1. Microbiology: A Systems Approach, 2nd ed.
Chapter 23: Infectious Diseases Affecting the Genitourinary System

2. 23.1 The Genitourinary Tract and Its Defenses
Urinary tract: removes substances from the blood, regulates certain body processes, and forms urine and transports it out of the body
Includes the kidneys, ureters, bladder, and urethra
Defenses
Flushing action of urine
Desquamation of the epithelial cells
Acidity of urine
Antibacterial proteins in urine
Secretory IgA

3. Genital System
Genital system: reproduction , aka the reproductive system
Male reproductive system includes the testes, epididymis, vas deferens, prostate gland, scrotum, and penis
Defenses: flushing action of urine
Female reproductive system includes the uterus, fallopian tubes, ovaries, and vagina
Defenses vary over the lifetime of the woman
Childhood and after menopause: mucous is the major defense with secretory IgA antibodies
During reproductive years: changes in pH

4. Figure 23.1

5. Figure 23.2

6. Figure 23.3

7. 23.2 Normal Biota of the Urinary Tract
Outer region of the urethra harbors some normal biota
Nonhemolytic streptococci, staphylocci, corynebacteria, and some lactobacilli
Normal Biota of the Male Genital Tract
Same as described for urethra, since the urethra is the terminal “tube”
Normal Biota of the Female Genital Tract
The vagina harbors a normal population of microbes
Lactobacillusi species
Candida albicans at low levels

9. 23.3 Urinary Tract Diseases Caused by Microorganisms
Urinary Tract Infections (UTIs)
Urine is a good growth medium for many microorganisms
Reduced urine flow or accidental introduction of bacteria into the bladder can result in cystitis
If the infection also affects the kidneys it is called pyelonephritis
An infection only in the urethra: urethritis

10. Cystitis Cystitis: sudden onset of symptoms Pain in the pubic area
Frequent urges to urinate even when the bladder is empty
Burning pain accompanying urination (dysuria)
Cloudy urine
Orange tinge to the urine (hematuria)
Fever and nausea
Back pain indicates kidneys may also be involved

12. Leptospirosis
Zoonosis associated with wild animals and domesticated animals
Can affect the kidneys, liver, brain, and eyes
Major effects on the kidneys and is shed into the environment through animal urine
Two phases
Early (leptospiremic) phase
Sudden high fever, chills, headache, muscle aches, conjunctivitis, and vomiting
Second phase (immune phase)
Milder fever, headache, Weil’s syndrome (kidney invasion, hepatic disease, jaundice, anemia, and neurological disturbances)

13. Figure 23.4

15. Urinary Schistosomiasis
Schistosoma haematobium lodges in to the blood vessels of the bladder
May or may not result in symptoms
If symptoms occur: itchiness in the area where the worm enters the body, fever, chills, diarrhea, and cough
Urinary tract symptoms occur later which may include blood in the urine and bladder obstruction

17. 23.4 Reproductive Tract Diseases Caused by Microorganisms
Many are transmitted through sexual contact, but not all are
Three broad categories of sexually transmitted diseases
Discharge diseases
Ulcer diseases
Wart diseases

18. Vaginitis and Vaginosis
Inflammation of the vagina
Vaginal itching to some degree
Burning and sometimes a discharge occurs
Symptoms depend on the etiologic agent

19. Candida albicans Normal biota living in low numbers
If grows rapidly and causes a yeast infection, white vaginal discharge occurs

20. Figure 23.5

21. Gardnerella species
Infection called vaginosis rather than vaginitis because inflammation in the vagina does not occur
Vaginal discharge with a very fishy odor, especially fater sex
Itching is common

23. Trichomonas vaginalis
Asymptomatic infections in approximately 50% of females and males
Some people experience long-term negative effects

24. Figure 23.7

26. Prostatitis Inflammation of the prostate gland Acute or chronic
Pain in the pelvic area, lower back, or genital area; frequent urge to urinate; blood in the urine; and/or painful ejaculation

28. Discharge Diseases with Major Manifestation in the Genitourinary Tract
Increase in fluid discharge in male and female reproductive tracts
Includes trichomoniasis, HIV, gonorrhea, and Chlamydia infection

29. Gonorrhea
N. gonorrhoeae is the etiologic agent- also known as the gonococcus
Symptoms in the male
Urethritis, painful urination and a yellowish discharge
Can occasionally spread from the urethra to the prostate gland and epididymis
Scar tissue in the spermatic ducts during healing can render a man infertile (rare)

