Lecture 7: Diseases Affecting Urinary and Reproductive System Flashcards
1
Q
Urinary system
A
- removes waste from blood, helps maintain homeostasis
- infections influenced by system’s anatomy
- 50% UTIs are sexually transmitted
2
Q
Females most at rx for infections
A
opening of urethra close to anus
3
Q
Known colonizers of urethra in males and females
common (4)
lesser (3)
A
Main
- corynobacterium
- streptococcus
- staphylococcus
- bacteroides
Lesser
- peptostreptococcus
- prevotella
- porphyromonas
4
Q
female susceptibility to kidney infection
A
urethra shorter, bacteria does not have to travel as far to reach kidneys
5
Q
Kidneys and ureter microbiota?
A
usually sterile
6
Q
Antimicrobial defenses of urinary system (7)
A
- shedding outermost cells of mucosa
- mucous secretion
- flushing action of urine
- pH (acidic)
- urea content
- antimicrobial proteins
- zinc secretion- inhibits E..coli
7
Q
UTIs characterization
A
characterized by presence of significant number of bacteria in urinary tract
8
Q
UTI sx (4)
A
- persistent urinary urgency
- persisten dysuria
- hematuria
- cloudy and strong smelling urine
9
Q
Most common cause of UTI (pathogen)
A
e. coli
10
Q
Infections of lower urinary tract
involve what 3 organs (3)
most common infections (3)
A
Involve
- urethra
- bladder
- prostate
Most common lower infections
- urethritis
- cystisis (inflam. bladder)
- prostitis
11
Q
Infections of upper urinary tract
A
involve kidneys and pyelonephritis
12
Q
Urethritis
def.
2 pathogen
sx (2)
A
- bacteria from lower intestine and anus reach the vagina
- neisseria gonorrhaea and chalmydia
- can be asymptomatic
- sx: dysuria and purulent discharge
13
Q
Cysitis
def
pathogen
high rx population
sx (4 rsh)
A
- infection of bladder
- e coli most common
- higher rx during pregnancy
- urinary catheter can cause hospital-acquired cystitis
- sx similar to urethritis; clinically distinguished by acute onset, more severe symptoms, bacterial cells in urine, hematuria
14
Q
prostitis
special pop.
2 types
A
inflammation and infection of protstate
- develops in young and older men following placement of indwelling catheter
- acute: sudden onset fever chills, increased urinary urgency and frequency
- chronic: signs and sx develop gradually and are less severe
15
Q
Pyelonephritis
definition
commonly caused by
A
UTI involving one or both kidneys
- more common in women
- 90% of cases caused by e. coli
- can lead to permanent damage of kidneys and can spread systemically
16
Q
Leptospirosis
A
- zoonotic disease affecting kidneys and other tissues
- hook at one end, resembles question mark
- spread by direct or indirect contact with urine of infected animal
- spirochetes found in contaminated waters, soil etc.
- bacteria enter via mucous membranes od eyes, nose, mouth
17
Q
Leptospitosis pathogen
A
thin, aerobic, gram-negatie mossige spirochete
18
Q
Clinical presentation leptospirosis
- incubation
- transmission
- sx (5)
- compilation
A
- rapid onset after 10 day incubation
- enters host through membranes od eyes, nose, mouth, and abrasions on feet
- 90% patients present with flu-like sx (chills, myalgia, HA, conjuctivitis), nausea/vomiting/diarrhea
- weil Syndrome: severe form leptospirosis: meningitis, liver, lung, and kidney damage
19
Q
Weil syndrome
complications (3)
A
severe form leptospirosis
meningitis
liver
and kidney damage
20
Q
tx leptospirosis/weil syndrom
A
DCN, PROMPT
21
Q
Vaginal mirobiota
A
lactobacillus thrive in acidic pH of vagina, and convert lactic acid which further contributes to low pH
-susceptible to significant alterations (dysbiosis) that lead to common infections
22
Q
Non-sexually transmitted infections of female reproductive system (2)
A
- bacterial vaginosis
2. vaginal candidiases
23
Q
Bacterial vaginosis
caused by what pathogens (3)
tx
A
non-sexually transmitted infection of female reproductive system
garnerella vaginalis rods, prevotella, mobiluncus
tx: metronidazole or clindamysin (oral or vaginal, less rx c. diff)
most common vaginal infection in women of child-bearing age
-40-50% all gynecologic conditions
24
Q
Vaginal candidasis
pathogen
sx (2)
tx (3)
A
“yeast infection”
