1. Microbial Infections of the Urinary and Reproductive System

2. 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.

3. 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

4. MICROBIAL INFECTIONS OF THE URINARY SYSTEM

5. 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.

6. 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

7. 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

8. 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).

9. 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

10. Microbial Infections of the Reproductive System

11. 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.

12. 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

13. 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 %
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

14. 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

15. 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.

16. 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 days following exposure
Secondary: Skin and mucosal rashes
Latent period: No symptoms

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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: ISBN-10:
Tortora, G.J., Funke, B.R., and Case, C.L. (2013) Microbiology: An introduction. 11th ed. Pearson publishers NY.