Diseases of the Urinary &

Reproductive System
Group 6
BSPh 3A
Urinary System
 Composed of organs that regulate the chemical
composition and volume of the blood and as a result,
excrete mostly nitrogenous waste products and water.
 It consists of two kidneys, two ureters, a single urinary
bladder, and a single urethra.
 In the female, the urethra conveys only urine to the
exterior.
 In the male, the urethra is a common tube for both urine
and seminal fluid.
Reproductive System
Its function is to produce gametes to propagate the
species and in the female, to support and nourish
the enveloping embryo and fetus.
 The female reproductive system consists of two
ovaries, two uterine (fallopian) tubes, the uterus,
including the cervix, the vagina, and external
genitals.
 The male reproductive system consists of two
testes, a system of ducts, accessory glands, and the
Diseases of the Urinary System
Lower Urinary Tract Upper Urinary Tract
Infections: Infections:
 Cystitis Pyelonephritis
 Urethritis
Systemic Bacterial Disease:
 Leptospirosis
Lower Urinary Tract Infections
CYSTITIS
 isa common
inflammation of
the urinary
bladder in
females.
Causative Agents

 E. coli / Escherichia coli

 Staphylococcus saprophyticus
Signs & Symptoms

Strong or foul smelling urine

Low fever (not everyone will have a fever)
Dysuria
Pyuria
Pressure or cramping in the lower middle abdomen or back
Strong need to urinate often, even right after the bladder
has been emptied
Laboratory Diagnosis

 As a general rule, a urine sample with more than 100

colony forming units (CFUs) per milliliter of potential
pathogens (such as coliforms) from a female patient with
cystitis is considered significant. The diagnosis should
also include a positive urine test for leukocyte esterase
(LE).
Treatments:

• The first-choice agents for treatment of uncomplicated acute cystitis in

women:
Nitrofurantoin monohydrate/macrocrystals
Trimethoprim-sulfamethoxazole (TMP-SMX)
Fosfomycin
Beta-lactam antibiotics
Fosfomycin and nitrofurantoin monohydrate/macrocrystals
For Complicated Cystitis:
 Fluoroquinolone antibiotics or ampicillin
URETHRITIS
 Inflammation of the urethra
Causative Agents

• Bacteria that commonly cause urethritis include:

 E. coli 
 Neisseria gonorrheae
 Chlamydia trachomatis
Laboratory Diagnosis

 Physical examination, including the genitals,

abdomen, and rectum
 Urine tests for gonorrhea, chlamydia, or other
bacteria
 Examination of any discharge under a
microscope
Signs & Symptoms

 Dysuria
Treatments

 Doxycycline (Vibramycin), Adoxa, Monodox, Oracea

 Azithromycin (Zmax), Zithromax
 Ceftriaxone (Rocephin)

If Urethritis is due to trichomonas infection, it is usually

treated with:
 Metronidazole (Flagyl)
Tinidazole (Tindamax)
Upper Urinary Tract Infections
PYELONEPHRITIS
 is an inflammation of the
kidney tissue, calyces, and
renal pelvis.
 In females, it is a
complication of the lower
urinary tract infection
Causative Agents

 Escherichia coli or E. coli

Signs & Symptoms

 Fever
 Back pain
Laboratory Diagnosis

 Blood Culture
 Gram stain of the urine
 A urine sample of more than 10,000 CFUs/ml
and a positive LE test indicate pyelonephritis.
Treatment

 Begins with intravenous, extended term

administration of a broad-spectrum antibiotic,
such as a second- or third-generation
cephalosporin.
SYSTEMIC BACTERIAL DISEASE
LEPTOSPIROSIS (Weil’s Disease)

 An infectious bacterial disease that occurs in

rodents, dogs, and other mammals and can be
transmitted to humans causes severe kidney or
liver disease.
Causative Agent

 Leptospira interrogans
Mode of Transmission

 People get leptospirosis by contact with fresh

water, wet soil or vegetation contaminated by
the urine of infected animals.
Signs & Symptoms

After an incubation period of 1 to 2 weeks, headaches,

muscular aches, chills, and fever abruptly appear.
Several days later, the acute symptoms disappear, and
the temperature returns to normal.
A few days later, however, a second episode of fever
may occur. In a small number of cases the kidneys and
liver become seriously infected (Weil's disease); kidney
failure is the most common cause of death.
Laboratory Diagnosis

Most cases of leptospirosis are diagnosed by a

serological test that is complicated and usually
done by central reference laboratories.
However, a number of rapid serological tests are
available for a preliminary diagnosis. Also, a
diagnosis can be made by sampling blood, urine,
or other fluids for the organism or its DNA.
Treatment