c. albicans responsible agent for non-sexually transmitted infection of reproductive system
- decreased lactobacilli allow c.albicans to grow
sx: itching, white discharge
tx: nystatin, clotrimazole, fluconazole
25
3 key changes leading to bacterial vaginosis
1. dysbiosis
2. production volatile amines
3. pH > 4.5
26
chlamydial urethritis
pathogen
transmission
1. most frequently reported STD
2. chlamydia trachoma's
3. one of several non-gonococcal urethritis
4. sexually transmitted by contact with mucous membrane secretion of semen of infected person
* more common in men t
27
chlamydia lifecyle
characteristics pathogen
2 phases
c. trachomatis: small, round/ovoid-shaped organism, obligate, intracellular parasite
1. two phases
a. elementary body (EB): non-replicating, extracellular, infectious
b. reticulate body (RB): replicating, intracellular, non-infectious
28
chlamydia disease
transmission
sx (male/female)
complication
t: vaginal, anal, oral sex
- silent disease, 85-90% have no symptoms
sx: slight vaginal discharge and inflammation of the cervix
- burning pain during urination possible if urethra is infected
- males: painful urination and water/milky discharge
- can cause infertility in males
can cause pelvic inflammatory disease
29
Salpingitis
spreading of disease to the fallopian tubes
| -blockage and inflammation of fallopian tubes can cause infertility
30
chalmydia other facts
dx test
tx
1. can occur in parynx or anus
2. newborns can contract chlamydial ophthalmia during delivery
3. lab text=sample of urethra in men or cerix in women and using PCR ro detect chalmydial DNA
4: tx: tetracyclines (DCN), or macrocodes (azithromycin)
31
Gonorrhea
pathogen
shape
susceptibility
transmission
1. can be an infection in any sexually active person
2. caused by Neisseria Gornorrheae "the clap"
3. double bean shape
4. susceptible to most antiseptics and disinfectants, sensitive to dehydration
- survives only a brief period outside the body
5. transmission: sexual contact, newborn during birth
32
Neisseria gonorrhoeae
5 characteristicns
1. small
2. nonencapsulated
3. nonmotile
4. gram (-)
5. diplococcus
33
Gonorrhea
incubation
affects what organs
special population
1. incubation: 2-6 days
2. affects: reproductive organs, female: cervix/urethra/fallopian tubes, male: infects urethra, pharynx, rectum, eyes
3. rarely can disseminate and cause arthritis or dermatitis
4. infant can contract gonoccal ophthalmia while passing through birth canal
34
Gonorrhea females
Major complication
Other complications (3)
tx
many infected females are asymptomatic and contribute to the spread of the disease, may present with PID
1. can spread to fallopian tubes/salpingitis
2. can lead to sterility
3. can lead to ectopic pregnancy
tx: high dose ceftriaxone IM x1 dose
35
Gonorrhea Males
sx/complications (6)
tx
1. tingling penis
2. pain when urinating
3. penile dischrge
4. swollen lymph nodes
5. painful testicles
6. infertility
tx: high dose ceftriaxone IM x1 dose
36
PID
pathogens (3)
complications
sx
pelvic inflammatory disease
1. polymicrobail infection
- neisseria gonorrhoeae
- chlamydia trachomatis
- anaerobes
2. salpingitis- infection fallopian tube
- scarring blocks passage of ova from ovary to uterus, causing sterility
- blocked uterine tube may cause fertilized ovum to be implanted in the tube rather than uterus (ectopic pregnancy)
3. sx: chronic abdominal pain; pain during or after menses particularly suggestive
4. preventing PID is main reason for treating STD
37
Syphilis
caused by what patogen
1. chronic, infectious disease
2. top 5 most reported microbial disease in US
3. treponema palladium, spirochete for which humans are only host
38
Syphilis
incubation period
sx
1. I: 3 weeks avg, can vary
2. chancre where bacteria entered body
- painless circular small raised edges
- persists 3-6 weeks, healthcares spontaneously
39
secondly syphilis
```
def
sx
```
1. occurs when spirochete spreads through blood and lymph to other organs
2. sx: fever, skin rash, swollen nodes, transmission can occur through lesions
- chornic latent stage of 3-30 years follows in which relapses of secondary syphilis can occur, will be infectious at this point
