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BMD 330: Genitourinary System Diseases

front 1

Urinary Tract Infections Disease (E. coli)

back 1

  • Causative organism: Escherichia coli
  • Mode of Transmission: opportunism: transfer from GI tract
    (community-acquired) or environment or GI tract (via catheter)
  • Virulence Factors: Adhesins, motility
  • Culture/Diagnosis: usually culture-based; antimicrobial susceptibilities always
    checked
  • Prevention: hygiene practices; in case of CA-UTIs, limit catheter usage
  • Treatment: Usually nitrofurantoin
  • Signs and Symptoms: typically present with dysuria (burning urination), urinary frequency and urgency, suprapubic pain, and cloudy or foul-smelling urine; if the infection ascends to the kidneys, it can cause flank pain, fever, and nausea/vomiting (pyelonephritis).

front 2

Urinary Tract Infections Disease (Staph)

back 2

  • Causative organism: Staphylococcus saprophyticus
  • Mode of Transmission: opportunism: transfer from GI tract
    (community-acquired) or environment or GI tract (via catheter)
  • Virulence Factors: N/A
  • Culture/Diagnosis: usually culture-based; antimicrobial susceptibilities always
    checked
  • Prevention: hygiene practices; in case of CA-UTIs, limit catheter usage
  • Treatment: Usually nitrofurantoin
  • Signs and Symptoms: typically present with dysuria (burning urination), urinary frequency and urgency, suprapubic pain, and sometimes hematuria; symptoms are similar to other UTIs and may occasionally be accompanied by mild fever if the infection ascends.

front 3

Urinary Tract Infections Disease (Entercoccus)

back 3

  • Causative organism: Enterococcus
  • Mode of Transmission: opportunism: transfer from GI tract
    (community-acquired) or environment or GI tract (via catheter)
  • Virulence Factors: N/A
  • Culture/Diagnosis: usually culture-based; antimicrobial susceptibilities always
    checked
  • Prevention: hygiene practices; in case of CA-UTIs, limit catheter usage
  • Treatment: Based on susceptibility testing; vancomycin-resistant, Enterococcus is in Serious Threat category in CDC, and Antibiotic Resistance Report
  • Signs and Symptoms: typically present with dysuria (burning urination), urinary frequency and urgency, suprapubic pain, and cloudy or foul-smelling urine; in more severe or complicated cases, fever and flank pain may occur if the infection spreads to the kidneys (pyelonephritis).

front 4

Leptospirosis Disease

back 4

  • Causative organism: Leptospira interrogans
  • Mode of Transmission: Vehicle: contaminated soil or water
  • Virulence Factors: Adhesins, invasion proteins
  • Culture/Diagnosis: Slide agglutination test of patient’s blood for
    antibodies: in the United States, CDC will culture specimens
  • Prevention: Avoiding contaminated vehicles
  • Treatment: Doxycycline, penicillin G, or ceftriaxone
  • Signs and Symptoms:
  • Leptospirosis phase:
    • sudden high fever, chills, headache, muscle aches,
    conjunctivitis, and vomiting
  • Immune phase:
    • Mild fever, headache due to leptospiral meningitis
    • Weil’s syndrome: kidney invasion, hepatic disease, jaundice,
    anemia, and neurological disturbances
  • Long-term disability and death can result

front 5

Urinary Schistosomiasis

back 5

  • Causative organism: Schistosoma haematobium
  • Mode of Transmission: Vehicle: contaminated water
  • Virulence Factors: Antigenic “cloaking,” induction of granulomatous
    response
  • Culture/Diagnosis: Identification of eggs in urine, PCR methods
  • Prevention: Avoiding contaminated vehicles
  • Treatment: Praziquantel
  • Signs and Symptoms: Itchiness in the area where the helminth enters the
    body, Fever, chills, diarrhea, and cough
    • Urinary tract symptoms occur at a later date and can cause chronic infection

front 6

Vaginitis (Candida)

