
  • MolluscumContagiosum
    • Unclassified virus in the pox family
    • Can take the form of skin lesions
    • Wartlike growths on the mucous membranes or skin of the genital area
group b streptococcus colonization neonatal disease
Group B Streptococcus “Colonization”- Neonatal Disease
  • 10% to 40% of women in the U.S. are colonized asymptomatically by group B Streptococcus
  • When these women become pregnant, about half of their infants become colonized by the bacterium during passage through the birth canal
  • Small percentage of infected infants experience life-threatening bloodstream infections, meningitis, or pneumonia