40
tertiary syphillis
complications
1. formation of non-infectious gammas
- weakenig or bursting of blood vessels
- degeneration spinal chord tissues
- brain damage leading to personality and judgement changes
41
congenital syphillis
complications
tx
prevention
dx
can occur in fetus of pregnant women
- still birth
- birth defects: hutchinson's triad: deafness, impaired vision, noted peg shaped teeth
- tx: penicillin G 2.4 million units IM x 1 dose
- P: safe sex partners
- d: observation spirochetes by microscopy, antibody tests
42
Diagnosis syphilis
1. RPR: rapid plasma regain
- antbodies to damaged cell components, not actual treponems
2. t. palladium enzyme immunoassay (TP-EIA)
- detects antibodies specific to t. pallidum
43
Genital Herpes
serotype
tx
1. HSV-2
| tx: acyclovir, famciclovir
44
signs of primary herpes infection
1. itching or throbbing in genetical area
2. reddening and appearance of blisters
3. blisters crust over and disappear after 3 weeks
4. 50% all infected individuals only experience one outbreak in lifetime
45
Human Papilomaviruses
1. some cause genital warts and can cause cancer
| 2. condylomata tranmitted through sexual conduct
46
Condylomata
transmission
complications
prevention
genital warts
t: oral, vaginal, anal sex
- often asymptomatic
- can be transmitted to newborns during delivers
- can cause cervical cancer
- Gardisil vax
47
HPV (5 points)
1. DNA virus, 200+ serotypes
2. t sexual contact or microscopic abrasions
3. disease depends on types
4. P: vaccination against HPV strains
5. can cause caner of anus, vagina/vulva, penis, mouth, throat
48
HPV types 16 & 18
cause 70% cervical cancer, assoc. with other cancers
49
Garasil 9
targets HPV 6, 11, 16, 18, 31, 33, 45, 52, 58
- only available in US
- protects against cervical, vulvar, vaginal, anal, oropharyngeal, and other head and neck cancers
50
Trichomoniasis
populations
transmission
parasitic protozoan, exists in only 1 morphological stage
1. women > men
- can lead to infertility
- can lead to prostate cancer in meant
1. adherence factors allow cervicovaginal epithelium colonization in women
2. t: direct skin-skin contact with infected individual, most often vaginal intercourse
51
Trichomoniasis
sx (3)
complication (6)
tx (3)
1. common cause vaginitis in women
2. intense itching and discomfort during urination and sexual intercourse, frothy, greenish vaginal discharge with musty malodorous smell
4. complications: preterm delivers, low birth weight, increased mortality, predisposing HIV infection, AIDS, cervical cancer
5. tx: metronidazole, tinidaole, secnidazole
52
Mild- Moderate PID tx (3)
1. single dose long acting cephalosporin (ceftriazone) 500-1000 mg IM
2. + DCN 100 mg daily x14 days
3. PLUS metronidazole 500 mg orally 2x daily for 14 days
53
inpatient tx for PID
| option 1
a. cefoxitin 2 g IV every 6 hours
b. cefotetan 2 g IV every 12 hours
c. PLUS DCN 100 mg orally or IV every 12 hours
54
inpatient tx PID
| option 2
clindamycin 900 mg IV Every 8 hours
PLUS gentamicin 3-5 mg/kg IV daily
55
Tx neonatal eye infection of Neisseria Gonorrhoeae
complications
prevention
tx
1. acquired via passage through cervix/vagina or within the uterus
2. can cause blindness if left untreated
3. Px: maternal screening during pregnancy so mother can be treated if infected
- neonatal prophylaxis with erythromycin or tetracycline ointment applied up to 1 hour after birth
- rec. for all newborns by CDC and American Academy of Pediatrics
4. tx neonatal infection
- ceftriaxone 25-50 mg/kg (MAX=125 mg) IV or IM x1 dose
- Cefotaxime or ceftrazidine alternatives
56
Neonatal eye infections: chlamydia trachomatis
1. Aq. during birth in infants born vaginally to infected mothers
2. causes neonatal conjunctivitis or pneumonia
3. untreated conjunctivitis scan cause corneal and conjunctiontival scarring
4. px: maternal screening during pregnancy for all women < 25 years old
- neonatal prophylaxis is not effected for c. trachomatis
5. tx: erythromycin 50 mg/kg orally in 4 divided doses per day for 14 days
OR azithromycin 20 mg/kg given orally once daily x3 days
**Topical therapy NOT effective for c. trachomatis
