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  1. 1. Chapter 26: Diseases of the Urinary and Reproductive System <ul><li>The urinary system </li></ul><ul><li>Regulates the composition and volume of the blood </li></ul><ul><li>Excretes nitrogenous waste products and water </li></ul><ul><li>Prone to infection since there is an opening to the external environment and the mucosal membranes are supportive of bacterial growth </li></ul>
  2. 2. Structure and function of the urinary tract <ul><li>The urinary tract consists of: </li></ul><ul><ul><li>2 ureters </li></ul></ul><ul><ul><li>1 bladder </li></ul></ul><ul><ul><li>1 urethra </li></ul></ul><ul><ul><li>2 kidneys </li></ul></ul><ul><li>Urine (waste products) are removed from the blood as it moves though the kidney </li></ul><ul><li>The urine then moves through the ureters into the bladder and exits the body through the urethra </li></ul><ul><ul><li>a. The male urethra also transports the seminal fluid </li></ul></ul>
  3. 3. Normal microbiota of the urinary tract <ul><li>The kidney, ureters, bladder, and upper urethra are kept sterile by the flow of urine </li></ul><ul><ul><li>a. Normal urine is acidic which has antimicrobial properties </li></ul></ul><ul><li>2. The outer region of the urethra harbors the following microbiota: nonhemolytic streptococci, staphylococci, corynebacteria, and some lactobacillus </li></ul>
  4. 4. Urinary tract infections (UTIs) <ul><li>Women have a short urethra which is close to the anus allowing bacteria from the GI tract into the bladder </li></ul><ul><li>Cystitis = common inflammation of the urinary bladder </li></ul><ul><ul><li>Pathogen = most common – E. coli – gram negative rod </li></ul></ul><ul><ul><li>Sxs: dysuria = difficult, painful urination and pyuria = pus in the urine, fever and nausea may be present </li></ul></ul>
  5. 5. Urinary tract infections (UTIs) <ul><li>3. Virulence = E. coli have adhesions at the ends of their long fimbriae that they use to attach to epithelial lining of the urinary tract </li></ul><ul><li>4. Prevention – empty bladder frequently and sanitary practices </li></ul><ul><li>5. Tx is antibiotics </li></ul>
  6. 6. Urinary tract infections (UTIs) <ul><li>Pyelonephritis = inflammation of 1 or both kidneys usually caused by E. coli </li></ul><ul><li>Untreated cystitis may lead to pyelonephritis which can then lead to bacteremia </li></ul><ul><li>Sxs = fever, flank and back pain </li></ul><ul><li>If the disease becomes chronic, scar tissue can form in the kidney leading to dysfunction </li></ul><ul><li>Can be life threatening so treatment begins with IV antibiotics </li></ul>
  7. 7. Urinary tract infections (UTIs) <ul><li>Leptospirosis </li></ul><ul><li>Pathogen = the spirochete Leptospira interrogans </li></ul><ul><li>Infection is a zoonosis associated with wild and domesticated animals </li></ul><ul><li>Mode of transmission – vehicle – urine or urine contaminated soil or water from an infected animal enters the mucous membranes of the eyes, nose or through a skin abrasion </li></ul>
  8. 8. Urinary tract infections (UTIs) <ul><li>Leptospirosis </li></ul><ul><li>4. Sxs: Leptospirosis has 2 phases </li></ul><ul><li>a. during the early phase the pathogen appears in the blood and CSF causing sudden high fever, chills, HA, muscle aches, conjunctivitis, vomiting </li></ul><ul><li>b. 2 nd phase the blood infection is cleared by body defenses and the fever is milder, HA due to leptospiral meningitis and Weil’s syndrome </li></ul><ul><li>1) Weil’s syndrome – kidney invasion, hepatic disease, jaundice, anemia, neurological disturbances </li></ul><ul><li>5. Dx is made by serological tests, or testing fluids for the organism or it’s DNA </li></ul><ul><li>6. Tx is doxycycline (a tetracycline) </li></ul>
  9. 9. The reproductive tract <ul><li>The reproductive system in males and females is involved in the production of gametes – sperm and eggs </li></ul><ul><li>These tracts are normally sterile except for the female vagina that is colonized by several types of resident microbiota </li></ul>
