1. Urogenital Infection In Diabetic
Females
Dr. Mamdouh Sabry
MD. Ain Shams, Ph.D. France
Consultant Ob. & Gyn.
EL Mataria Teaching Hospital, Nasser Institute
Cairo, Egypt

2.  Diabetic patients have higher risk of infection
with more risk of morbidity due to many factors
Hyperglycemia and acidemia that exacerbate
impairments in humoral immunity, polymorphs and
lymphocyte functions, ↓ random motion of
neutrophils, chemotaxis, phogocystosis and
microbial killing mechanisms.
Glucose levels in genital tissues enhance yeast
adhesion and growth.
Long standing D.M causes vasclopathy with poor
tissue perfusion.
Diabetic neuropathy results in delay response.

3.  As well as the sexual freedom, the earlier onset
of sexual activity and the revolution in
contraceptive pattern during last century
generated the virtual evolution of (STDs).
 ≤ 50% of women (♀♀♀) will have symptoms of
UTI.
 Women are more susceptible to infection than
men due to
 Anatomy of ♀ genital tract
 Ascent of organisms during sexual intercourse.
 Pregnancy
 Menopause.
( Anatomy – Physiology – Hormonal )

4. Urinary pathogens
 Usually single organism.
 E coli → Commonest, Proteus spp. 33% (boys <
5 years).
 Klebsiella spp. and coagulase negative
staphylococci.
 PS. spp. & staphylococci, others, follow
instrumentation and in abnormal UT.
 Mixed organisms → Catheterized pts.
 Chlamydia, Mycoplasma T.V. and Gonococci.
 T.B → -ve. cultures.
 Recurrence; re-infection 80% X relapse.

5. Emphysematous pyelonephritis → x ray → renal gas
E coli, kleb. or organisms capable of fermenting
glucose → CO2

7. Investigations
 Urine exam:  10/ml. WBCs.  culture  100/ml. PH, ….
 Mid stream urine:  105 CFU/ml, below this mostly due to
contamination.
 103 – 104 CFU/ml +  urine output  acute uretheral
syndrome.
 Ultrasound
 X ray
 IVP
 Micturation cystogram  reflux
 Cystoscope
 CT Scan, Isotope  scarring.

8. -  fluid intake.
- HRT.
- Post coital antibiotics.
- Chang pH of urine.
- Probiotics   PH, - H2O2.
-  frequency of bladder emptying.
- ♀ voiding after intercourse.
- Screening &ttt of silent bacteruria.
- Urovaccine 1/ day 3ms.
Treatment
(1) Prevention

9. Lower UTI
 3x5 days course
 Fosfomycine 3gm. Single dose
 Beta lactams
 TMP. SMX
 Fluoroquinolones
 Nitrofurantoin 1x4
14 days treatment (in or out patient).
Fluoroquinolones.
Fluoroquinolones + aminoglycosides (catheter).
Penicillins + aminoglycosides (catheter).
Piperacillin + Tazobactam
Cefotaxim - Ceftriaxone
Ticaracillin + clavulinic acid.
B lactams if gm + ve.
Special consideration: pregnancy, Lactation.
Upper UTI

10. Sexually transmitted pathogens
Bacterial agents:
N. gonorrhoeae (V)
C. trachomatis (III)
T. pallidum
H. ducreyi
Shigella spp.
Compylobacter
Group B streptococcus
G. vaginalis
Genital mycoplasmas
M. hominis
U. urealyticum
Fungal agents
C. albicans
Other fungi
Viral agents
Herpes simplex virus (IV)
Human papilloma virus (I)
HIV (VII)
Hepatitis A, B, C, D, G ± (VI)
Molluscum contagiosum V
Epstein – Barr virus
Human herpes V. type E
Human lymphotropic Vs.
Protozoan agents
T. vaginalis (II)
E. histolytica
G. lambia
Ectoparasites
P. pubis
P. scabiei

11. Major Sexually transmitted diseases
Syndrome/ complication STD Agent (s)
AIDS HIV
Pelvic inflammatory disease N.G., C.T., M.hom.,….
Female lower genital tract infection
Vulvitis C. albicans, herpes simplex V.
Vaginitis C. albicans, T. vaginalis
Cervicitis N.G., C.T., H.S. V.
Urethritis N.G., C.T.
Bacterial vaginosis G.V., Bact. spp., Peptos. spp., M.hom.
Genital warts HPV
Male genital tract
Urethritis sp. & non sp. N.G., C.T., U.U.,T.V
Epididymitis C.T., N.G.,T.V
Proctitis N.G., HSV, C.T.
Genital ulceration HSV, T.P., H.D., C.T (LGV)
Hepatitis HAV, HBV, HCV, CMV
Acute arthritis N.G., C.T.
Enterocolitis G.L., E.H., Shigella, Compylobacter

12. PREVENTION OF STD
 The primary prevention is directed to prevent
disease in future patient and contact (peaceful
screening)
• Abstain from sexual intercourse.
• Monogamous relationship (marriage)
 Preventive measures; drugs, barriers, vaccines
• ♂ Condom ♀ Condom
• Vaginal spermicides + cervical barriers.

13. Screening for STDs
 All individual attending STI clinics
 All patients with another STI. e.g. genital warts.
 Patients with recurrent vaginal discharge or vulval
symptoms
 Patients complaining of lower abdominal pain
 Patients with recurrent uretheral discharge, dysuria!
 Patients complaining of genital sore or ulcer
 Patients complaining of scrotal swelling or pain
 Mothers of enfants with Chlamydia conjunctivitis
 Before IVF

14. Post-exposure prophylaxis (sexual assault)
• NG, Ch.T, TV
• Ceftriaxone 125 mg x1 im
Plus
• Azithromycin 1 gm x1 or
doxycycline 100 mg x 2
x7 Plus
• Metronidazole 2 gm x1
• HIV
• Zidovudine and
• Lamuvudine or
• Didanosine and
• Stavudine + ?
• Nelfinavir or
• Indinavir
• All for 28 days.

15. Treatment
Drug selected for treating STIs should fulfill the
following criteria:
 High efficacy at least 95% .
 Low coast .
 Acceptable toxicity and tolerance .
 Single dose as much as possible .
 Oral administration .
 No contraindication .
 Organism resistance is unlikely to develop .

16. Treatment (Cont.)
I. HPV
II. T.V.
III. Ch.T.
IV. H.S. virus
V. Gonorrhoea
VI. HBV
VII.Syphilis
VIII.HIV
IX. Fungal
X. PID
XI. Bacterial vaginosis

17. Conclusion
 In simple words, prevention is better than cure
which means control blood glucose level in
diabetics.
 ↑ Awareness → media, HCW., premarital
counseling; this will help in UTI .
 In STD; no safe sex is available outside
marriage; no barriers can prevent; enough
vaccines are not available.
 We need revolution to get rid of imported
western sexual freedom.