Urinary and reproductive system

Cystitis
1. E. coli and Staphylococcus saprophytic
  1. Symp: Dysuria, Pyuria
  2. Dx:>1,000 CFUs/mL of a single species and a positive leukocyte esterase test
  3. Tx: Nitrofurantoin
  4. 8 times more common in women than men due to short length urethra and anal prosperity
Syphilis
1. Caused by Treponema pallidum
  1. Gram-negative spirochete ✓Grows slowly in cell culture
2. Invades the mucosa or through skin breaks and enters the bloodstream
3. Induces an inflammatory response
4. Some strains cause yaws ✓Skin disease is not sexually transmitted.
5. Stages
  1. Primary stage ✓Chancre at the site of infection about 3 weeks after exposure ▪Painless and highly infectious ▪ Disappears after 2 weeks
  2. Secondary stage ✓Skin and mucosal rashes, especially on the palms and soles ▪ Due to an inflammatory response
  3. Latent period ✓No symptoms
  4. Tertiary stage ✓Appear years after latency ▪ Due to cell-mediated immune reactions ✓Gummatous syphilis: gummas on many organs ✓Cardiovascular syphilis: weakens the aorta ✓Neurosyphilis: affects the CNS; dementia
6. Congenital: neurological damage to the fetus
7. Microscopic tests ✓Direct fluorescent-antibody test (DFA-TP) with monoclonal antibodies ➢Nontreponemal serological tests ✓Slide agglutination VDRL test ✓Rapid plasma reagin (RPR) test ➢Treponemal-type serological tests ✓Enzyme immunoassay (EIA) ✓Fluorescent treponemal antibody absorption test (FTA-ABS)
8. Tx: benzathine penicillin
Leptospirosis
1. Leptospira interrogans
  1. Fine spiral; stains poorly; obligate aerobe
  2. Transmitted by skin/mucosal contact from urine- contaminated water from domestic or wild animals
  3. Headaches, muscular aches, fever Kidney failure (Weil's disease) ✓Pulmonary hemorrhagic syndrome
  4. Diagnosed with a rapid serological test
  5. Tx: doxycycline
Pelvic Inflammatory Disease (PID)
1. Extensive bacterial infection of the female pelvic organs
2. Polymicrobial infection, usually: ✓N. gonorrhoeae ✓C. trachomatis
3. Chronic abdominal pain
4. Salpingitis:
  1. infection of the uterine tubes ✓Most serious form of PID ✓Scarring can cause infertility or ectopic pregnancy.
5. Treatment with doxycycline and cefotetan (a β-lactam)
Gonorrhea
1. Caused by Neisseria gonorrhoeae
  1. Gram-negative diplococcus
2. In the United States the incidence increased in 2016 to 130 cases per 100,000 people
3. Attaches to the epithelial mucosa by the fimbriae
  1. Invades the spaces between the columnar epithelial cells
    1. ▪Causes inflammation ▪Forms pus ▪Pharyngeal gonorrhea and anal gonorrhea
4. Symptoms ✓Men: painful urination and discharge of pus; epididymitis ✓Women: fewer symptoms; pelvic inflammatory disease
5. If left untreated, may disseminate and become systemic, Endocarditis Meningitis, Arthritis
6. Ophthalmia neonatorum: infant blindness due to a gonorrheal infection of the eyes
7. Diagnosis with Gram stain, ELISA, or monoclonal antibodies
8. Treatment with ceftrixone and azithromycin
Pyelonephritis
1. 75% E.coli
  1. Symp: fever and back or flank pain
  2. Dx: >100,000 CFUs/ml of single species and positive LE test
  3. Can form scar tissue in kidney and become life threatening
2. Tx: nitrofurantoin
Nongonococcal Urethritis (NGU)
1. Nonspecific urethritis (NSU)
  1. Any inflammation of the urethra not caused by N. gonorrhoeae
2. ➢Caused by: ✓Chlamydia trachomatis ✓Mycoplasma genitalium ✓Ureaplasma urealyticum
3. Painful urination and watery discharge; often asymptomatic; pelvic inflammatory disease (PID) in women
4. Diagnosis: NAATs
5. Treatment with azithromycin and doxycycline
Lymphogranuloma Venereum (LGV)
1. Caused by C. trachomatis
2. Infects the lymphoid tissue
  1. Regional lymph nodes become enlarged and tender ✓Discharge of pus and scarring
3. Diagnosis with blood test for antibodies to the organism; ELISA or NAAT
4. Tx:doxycycline
Chancroid (Soft Chancre)
1. Caused by Haemophilus ducreyi ✓Gram-negative rod
2. Painful ulcers of the genitals and swollen lymph nodes in the groin ✓Factors in the sexual transmission of HIV
3. Treatment with azithromycin or ceftriaxone
Bacterial Vaginosis
1. Caused by Gardnerella vaginalis ✓Pleomorphic Gram-negative rod
2. Vaginitis: inflammation of the vagina due to infection
3. Vaginosis: no sign of inflammation
4. pH above 4.5, fishy odor, copious frothy discharge
5. Clue cells ✓Sloughed-off vaginal epithelial cells covered with a biofilm of G. vaginalis
6. Treatment with metronidazole
Genital Herpes
1. Caused by herpes simplex virus type 2 (HSV–2)
2. Painful vesicles on the genitals; painful urination ✓Heals within 2 weeks
3. Recurrences from viruses latent in nerve cells ✓Due to menstruation, emotional stress, or illness
4. Diagnosis via culture or PCR
5. No cure; suppression and management with acyclovir, famciclovir, and valacyclovir
6. Neonatal Herpes
  1. Herpesvirus crosses the placental barrier and infects the fetus ✓Damages the CNS, developmental delays, blindness, hearing loss
  2. Survival rate of 40%
  3. Newborns infected from HSV exposure during delivery
  4. Diagnosed by PCR tests and fluorescent antibody tests
  5. Treatment with intravenous acyclovir
Genital Warts
1. Caused by human papillomaviruses Genital warts
2. Also known as condyloma acuminata
3. Serotypes 16 and 18 cause cervical cancer ✓Kills 4000 women in the United States annually
4. Treatment via removal of warts; podofilox and imiquimod
5. Prevention with the quadrivalent or nine-valent HPV vaccines
Candidiasis
1. Caused by C. albicans
2. Grows on the mucosa of the mouth, the intestinal tract, and the genitourinary tract ✓Due to opportunistic overgrowth caused by: ▪Antibiotic use ▪ Diabetes ▪ Hormones
3. Oral candidiasis: thrush
4. Vulvovaginal candidiasis: vaginitis
5. Yeasty, thick, yellow discharge
6. Treatment with clotrimazole or fluconazole
Trichomoniasis
1. Caused by Trichomonas vaginalis
  1. Normal inhabitant of the vagina and urethra
2. Grows when normal acidity of the vagina is disturbed
3. Irritation and a profuse, frothy, greenish yellow, foul odor discharge
4. Diagnosis with microscopic identification or a DNA probe
5. Treatment with metronidazole

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Urinary and reproductive system

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