Chapter 23 Infectious Diseases Affecting the Genitourinary System Chapter Outline

23.1. The Genitourinary Tract and Its Defenses A. Reproductive system 1. Male reproductive system produces, maintains, and transports sperm cells a. Consists of: i. Testes ii. Epididymis iii. Vas deferens iv. Prostate gland v. Scrotum (testes) vi. Penis b. Defenses include: i. Flushing action of urine 2. Female reproductive system produces eggs in a 28-day cycle a. Consists of: i. Uterus ii. Fallopian tubes iii. Ovaries iv. Vagina b. Defenses include: i. Mucus ii. Acidic pH in vagina iii. Secretory IgA B. Urinary tract 1. Kidneys 2. Ureters 3. Bladder 4. Urethra 5. Defenses include: a. Flushing action of urine b. Shedding of epithelial cells lining the urinary tract (desquamation) c. Acidity of urine d. Lysozyme and lactoferrin in urine e. Secretory IgA 23.2. Normal Biota of the Genitourinary Tract A. Outer region of the urethra harbors some normal biota 1. Nonhemolytic streptococci, staphylococci, corynebacteria, and some lactobacilli B. Normal biota of the male genital tract 1. Same as that of the urinary tract above C. Normal biota of the female genital tract 1. Vagina has normal biota 2. Cervix and above has no normal biota 3. Before puberty and after menopause, pH of vagina is close to neutral a. Normal biota similar to that of the urethra 4. After onset of puberty, release of glycogen induced by estrogen leads to an acidic pH in the vagina:

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a. Lactobacillus species b. Also Candida albicans (fungus) in low numbers 23.3. Urinary Tract Diseases Caused by Microorganisms A. Urinary tract infections (UTIs) 1. Bladder (cystitis) 2. Kidneys (pyelonephritis) 3. Urethra (urethritis) 4. Signs and symptoms a. Dysuria b. Hematuria c. Fever and nausea d. Back pain e. Septicemia can occur if pyelonephritis is inadequately treated 5. Causative agents a. E. coli, Staphylococcus saprophyticus and Proteus mirabilis 6. Pathogenesis and virulence factors 7. Transmission and epidemiology a. Nosocomial infections 8. Prevention a. Vaccine in development for E. coli 9. Treatment B. Leptospirosis 1. Signs and symptoms a. Leptospiremic phase b. Immune phase i. Weils syndrome 2. Causative agent a. Leptospira interrogans 3. Pathogenesis and virulence factors 4. Transmission and epidemiology a. Zoonosis, found in rodents, skunks, raccoons b. Also found in cattle, dogs, horses, and pigs 5. Prevention a. Vaccine available (limited use) 6. Treatment a. Amoxicillin or doxycycline C. Urinary Schistosomiasis 1. Signs and symptoms 2. Causative agent a. Schistosoma haematobium 3. Pathogenesis and virulence factors 4. Transmission and epidemiology 5. Culture and diagnosis 6. Prevention and treatment 23.4. Reproductive Tract Diseases Caused by Microorganisms A. Vaginitis and vaginosis 1. Signs and symptoms 2. Causative agent a. Candida albicans i. Pathogenesis and virulence factors: vaginitis ii. Transmission and epidemiology

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iii. Prevention and treatment b. Gardnerella species i. Pathogenesis and virulence factors: vaginosis, PID ii. Transmission and epidemiology iii. Culture and diagnosis iv. Prevention and treatment c. Trichomonas vaginalis i. Pathogenesis and virulence factors ii. Transmission and epidemiology: STD iii. Prevention and treatment B. Prostatitis 1. Acute a. Bacterial infection 2. Chronic a. Often bacterial, sometimes not 3. Symptoms include pain in the pelvic area, lower back, or genital area; frequence urge to urinate; blood in the urine; and/or painful ejaculation C. Discharge diseases with major manifestation in the genitourinary tract 1. Gonorrhea a. Signs and symptoms i. Urethritis ii. Salpingitis iii. Pelvic inflammatory disease (PID) b. Causative agent i. Neisseria gonorrhoeae c. Pathogenesis and virulence factors i. Attachment through fimbriae ii. Host cell invasion iii. IgA protease d. Transmission and epidemiology i. Sexually transmitted disease (STD) ii. Approximately 10% of males and 50% of females experience no symptoms e. Culture and diagnosis i. Gram stain of urethral discharge from males is diagnostic ii. PCR or ELISA needed in females due to normal biota f. Prevention g. Treatment i. Gonococcal Isolate Surveillance Project (GISP) ii. Antibiotic resistance to penicillin 2. Chlamydia a. Signs and symptoms i. Nongonococcal urethritis (NGU), cervicitis, PID ii. Lymphogranuloma venereum b. Causative agent i. Chlamydia trachomatis c. Pathogenesis and virulence factors i. Obligate intracellular pathogens d. Transmission and epidemiology e. Culture and diagnosis i. PCR or ELISA

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f. Prevention g. Treatment i. Azithromycin D. Genital ulcer diseases 1. Syphilis a. Signs and symptoms i. Primary syphilis ii. Secondary syphilis iii. Latency and tertiary syphilis iv. Congenital syphilis b. Causative agent i. Treponema pallidum ii. Spirochete c. Pathogenesis and virulence factors i. Binds to epithelium with hooked tip d. Transmission and epidemiology i. Humans are sole natural hosts ii. Bacterium is very sensitive to heat, drying, soap, disinfectants e. Culture and diagnosis i. Immunofluorescence ii. Wasserman iii. RPR, VDRL f. Prevention i. Detection and treatment of sexual contacts of syphilitic patients ii. Barrier protection g. Treatment i. Penicillin G 2. Chancroid a. Haemophilus ducreyipleomorphic gram-negative rod b. Primarily transmitted through sexual contact 3. Genital herpes a. Signs and symptoms i. Genital herpes b. Herpes of the newborn c. Causative agent i. Herpes simplex viruses (HSV) ii. HSV-1 and HSV-2 are DNA viruses d. Pathogenesis and virulence factors e. Transmission and epidemiology f. Culture and diagnosis g. Prevention i. Vaccines in clinical trials ii. Condoms 1. Male 2. Female h. Treatment i. Acyclovir ii. Valtrex E. Wart diseases 1. Human papilloma virus a. Signs and symptoms

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i. Genital warts ii. Condyloma acuminata iii. Malignancies b. Causative agent i. Human papilloma virus (HPV) ii. Nonenveloped DNA viruses c. Pathogenesis and virulence factors i. Oncogenes d. Transmission and epidemiology i. Direct contact e. Culture and diagnosis f. Prevention i. Gardasil vaccine ii. Prevents infection by four types of HPV iii. Pap smear g. Treatment i. Infection with any HPV is incurable ii. Cancerous cells can be removed but virus remains behind 2. Molluscum contagiosum a. A pox family virus b. Skin lesions c. Can be transmitted sexually or through fomites F. Group B strep colonizationneonatal disease 1. Asymptomatic colonization of women by a beta-hemolytic Group B Streptococcus 2. Small percentage of infected infants experience: a. Life-threatening bloodstream infections b. Meningitis c. Pneumonia 3. Pregnant women should be screened at 35 to 37 weeks of pregnancy 4. Positive women should be treated with ampicillin or penicillin

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