30. Symptoms in the Female
Likely that both urinary and genital tracts will be infected
Mucopurulent or bloody vaginal discharge
Painful urination if urethra is affected
Major complications occur when the infection ascends from the vagina and cervix to higher reproductive structures
Salpingitis
Pelvic inflammatory disease

31. Figure 23.8

32. Figure 23.9

33. Figure 23.10

34. Figure 23.11

35. Chlamydia Most common reportable infectious disease in the U.S.
Majority of cases are asymptomatic
Symptoms in males
Inflammation of the urethra
Symptoms mimicking gonorrhea
Untreated infections may lead to epididymitis
Symptoms in females
Cervicitis
Discharge
Salpingitis
May lead to PID

36. Certain strains can invade the lymphatic tissues, resulting in lymphogranuloma venereum
Headache, fever, muscle aches
Lymph nodes fill with granuloma cells and become enlarged and tender
Babies born to mothers with infections can develop eye infections and pneumonia

37. Figure 23.12

38. Figure 23.13

40. Genital Ulcer Diseases
Three common infectious conditions resulting in lesions on a person’s genitals
Syphilis, chancroid, and genital herpes
Having one of these diseases increases the chances of infection with HIV because of the open lesions

41. Syphilis
Three distinct clinical stages: primary, secondary, and tertiary
Latent periods of varying duration also occur
Transmissible during the primary and secondary stages, and the early latency period between secondary and tertiary
Largely nontransmissible during late latent and tertiary stages

42. Primary Syphilis
Appearance of a hard chancre at the site of entry of the pathogen (after an incubation period of 9 days to 3 months)
Lymph nodes draining the affected region become enlarged and firm
Chancre filled with spirochetes
Chancre heals spontaneously in 3 to 6 weeks but by then the spirochete has moved into the circulation

43. Secondary Syphilis 3 weeks to 6 months after the chancre heals
Many systems have been invaded
Fever, headache, sore throat, followed by lymphadenopathy and a red or brown rash that breaks out on all skin surfaces
Hair often falls out
Lesions contain viable spirochetes and disappear spontaneously in a few weeks
Major complications occur in bones, hair follicles, joints, liver, eyes, and brain

44. Figure 23.14

45. Latency and Tertiary Syphilis
Highly varied latent period, can last for 20 years or longer
Tertiary syphilis is rare because of the use of antibiotics
Major complications occur by this stage
Cardiovascular syphilis- weakens the arteries in the aortic wall
Gummas develop in tissues such as the liver, skin, bone, and cartilage

46. Figure 23.15

47. Congenital Syphilis
From a pregnant woman’s circulation into the placenta and fetal tissues
Inhibits fetal growth
Disrupts critical periods of development

48. Figure 23.16

49. Figure 23.17

50. Figure 23.18

51. Chancroid No systemwide effects
Infection usually begins as a soft papule at the point of contact
Develops into a soft chancre (painful in men, but may be unnoticed in women)
Inguinal lymph nodes can become swollen and tender

52. Genital Herpes Caused by herpes simplex viruses (HSVs)
Multiple presentations
No symptoms, or single or multiple vesicles on the genitalia, perineum, thigh, and buttocks
Lesions from initial infection can be accompanied by malaise, anorexia, fever, and bilateral swelling and tenderness of the groin
Occasionally meningitis or encephalitis can develojp
After recovery from initial infection, may have recurrent episodes of lesions; generally less severe
In the neonate and fetus, HSV infections are very destructive and can be fatal

53. Figure 23.19

54. Figure 23.20

55. Figure 23.21

56. Figure 23.22

57. Figure 23.23

59. Wart Diseases Human papillomavirus (HPV) Molluscum Contagiosum
Causative agents of genital warts
An individual can be infected with HPV without having warts, however
Molluscum Contagiosum
Unclassified virus in the pox family
Can take the form of skin lesions
Wartlike growths on the mucous membranes or skin of the genital area

61. Group B Streptococcus “Colonization”- Neonatal Disease
10% to 40% of women in the U.S. are colonized asymptomatically by group B Streptococcus
When these women become pregnant, about half of their infants become colonized by the bacterium during passage through the birth canal
Small percentage of infected infants experience life-threatening bloodstream infections, meningitis, or pneumonia

63. Figure 23.24a

64. Figure 23.24b