back 6

  • Causative organism: Candida albicans
  • Mode of Transmission: Opportunism
  • Virulence Factors: N/A
  • Culture/Diagnosis: Wet prep or Gram stain
  • Prevention: N/A
  • Treatment: Topical or oral azole drugs, some over-the-counter drugs
  • Signs and Symptoms: Inflammation of the vagina, characterized by some
    degree of vaginal itching, burning, and White, curd-like discharge

front 7

Vaginitis (Trichomoniasis) [Most common nonviral sexually transmitted disease]

back 7

  • Causative organism: Trichomonas vaginalis
  • Mode of Transmission: Direct contact (STI)
  • Virulence Factors: N/A
  • Culture/Diagnosis: Protozoa seen on Pap smear or Gram stain; culture is the
    gold standard
  • Prevention: Barrier use during intercourse
  • Treatment: Metronidazole, tinidazole
  • Signs and Symptoms: Inflammation of the vagina, characterized by some
    degree of vaginal itching, burning, and discharge may be greenish in women but men seldom have symptoms and many cases are asymptomatic

front 8

Vaginosis

back 8

  • Causative organism: Mixed infection of Gardnerella vaginalis, Atopobium, and
    Mobiluncus
  • Mode of Transmission: Opportunism or STI
  • Virulence Factors: N/A
  • Culture/Diagnosis: Visual exam of vagina or clue cells seen in Pap smear or other smear
  • Prevention: N/A
  • Treatment: Metronidazole or clindamycin
  • Signs and Symptoms: Does not induce inflammation in the vagina
    • Produces discharge with a fishy odor, and itching is common, Can lead to PID, infertility, and ectopic pregnancies
    • Not sexually transmitted, but more common in sexually active
    women

front 9

Prostatitis

back 9

  • Causative organism: GI tract biota
  • Mode of Transmission: Endogenous transfer from GI tract; otherwise unknown
  • Virulence Factors: Various
  • Culture/Diagnosis: Digital rectal exam to examine prostate; culture of urine or semen
  • Prevention: None
  • Treatment: Antibiotics, muscle relaxers, alpha blockers
  • Signs and Symptoms: Pain in the groin and lower back, Frequent urge to urinate, Difficulty urinating, Blood in the urine, and Painful ejaculation

front 10

Gonorrhea

back 10

  • Causative organism: Neisseria gonorrhoeae
  • Mode of Transmission: Direct contact (STI), also vertical
  • Virulence Factors: Fimbrial adhesins, antigenic variation, IgA protease, membrane blebs/endotoxin
  • Culture/Diagnosis: Gram stain in males, rapid tests (PCR, ELISA) for females, culture on Thayer-Martin agar
  • Prevention: Avoid contact; condom use
  • Treatment: Coinfection by gonorrhea and Chlamydia should be assumed; treat
    with ceftriaxone + azithromycin; antibiotic-resistant strains on Urgent Threat list from CDC
  • Signs and Symptoms:
  • Males: urethritis, painful urination, yellowish discharges,
    many cases asymptomatic
    • Females: mucopurulent or bloody vaginal discharge,
    painful urination

front 11

Chlamydia

back 11

  • Causative organism: Chlamydia trachomatis
  • Mode of Transmission: Direct contact (STI), vertical
  • Virulence Factors: Intracellular growth resulting in avoiding immune system and cytokine release, unusual cell wall preventing phagolysosome fusion
  • Culture/Diagnosis: PCR or ELISA, can be followed by cell culture
  • Prevention: Avoid contact; condom use
  • Treatment: Coinfection by Chlamydia and gonorrhea should be assumed; treat with doxycycline or azithromycin
  • Signs and Symptoms:
  • Males: discharge and painful urination
    • Females: cervicitis, discharge, salpingitis, and PID
    • Up to 75% of Chlamydia infections are asymptomatic

