Chapter 23

 

Infectious Diseases Affecting the Genitourinary System

 

 

Urinary Tract Diseases

   Any condition that prevents or impairs the normal emptying of the bladder may increase the risk for infection

   Although the urinary system is most likely infected from organisms ascending the urethra, it can also be invaded by infections from the bloodstream

 

 

 

Urinary Tract Diseases: Bacterial Cystitis

   Inflammation of the bladder; also called urinary tract infection (UTI)

  More common in women due to shorter urethra and closeness of urethra to anus

   Symptoms include painful urination, urinary urgency and frequency, cloudy urine in small amounts

   Pyelonephritis - bacteria invade the ureters and cause a kidney infection

  causes fever, chills, back pain, vomiting and can lead to septicemia and kidney failure

   Most UTIs originate from normal intestinal flora such as E. coli (80-90%), Staphylococcus saprophyticus, & Proteus species

   UTIs are the most common nosocomial infection and are usually acquired from catheters

   Treated with antibiotics

 

 

 

 

Leptospirosis

   Causative agent is Leptospira interrogans

   Originates from the bloodstream rather than the lower urinary system 

   Leptospiremic phase

  septicemic phase that occurs 10 days after infection with headache, spiking fever, chills, bloodshot eyes, and muscle  pain

   Immune phase

  milder period where blood infection is cleared

  Weils syndrome - can lead to damage of multiple organs (heart, brain, liver, kidney)

   Transmission is by contact of skin or mucous membranes with infected animal urine

  In soil or water where the organisms can remain infectious for as long as two weeks

   Treatment with antibiotics early

 

 

 

Reproductive Tract  Diseases: Bacterial Vaginosis

   Associated with a decrease in protective Lactobacillus in the vagina and increase in bacterial species such as Gardnerella vaginalis and Mobiluncus            

   Symptoms include itching, a gray-white discharge from the vagina and a pungent fishy odor

   Chronic infection may lead to infertility

   May or may not be sexually transmitted

   Treat with antibiotics

 

 

 

Vulvovaginal Candidiasis (Yeast Infection)

   Caused by the yeast Candida albicans

  part of the normal flora in 50-100% of people

   Causes symptoms of vaginitis including itching, burning, thick white vaginal discharge, redness and swelling

   Results from disruption of the normal flora caused by antibiotic treatment, pregnancy, diabetes

   Considered non-contagious but may be sexually transmitted

   Treat with topical or oral anti-fungals

 

 

 

Discharge Diseases: Gonorrhea

   Caused by Neisseria gonorrhoeae

  Virulence factors include IgA protease and phase variation of fimbriae

  Continually changes antigens to confuse immune system

   Men may develop urethritis, painful urination, and a thick mucus discharge from the penis

may spread to prostate gland and epididymis and cause scarring and sterility

   50% of women are asymptomatic and more likely to be unknowing carriers

Symptoms are a  mucopurulent or bloody vaginal discharge along with a UTI

Salpingitis inflammation and scarring of the fallopian tubes when the infection ascends beyond the vagina and cervix

  results in pelvic inflammatory disease (PID)

  increases the risk for sterility and ectopic pregnancies

   Bacteria can enter bloodstream and affect the joints, skin, heart, and brain

   Ophthalmia neonatorum - eye infection of newborn babies acquired from infected mothers during birth

treat eyes with antibiotic <1 hour after birth

   Treated with antibiotics, but many are resistant

PPNG and TRNG

 

 

 

Chlamydia

   The causative agent is Chlamydia trachomatis

   70-85% of females and 10-25% of males are asymptomatic

   In males the bacteria causes urethritis, a gray-discharge from the penis, and painful testes (epididymitis)

   In women it results in cervicitis accompanied by white discharge and  abdominal pain

Inflammation can cause salpingitis which can lead to sterility and ectopic pregnancy from PID

   Newborn babies of infected mothers can develop inclusion conjunctivitis and pneumonia during birth

   Lymphogranuloma venereum lymph nodes in the groin swell and drain pus

   Treated with antibiotics

 

 

 

Trichomoniasis

   Caused by the flagellated protozoan Trichomonas vaginalis

   Usually asymptomatic, but may involve the production of a frothy, green or yellow discharge and itching and burning 

   Infected men are usually asymptomatic carriers, but can have penile discharge, painful urination, or painful testes

   Chronic infection may lead to infertility

   Treated with anti-protozoan drugs

 

 

 

Genital Ulcer Diseases: Syphilis

   Caused by Treponema pallidum

   Difficult to diagnose because symptoms resemble many other diseases and are separated in time

   Primary syphilis

A hard chancre (painless ulcer) forms at the site of infection usually on the internal or external genitalia

Usually heals without treatment in 3-6 weeks but the disease is still present

   Secondary syphilis

Usually begins about 6 weeks after the chancre heals

Initial symptoms are aches and pains, runny nose, watery eyes, and sore throat

These progress into infection of the lymph nodes and a rash covering the whole body

Infectious lesions form on skin and mucous membranes, especially in the mouth

Symptoms usually disappear in a few weeks

   Tertiary syphilis

If the patient enters the tertiary stage the complications are serious

Gummas painful tumors that can develop in liver, skin, bone, and cartilage

Neurosyphilis can cause convulsions, blindness, and dementia

   Congenital syphilis - crosses the placenta to involve the fetus

Symptoms can range from mild to extreme depending on when exposure occurred

   Penicillin is effective treatment

 

 

Chancroid

   Characterized by single or multiple genital sores called soft chancres and swollen lymph nodes that may rupture

   Unlike syphilis the chancre is very painful and multiples may fuse to form one large lesion (coalesce)

   Caused by Haemophilus ducreyi

   Sexual transmission only; commonly seen among prostitutes

   Treated with antibiotics

 

 

 

Genital Herpes

   Caused by herpes simplex virus Type 2 (HSV-2)

   Symptoms include itching, burning, or painful sensations and local lymph node enlargement

small vesicles may form that break and  leave ulcerated areas that then crust over

   The latent virus establishes itself in sensory neurons and cannot be cured

Upon reactivation, the virus reinfects the area supplied by the nerve

Many persons have no symptoms while others have frequent recurrences

   Transmission can occur in the absence of symptoms but the risk is much higher when lesions are present

   Immunocompromised patients can develop meningitis or encephalitis

   HSV poses a serious risk to newborn babies if the mother has a primary infection near delivery

can affect the mouth, skin, eyes, or central nervous system

   Acyclovir can decrease severity and recurrences

 

 

   Genital ulcer diseases can facilitate the spread of HIV

 

 

 

Wart Diseases: Genital Warts and Cervical Cancer

   Caused by Human Papillomaviruses (HPV)

30 types associated with genital warts

   Range from tiny, inconspicuous papillomas (warts) to large cauliflower-like growths (condyloma acuminata)

   Primarily affects the external genitalia but may infect the cervix, urethra, and anus

   Non-wart causing strains of HPV have been linked to cervical cancer

most infections are asymptomatic

detected with Pap smear

treated by laser removal or freezing

vaccine available