Urinary Tract Infections Disease (E. coli)

• 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).

Urinary Tract Infections Disease (Staph)

• 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.

Urinary Tract Infections Disease (Entercoccus)

• 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).

Leptospirosis Disease

• 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

Urinary Schistosomiasis

• 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

Vaginitis (Candida)

• 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

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

• 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

Vaginosis

• 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

Prostatitis

• 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

Gonorrhea

• 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

Chlamydia

• 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

Syphilis

• 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

Chancroid

• 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

Herpes

• 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

HPV

• 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

Molluscum Contagiosum

• 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

Group B Streptococcus Colonization Disease (Neonatal Disease)

• 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.