front 12

Syphilis

back 12

  • Causative organism: Treponema pallidum
  • Mode of Transmission: Direct contact and vertical
  • Virulence Factors: Lipoproteins
  • Culture/Diagnosis: Direct tests (immunofluorescence, dark-field microscopy),
    blood tests for treponemal and nontreponemal antibodies, PCR
  • Prevention: Antibiotic treatment of all possible contacts, avoiding contact
  • Treatment: Penicillin G
  • Signs and Symptoms: progresses in stages: primary stage causes a painless chancre at the infection site; secondary stage includes a widespread rash (often on palms/soles), fever, and lymphadenopathy; latent stage is asymptomatic; and tertiary stage can cause severe neurologic, cardiovascular, and gummatous tissue damage if untreated.
  • Effects on Fetus: Congenital syphilis

front 13

Chancroid

back 13

  • Causative organism: Haemophilus ducreyi
  • Mode of Transmission: Direct contact (vertical transmission not documented)
  • Virulence Factors: Hemolysin (exotoxin)
  • Culture/Diagnosis: Rule out other ulcer diseases
  • Prevention: Avoiding contact
  • Treatment: Ceftriaxone or azithromycin
  • Signs and Symptoms: causes painful, soft genital ulcers with ragged edges, often accompanied by tender, swollen inguinal lymph nodes that may form abscesses (buboes). Painful chancre in men and often unnoticed in women
  • Effects on Fetus: None

front 14

Herpes

back 14

  • Causative organism: Herpes simplex 1 and 2
  • Mode of Transmission: Direct contact, vertical
  • Virulence Factors: Latency
  • Culture/Diagnosis: Clinical presentation, PCR, Ab tests, growth of virus in cell
    culture
  • Prevention: Avoiding contact, antivirals can reduce recurrences
  • Treatment: Acyclovir and derivatives
  • Signs and Symptoms: causes painful, fluid-filled vesicles or blisters on the mouth or genitals that rupture into ulcers, often preceded by tingling or burning; the virus remains latent in nerve ganglia and can reactivate causing recurrent outbreaks.
  • Effects on Fetus: Blindness, disseminated herpes infection

front 15

HPV

back 15

  • Causative organism: Human papillomaviruses
  • Mode of Transmission: Direct contact (STI), also autoinoculation, indirect contact
  • Virulence Factors: Oncogenes (in the case of malignant types of HPV)
  • Culture/Diagnosis: PCR tests for certain HPV types, clinical diagnosis; Pap
    smear
  • Prevention: Vaccine available; avoid direct contact and prevent cancer by
    screening cervix
  • Treatment: Warts or precancerous tissue can be removed; virus not treatable
  • Signs and Symptoms:
  • Females: growths on the vulva and in and around the vagina as well as silent infections of the cervix
    • Males: warts on the penis and scrotum
    • Both sexes: warts in or on the anus, and the skin around the groin between the thigh and pelvis
    • Condyloma acuminata: branching, cauliflower-like masses
  • Effects on Fetus: May cause laryngeal warts

front 16

Molluscum Contagiosum

back 16

  • Causative organism: Poxvirus, sometimes called the molluscum contagiosum
    virus (MCV)
  • Mode of Transmission: Direct contact (STI), also indirect and autoinoculation
  • Virulence Factors: N/A
  • Culture/Diagnosis: Clinical diagnosis, also histology, PCR
  • Prevention: Avoid direct contact
  • Treatment: Warts can be removed; virus not treatable
  • Signs and Symptoms: Causes wart-like growths on the mucous membranes or
    the skin of the genital area
  • Effects on Fetus: N/A

front 17

Group B Streptococcus Colonization Disease (Neonatal Disease)

back 17

  • Causative organism: Group B Streptococcus
  • Mode of Transmission: Vertical
  • Virulence Factors: N/A
  • Culture/Diagnosis: Culture of mother’s genital tract
  • Prevention/ Treatment: Treat mother with penicillin/ ampicillin
  • Signs and Symptoms: often asymptomatic in adults, especially in the gastrointestinal and genitourinary tracts, but can cause serious neonatal infections (sepsis, pneumonia, meningitis) during childbirth if transmitted from mother to infant; in adults it may rarely cause UTI, bacteremia, or skin/soft tissue infections in immunocompromised patients.