Doxycyline (a tetracycline) is the recommended

antibiotic for treatment; however, administration
of antibiotics in later stages is often
unsatisfactory.
Diseases of the Reproductive System
Bacterial Diseases: Protozoan Diseases:
 Gonorrhea  Trichomoniasis
 Syphilis
 Lymphogranuloma Venerum
 Chancroid

Viral Diseases:
 Genital Herpes
 Condylomata Acuminata
 AIDS/HIV
Bacterial Diseases
GONORRHEA
 A venereal disease involving inflammatory
discharge from the urethra or vagina in female
and penis in the male.
Causative Agent

 Neisseria gonorrhoeae
Signs & Symptoms

• Male: • Female:
Greenish yellow or whitish discharge from
Greenish yellow or the vagina.
whitish discharge from Lower abdominal or pelvic pain.
the penis. Burning when urinating.
Conjunctivitis (red, itchy eyes)
Burning when urinating.
Bleeding between periods.
Painful or swollen Spotting after intercourse.
testicles. Swelling of the vulva (vulvitis)
Mode of Transmission

 Primarily transmitted by sexual contact

Clinical Findings

• Gonorrhea infection in males:

Infection is restricted to the urethra and manifests purulent urethral
discharge and dysuria
• Gonorrhea infection in females:
Primary site: Cervix
May manifest with purulent vaginal discharge, dysuria and abdominal
pain.
Ascending infection like salpingitis, abscesses involving the fallopian
tubes and ovaries and pelvic inflammatory disease may develop if not
properly treated.
Clinical Findings

• Disseminated infections
Occurs 1-3% of cases
It present as fever, migratory arthralgia, suppurative arthritis of the
wrists, knees and ankles with erythematous base over extremities
• Other diseases associated with Neisseria gonorrhoeae:
Perihepatitis – Fitz-Hugh-Curtis Syndrome
Purulent Conjunctivitis
In newborns, it can cause opthalmia neonatorum upon passage
through the birth canal. It can result to blindness of the child.
Clinical Findings
• Untreated Gonorrhea:
It can disseminate and cause systemic infection
Complications of the heart (gonorrhea endocarditis),
joints, meninges (gonorrhea meningitis), and other parts
of the body.
Laboratory Diagnosis

Microscopy: Gram Stain

Culture: Thayer-Martin Medium
Treatment

Uncomplicated Gonorrhea
• Ceftriaxone
• Ciprofloxacin
• Cefixime
• Ofloxacin
• For a mixed infection with Chlamydia
• Any aforementioned drugs must be combined with Doxycycline
or Azithromycin
• Opthalmia Neonatorum
• 1% Silver Nitrate (previous) or 0.5% Erythromycin eye ointment
SYPHILIS
 A chronic bacterial disease that is contracted
chiefly by infection during sexual intercourse, but
also congenitally by infection of a developing
fetus.
Causative Agent

 Treponema pallidum
Mode of Transmission

Direct sexual contact

Congenitally
Blood transfusion
Clinical Findings

 Adult Syphilis
 Congenital Syphilis
Adult Syphilis

• Primary Syphilis
• Highly infectious stage
• Primary lesion: Chancre
• Secondary Syphilis
• It presents with flu-like symptoms and a generalized mucocutaneous rash.
• Characteristic lesion: Condylomata latum
• Latent Syphilis
• Patient is asymptomatic.
• Reactivation of secondary or progress to tertiary syphilis
• Tertiary Syphilis
• Characterized by skin (gummas) and other organ involvement such as cardiovascular
Congenital Syphilis

 Early Congenital Syphilis

• Manifests runny nose, rash, and condylomata lata as
well as hepatosplenomegaly
 Late Congenital Syphilis
• Manifested as 8th Nerve Deafness with bone and teeth
deformities.
• 
Laboratory Diagnosis

Darkfield microscopy
Serology
• Non-specific treponemal test – VDRL (Venereal
Disease Research Laboratory)
• Specific treponemal test – fluorescent
treponemal antibody absorption (FTA-ABS)
Treatment

Drug of Choice: PENICILLIN

Alternative Drugs: Tetracycline/Doxycycline
Prevention

 No vaccine
 Control is through practice safe sex techniques
of sexual partners
LYMPHOGRANULOMA VENEREUM
 also known as Climatic bubo, Durand–Nicolas–Favre
disease, is a sexually transmitted disease caused by the
invasive serovars L1, L2, L2a or L3 of Chlamydia
trachomatis. 
 LGV is primarily an infection of lymphatics and lymph
nodes.
Causative Agent

Chlamydia trachomatis – obligate intracellular

parasite that lack a cell wall.
Serotypes D to K – associated with non-
gonococcal urethritis, cervicitis and PID
Serotypes L1, L2, L3 – lymphogranuloma
venereum
Mode of Transmission

