Microbial Infections of the Urinary and Reproductive System

LEARNING OBJECTIVES At the end of this lecture the students will be able to: Identify the common microbial infections involving the urinary and reproductive system Differentiate which specific pathogens that are responsible for the development of the disease in the specific system Outline the various signs and symptoms Describe the treatments involved.

OUTLINE Microbial Diseases of the Urinary System Bacterial Diseases: Review of the structure and function Normal flora Bacterial Diseases: Cystitis Pyelonephritis Leptospirosis Microbial Diseases of the Reproductive System Bacterial Diseases: STD Gonorrhea Nongonococcal urethritis Pelvic Inflammatory Disease Syphilis Viral Genital Herpes Genital Warts Fungal Candidiasis Protozoan Trichomoniasis

MICROBIAL INFECTIONS OF THE URINARY SYSTEM

Structure and Function of the Urinary System The urinary system regulates the chemical composition and volume of blood and excretes nitrogenous waste and water. Urine is transported from the kidneys to the ureters to the urinary bladder and is eliminated through the urethra. Valves prevent urine from flowing back to the urinary bladder and kidneys. The flushing action of urine and the acidity of the normal urine have some microbial value.

Normal Flora Urinary bladder and upper urinary tract sterile Urethra - low normal flora Vagina Low pH and estrogen stimulate glycogen Lactobacilli digest glycogen produce acid products. Therefore low pH inhibits unwanted growth. Pre menstrual and post menopause low estrogen and different flora If >1,000 bacteria/ml or 100 coliforms/ml of urine indicates infection

Microbial disease of the Urinary System Bacterial Diseases CYSTITIS is a common inflammation of the urinary bladder in females Symptoms: dysuria (difficult, painful, urgent urination) and pyuria More common in females due to proximity to GI tract and shorter urethra Common causes: E. coli and Staphylococcus saprophyticus Treatment: Trimethropin- sulfamethoxazole

PYELONEPHRITIS About 25% untreated cases of cystitis progress to pyelonephritis This is an inflammation of one or both kidneys which generally results in bacteremia; potentially a life-threatening condition When chronic, scar tissue forms in the kidneys and severely impairs functions Symptoms: fever and flank or back pain In females, this is a complication of the lower urinary tract infections. Causative agent: E. coli Treatment: begins with intravenous, extended-term administration of a broad-spectrum antibiotics ( second or third generation cephalosporin).

LEPTOSPIROSIS Primarily a disease of domestic or wild animals but can be passed to humans and sometimes cause severe kidney or liver disease. Causative Agent: spirochete Leptospira interrogans Humans become infected by contact of urine-contaminated water or soil or sometimes with animal tissue Pathogen enters through minor abrasions Symptoms: headache, muscular aches, fever, kidney failure a possible complication Treatment: Doxycycline

Microbial Infections of the Reproductive System

Structure and Function The reproductive system produces gametes for reproduction and in the female, supports the growing embryo. The female reproductive system consists of two ovaries, two uterine tubes, the uterus, cervix, vagina and the external genitals. The male reproductive system consists of two testes, ducts, accessory glands, and the penis, seminal fluid leaves the male body through the urethra.

Microbial Diseases of the Reproductive System Bacterial Diseases Sexually Transmitted Diseases (STDs ) diseases of the reproductive system transmitted by sexual activity this term has been replaced by Sexually Transmitted infections because many persons infected do not have apparent signs or symptoms. Prevented by condoms Treated with antibiotics if bacterial

GONORRHEA cause by Neisseria gonorrhoeae Attaches to oral or urogenital mucosa by fimbriae “catch a ride on sperm” Female to male - 30% Male to female - 60 - 90% Females may be asymptomatic; males have painful urination and pus discharge (80% of time) Treatment with antibiotics Untreated may result in PID - abdominal infection - pain and scarring Ectopic pregnancy Reduced fertility and Sterility (~25%) Ophthalmia neonatorum

Nongonococcal Urethritis (NGU) Also known as nonspecific urethritis (NSU) is an inflammation of the urethra not caused by Neisseria gonorrhea May be transmitted to newborn's eyes Symptoms: include painful urination and a watery discharge

Pelvic Inflammatory Disease Bacterial infection of the female pelvic organs, particularly the uterus, cervix, uterine tubes or ovaries. Caused by: N. gonorrhoeae, C. trachomatis Can block uterine tubes Symptoms: The major symptoms are lower abdominal pain and abnormal vaginal discharge Other symptoms: as fever, pain in the right upper abdomen, painful intercourse, and irregular menstrual bleeding can when caused by chlamydial infection, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs.

SYPHILIS Causative agent: Treponema pallidum ( a gram-negative spirochete) Primary Stage: initial sign is a small, hard- based chancre, or a sore appearing at the site of infection 10-90 days following exposure Secondary: Skin and mucosal rashes Latent period: No symptoms

Congenital: Neurological damage Tertiary: occurs only after an interval of many years from the onset of the latent phase. In the third stage large degenerative lesions called gummas form on the skin, bone and nervous system as a result of hypersensitivity reactions. Other symptoms include mental retardation, blindness and physical instability. This is a gumma that has formed on the hand of a patient in the tertiary stage of syphilis Congenital: Neurological damage Primary & secondary stages treated with penicillin

Viral Disease of the Reproductive Systems GENITAL HERPES Herpes simplex virus 2 (Human herpesvirus 2) or HHV 2 Symptoms: Burning vesicular rash Recurrences from viruses latent in nerves (80%) Usually recurrences are progressive reduced Neonatal herpes transmitted to fetus or newborns Suppression: acyclovir or valacyclovir

Caused by human papillomaviruses Genital Warts Caused by human papillomaviruses Some human papillomaviruses that cause genital warts have been associated with cancer of the cervix Treatment: Imiquimod to stimulate interferon HPV 16 causes cervical cancer and cancer of the penis DNA test to detect cancer-causing strains Vaccination against HPV strains Gardasil

Fungal Diseases Candidiasis Caused by Candida albicans Very common 50% of women by age 25 have at least one office visit - 75% of women at least one occurence Grows on mucosa of mouth, intestinal tract, genitourinary tract NGU in males Vulvovaginal candidiasis – characterized by lesions that produce itching and irritation Predisposing factors – pregnancy, diabetes, tumors and broad- spectrum antibacterial chemotherapy Diagnosis by microscopic identification and culture of yeast Treatment: clotrimazole or miconazole

Protozoan Diseases TRICHOMONIASIS Trichomonas vaginalis is frequently a normal inhabitant of the vagina in women and the urethra in many men Pathogen can be found in the semen or urine of male carriers. Usually sexually transmitted. Results when normal acidity of the vagina is disturbed causing the protozoan to overgrow the normal microbial population of the genital mucosa Protozoan infection results to accumulation of leukocytes leading to profuse, greenish yellow discharge characterized by a foul odor. the discharge is accompanied by irritation and itching Treatment: oral metronidazole, administered to both sex partners

References: Engelkirk, P.G., Engelkirk, J.D. (2015). Burton’s Microbiology for the Health Sciences 10th Ed.Wolters Kluwer Health, Philadelphia, USA. Tortora, G.J., Funke, B.F. (2015). Microbiology: An Introduction. Pearson Publication. ISBN-13:978-0321929150. ISBN-10:0321929152. Tortora, G.J., Funke, B.R., and Case, C.L. (2013) Microbiology: An introduction. 11th ed. Pearson publishers NY.