  10. 10. Diseases of the Reproductive tract <ul><li>Gonorrhea – is the most common reportable disease in the US, aka “the clap” from the French clappoir which means brothel </li></ul><ul><li>Neisseria gonorrhoeae – Gram neg diplococcus aka gonococcus </li></ul><ul><ul><li>a. Attaches to mucosal cells by fimbriae </li></ul></ul>
  11. 11. Gonorrhea <ul><li>2. A single unprotected exposure results in infection </li></ul><ul><li>a. in men – 20-35% of the time </li></ul><ul><li>b. in women – 60 -90% of the time </li></ul><ul><li>3. Females – gonococci invade the cervix, urethra, and may spread to the fallopian tubes (salpingitis) causing adhesions which make it difficult for the passage of eggs </li></ul><ul><li>a. sxs = may be asymptomatic or have abdominal pain, burning on urination </li></ul><ul><li>1) can lead to PID – bacterial disease affecting the pelvic organs </li></ul>
  12. 12. Gonorrhea <ul><li>4. Males – primarily affects the urethra </li></ul><ul><li>a. onset accompanied by tingling in the penis followed by painful urination </li></ul><ul><li>b. also 1 st a watery discharge, later white, thick fluid – resembles semen </li></ul><ul><li>5. Untreated males and female may become sterile </li></ul><ul><li>6. Pregnant women with untreated gonorrhea can transmit the disease to the eyes of the newborn during delivery = opthalmia neonatorum </li></ul><ul><li>a. prevent with Ag nitrate or antibiotics in eyes </li></ul>
  13. 13. Gonorrhea <ul><li>7. Pharyngeal gonorrhea </li></ul><ul><li>a. pharynx affected </li></ul><ul><li>b. sx = septic sore throat </li></ul><ul><li>c. transmitted during oral sex with infected partner </li></ul><ul><li>8. Dx in men is a smear of pus with the gonococcus </li></ul><ul><li>9. Tx = penicillin </li></ul>
  14. 14. Syphilis – A STD that progresses through several stages <ul><li>Treponema pallidum - gram neg spirochete </li></ul><ul><li>Stages: </li></ul><ul><li>Primary stage syphilis </li></ul><ul><ul><li>A hard chancre (sore) appears at the site of infection 10 – 90 days after exposure </li></ul></ul><ul><ul><li>The chancre is painless and fluid ( teaming with the spirochete) forms in the center </li></ul></ul><ul><ul><li>The chancre disappears in 2 - 6 weeks </li></ul></ul><ul><ul><li>Bacteria enter the bloodstream and lymphatic system </li></ul></ul>
  15. 15. Syphilis <ul><li>2. Secondary stage syphilis </li></ul><ul><li>a. several weeks after the chancre disappears a red or brown rash develops on the skin including the palms and soles </li></ul><ul><li>b. these lesions of the rash have viable spirochetes and disappear spontaneously </li></ul><ul><li>c. sxs = fever, HA, sore throat, hair loss, lymphadenopathy </li></ul><ul><li>d. can run a VDRL test (Venereal Disease Research Laboratory) at this stage - detects 99% syphilis cases </li></ul>
  16. 16. Syphilis <ul><li>3. Latent period </li></ul><ul><li>a. no sxs </li></ul><ul><li>b. after 2 – 4 years of latency the disease is not infectious except from mother to fetus </li></ul><ul><li>4. Tertiary stage period – years from onset of latent stage </li></ul><ul><li>a. this stage is relatively rare today because of antibiotics </li></ul><ul><li>b. gummas develop in tissue = soft, granular lesions that weaken blood vessels causing them to bulge and burst </li></ul>
  17. 17. Syphilis <ul><li>4. c. cardiovascular syphilis results in weakening of the aorta </li></ul><ul><li> d. neurosyphilis can involve any part of the nervous system </li></ul><ul><li>1) gummas in the nervous system lead to paralysis and insanity </li></ul><ul><li>5. Tx = penicillin in primary and secondary stages, not effective in tertiary stage </li></ul><ul><li>6. Spirochetes can cross the placental barrier in pregnant women and cause congenital syphilis to the fetus </li></ul>