 Sexual Contact
Clinical Findings

Urogenital tract infections

o Asymptomatic.
o If symptomatic, it manifests cervicitis, endometritis,
urethritis, salpingitis, bartholinitis, perhepatitis, and
mucopurulent discharge.
Lymphogranuloma venereum
o Primary lesion appears at the site of infection.
o Lesion: Papule or ulcer
o Second stage: Manifested by enlarged lymph nodes that
are painful (buboes)
Laboratory Diagnosis

Giemsa-stained cell scrapings

Culture – most specific diagnostic method
 
Treatment

Azithromycin
Doxycycline
Erythromycin
CHANCROID (Soft Chancre)
 a venereal infection causing ulceration of the
lymph nodes in the groin.
Causative Agent

 Haemophilus ducreyi
Mode of Transmission

 Sexual Contact
Laboratory Diagnosis

 Microscopy and Culture

Treatment

 Cephalosphorins or Azithromycin
VIRAL DISEASES
GENITAL HERPES
 a disease characterized by blisters in the genital
area
Causative Agent

• Herpes simplex virus

• DNA Virus under the family of human Herpesviruses
• Two types of HSV: HSV-1 and HSV-2
• Capable of latency in the neurons
Mode of Transmission

Sexual Contact
Clinical Findings

Genital herpes is caused by HSV types 1 & 2 but

majority of cases are caused by type 2.
Primary Infections are asymptomatic.
Lesions: Vesicular and are accompanied by pruritus
and mucoid vaginal discharge
Neonatal Herpes – consequence of genital herpes
and is acquired in utero or upon passage through
infected birth canal
Laboratory Diagnosis

Tzanck Smear – demonstrate the characteristic

inclusion bodies (Cowdry type A)
Treatment

Drug of Choice: Acyclovir

No vaccine is available
CONDYLOMA ACUMINATA
refers to an epidermal manifestation attributed
to the epidermotropic human papillomavirus
(HPV)
known as GENITAL WARTS
Causative Agent

Human papillomavirus (Serotypes 6 & 11)

• DNA virus under the family of Papovaviruses
• Capable of immortalizing infected cell
Mode of Transmission

Sexual contact
Clinical Findings

Genital warts occur most commonly in the

genital or perianal areas
Infection is associated with cervical and penile
cancer (caused by serotypes 16 & 18)
Laboratory Diagnosis

Histologic examination
Papanicolaou smear
Treatment

 Injection of INTERFERON is preferred and most

beneficial treatment
ACQUIRED IMMUNODEFICIENCY
SYNDROME (AIDS)
Also known as Human Immunodeficiency Virus (HIV)
infection
Causative Agent

 Human Immunodeficiency virus (HIV)

• RNA virus under the family of Retroviruses.
• Possesses an enzyme, reverse transcriptase that
allows it to integrate its genome into the host cell’s
DNA.
 
Mode of Transmission

 Sexual Contact
 Parenteral Contact (blood transfusion, tattooing,
ear piercing, injections)
 Perinatal
Clinical Findings

HIV infection progresses from asymptomatic to profound

immunosuppression (full-blown AIDS)
Initially, patients present with flu-like or infectious mononucleosis-like
infections.
AIDS-related complex (ARC)
• Fever and lymphadenopathy occur
Kaposi’s sarcoma – hallmark of AIDS
Infections with Pneomocystis carinii (now as Pneumocystis jeruveci),
Mycobacterium intracellulare and severe cytomegalovirus infections
• Indicative of very low CD4+ cell count
Laboratory Diagnosis

Screening test: ELISA (Enzyme-linked

immunosorbent Assay)
Confirmatory test: Western blot assay
Treatment

• Reverse Transcriptase Inhibitors

• Azidothymidine (AZT)
• Dideoxycytidine (ddC)
• Used in combination with protease inhibitors like
• Indinavir or Saquinavir
Prevention

Avoidance of sexual contact with infected

individuals
Wearing of protective clothing such as gowns,
masks (healthcare professionals)
Disinfection of contaminated surfaces and
laundry
PROTOZOAN DISEASE
TRICHOMONIASIS
If the normal acidity of the vagina is disturbed,
the protozoan may overgrow the normal microbial
population of the genital mucosa
Causative Agent

• Trichomonas vaginalis
• Normal flora or inhabitant of the vagina in women and
of the urethra in many men
Clinical Findings

Often accompanied with gonorrhea

Resulting discharge: Profuse, yellow and
characterized by a foul odor
Asymptomatic
Known to cause preterm delivery and low birth
weight
Laboratory Diagnosis

 Microscopic examination
Treatment

Oral Metronidazole
• Administered to both sex partners
• A/E: Metallic taste in the mouth
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