Diseases of the Urinary & Reproductive Systems Chapter 24

Structures of Urinary System Kidneys Nephrons are functional unit (1.25 million per kidney) Ureters Urinary bladder Urethra Much longer in males

Structures of Reproductive System Females Urinary and reproductive systems are distinct

Males Urinary and reproductive systems share components

Normally urine and urinary tract above bladder are sterile Urethra contains normal resident flora Lactobacillus, Staphylococcus, Corynebacterium and Streptococcus Normal flora varies in female genital tract Depends on hormones Lactobacillus

Non-venereal diseases of urinary tract Affect males and females Urinary tract infections Leptospirosis

Urinary Tract Infections 8 million cases annually in US 600,000 nosocomial May include any or all of the organs Urethritis – inflammation of urethra Cystits – inflammation of the urinary bladder Ureteritis –inflammation of the ureters Pyelonephritis – inflammation of the kidneys

Causative agents: Usually intestinal flora E. coli – most common Proteus and Klebsiella Psudomonas Typically nosocomial Non-enteric bacteria Non-invasive and opportunistic

Signs and Symptoms Dysuria – frequent, painful urination cloudy urine with foul odor; may have pale red color 9due to blood in urine) Tenderness of pelvic area May have slight fever

Pathogens typically ascend urethra and attach to receptors on bladder lining May form biofilm Pyelonephritis Sudden elevation of temperature, chills, vomiting and back pain, bacteremia (may result in septicemia if bacteria gain entrance into the blood stream)

Epidemiology Typically results from auto-inoculation (except for nosocomial infections) 30% of women develop UTI Risk factors include: short urethra; sex; use of diaphragm; pregnancy, catheterization Infections less common in men More common after age 50 Prostatitis – inflammation of the prostate gland which decreases urine flow

Prevention Treatment Adequate fluid intake (2-4 liters daily) Cranberry juice may help prevent attachment of bacteria Void urine immediately after sex Proper personal hygiene Treatment Sulfonamides or cephalosporins

Leptospirosis Zoonotic disease Causative agent Leptospira interrogans Gram -, Spirochete Double axial filaments Over 200 antigenic types

Signs & Symptoms Abrupt onset of headache, spiking fever, chills and severe myalgia Eye redness Due to dilation of small blood vessels ½ of patients develop nausea, vomiting and diarrhea

Bacteria enter body through mucous membranes and breaks in skin Requires direct contact with urine or urine contaminated waters or soil Bacteria enter body through mucous membranes and breaks in skin Organism multiplies and travels to kidneys in blood stream

Epidemiology Worldwide distribution Infects many wild and domestic animals Asymptomatic carriers Organism is excreted in urine Survives in water or moist soil for weeks Farmers, ranchers, butchers, vets at high risk Rarely fatal

Prevention Treatment Avoid water contaminated with animal urine Swimming accounts for a large number of cases Maintain sanitary conditions for animals Vaccine available for livestock and pets Rodent control Treatment Oral doxycycline, chloramphenicol, erythromycin IV penicillin in severe cases

Non-venereal diseases of reproductive tract Toxic Shock Syndrome May affect males and females Bacterial Vaginosis Vaginal Candidiasis

Staphylococcal Toxic Shock Syndrome Causative agent: Staphylococcus aureus Virulent strains produce Toxic Shock Syndrome Toxin (TSST1 or TSST2) binds cells of immune system and triggers excess immune related chemicals be released

Signs & Symptoms Sudden onset fever, chills, vomiting, diarrhea, extremely low blood pressure, mental confusion and a severe red rash 50% mortality if untreated

Most cases involve menstruating women 25% of cases involved wound infection New mothers and surgical patients also at risk

Prevention Avoid highly absorbent tampons, diaphragms, contraceptive sponges or use them for shorter periods of time Treatment Remove foreign matter or drain infected wound immediately IV fluids to support blood pressure Vancomycin and anti-TSST immunoglobulin

Bacterial Vaginosis Causative agent: Change in vaginal flora May be caused by multiple anaerobic bacteria Gardnerella vaginalis Change in vaginal flora pH increases and allows overgrowth of pathogen

Signs & Symptoms Thin, grayish-white vaginal discharge Can be slightly bubbly Pungent ‘fishy’ odor Some itching and irritation 50% asymptomatic

Prevention Treatment No proven prevention Associated with multiple sexual partners, vaginal douching, anti-microbial therapy Treatment Metronidazole Vinegar douche Reestablishment of lactobacilli

Vaginal Candidiasis Causative agent Candida albicans Normal flora for up to 80% of women Opportunistic pathogen Dimorphic

Signs & Symptoms White mucoid colonies on vaginal mucus membranes and labia Severe itching and burning White curd-like discharge

Epidemiology Can be spread person to person Mother to newborn Rarely sexually transmitted Antibacterial medications increases risk Other risk factors include birth control, hormone therapy, AIDS, diabetes, invasive hospital procedures and cancers Changes in vaginal flora and pH

Prevention Treatment minimizing risk factors Intra-vaginal treatment with nystatin and clotrimazole Cream azoles may weaken latex condoms Oral fluconazole