  18. 18. Nongonococcal Urethritis (NGU) - STD <ul><li>1. Chlamydia trachomatis is the most common cause of NGU </li></ul><ul><li>2. Other causes of NGU = The mycoplasmas Ureaplasma urealyticum and Mycoplasma hominis infect the vagina of females and the urethra in females and males </li></ul><ul><li>3. sxs: </li></ul><ul><li>a. female = vaginal discharge, inflammation of the cervix, burning pain with urination, may spread to the fallopian tubes, may lead to PID and possible sterility </li></ul><ul><li>1) increased risk of cervical cancer </li></ul>
  19. 19. Nongonococcal Urethritis <ul><li>3. sxs: </li></ul><ul><li>b. male = painful urination, watery discharge, tingling sensation of the penis and inflammation of the epididymis ( an organ that lies along the posterior border of the testis), possible sterility </li></ul><ul><li>4. Newborns can contact the disease from an infected mother causing chlamydial ophthalmia or chlamydial pneumonia </li></ul>
  20. 20. Viral diseases of the reproductive system <ul><li>Genital Herpes – STD </li></ul><ul><li>1. Herpes simplex virus type 2 (also type 1) </li></ul><ul><li>2. Affects the external genitalia causing painful lesions in about 1 week after exposure </li></ul><ul><li>3. Fluid filled vesicles appear that rupture into painful ulcers </li></ul><ul><li>a. the vesicles contain the virus </li></ul><ul><li>b. the virus can be shed with no apparent lesions </li></ul>
  21. 21. Viral diseases of the reproductive system <ul><li>Genital Herpes </li></ul><ul><li>4. The virus has a lifetime latent period on nerve cells and can be re-activated by stress, illness, menstruation </li></ul><ul><li>5. Neonatal herpes can be passed to the fetus by an infected mother via the placenta or during childbirth </li></ul><ul><li>a. can cause neurological problems or mental impairment to the newborn </li></ul><ul><li>b. if mother has active lesions at the time of birth a C-section is advised </li></ul>
  22. 22. Viral diseases of the reproductive system <ul><li>Genital warts aka condylomata acuminata </li></ul><ul><li>Human papilloma viruses – DNA virus </li></ul><ul><li>Sexually transmitted papillomaviruses can cause growths on the penis or vagina </li></ul><ul><ul><li>a. Warts are pink and moist </li></ul></ul><ul><li>Linked to cervical cancer </li></ul><ul><li>In 2006 Gardasil vaccine protects against 70% of cancer causing papilloma viral strains </li></ul>
  23. 23. Fungal diseases of the Reproductive system <ul><li>Candidiasis </li></ul><ul><li>Candida albicans – an opportunistic dimorphic fungus </li></ul><ul><li>Held in check by Lactobacillus which produces lactic acid- acidic conditions make an inhospitable environment for Candida albicans </li></ul><ul><li>grows on mucous membranes of the mouth, GI tract and genitourinary tract </li></ul>
  24. 24. Fungal diseases of the Reproductive system <ul><li>Candidiasis </li></ul><ul><li>3. Oral candidiasis = thrush – newborns, AIDS pxs </li></ul><ul><li>4. Vulvovaginal candidiasis – most common cause of vaginitis </li></ul><ul><li>a. sx = severe itching, thick yellow cheesy discharge </li></ul><ul><li>b. predisposing factors = diabetes, antibiotic therapy, pg, BC pill </li></ul>
  25. 25. Protozoan diseases of the Reproductive Tract <ul><li>Trichomoniasis – non reportable STD </li></ul><ul><li>1. The flagellated protozoan Trichomonas vaginalis is a normal inhabitant in the vagina of females and urethra of males (rarely have sxs) </li></ul><ul><li>2. Trichomoniasis results when the acidity of the vagina is disturbed and the protozoa outgrows the normal microbiota </li></ul><ul><li>a. female – profuse greenish, yellow discharge with a foul odor accompanied by irritation and itching </li></ul><ul><li>b. male – asymptomatic or urethritis and burning urination </li></ul>
  26. 26. Protozoan diseases of the Reproductive Tract <ul><li>Trichomoniasis </li></ul><ul><li>May cause preterm labor and low birth weight </li></ul><ul><li>Dx = microscopic exam of discharge </li></ul><ul><li>Tx = Metronidazole </li></ul>