1. Diseases of the Urinary & Reproductive Systems
Chapter 24

2. Structures of Urinary System
Kidneys
Nephrons are functional unit (1.25 million per kidney)
Ureters
Urinary bladder
Urethra
Much longer in males

4. Structures of Reproductive System
Females
Urinary and reproductive systems are distinct

5. Males
Urinary and reproductive systems share components

6. Normally urine and urinary tract above bladder are sterile
Urethra contains normal resident flora
Lactobacillus, Staphylococcus, Corynebacterium and Streptococcus
Normal flora varies in female genital tract
Depends on hormones
Lactobacillus

7. Non-venereal diseases of urinary tract
Affect males and females
Urinary tract infections
Leptospirosis

8. Urinary Tract Infections
8 million cases annually in US
600,000 nosocomial
May include any or all of the organs
Urethritis – inflammation of urethra
Cystits – inflammation of the urinary bladder
Ureteritis –inflammation of the ureters
Pyelonephritis – inflammation of the kidneys

9. Causative agents: Usually intestinal flora E. coli – most common
Proteus and Klebsiella
Psudomonas
Typically nosocomial
Non-enteric bacteria
Non-invasive and opportunistic

10. Signs and Symptoms Dysuria – frequent, painful urination
cloudy urine with foul odor; may have pale red color 9due to blood in urine)
Tenderness of pelvic area
May have slight fever

11. Pathogens typically ascend urethra and attach to receptors on bladder lining
May form biofilm
Pyelonephritis
Sudden elevation of temperature, chills, vomiting and back pain, bacteremia (may result in septicemia if bacteria gain entrance into the blood stream)

12. Epidemiology
Typically results from auto-inoculation (except for nosocomial infections)
30% of women develop UTI
Risk factors include:
short urethra; sex; use of diaphragm; pregnancy, catheterization
Infections less common in men
More common after age 50
Prostatitis – inflammation of the prostate gland which decreases urine flow

13. Prevention Treatment Adequate fluid intake (2-4 liters daily)
Cranberry juice may help prevent attachment of bacteria
Void urine immediately after sex
Proper personal hygiene
Treatment
Sulfonamides or cephalosporins

14. Leptospirosis Zoonotic disease Causative agent Leptospira interrogans
Gram -, Spirochete
Double axial filaments
Over 200 antigenic types

15. Signs & Symptoms
Abrupt onset of headache, spiking fever, chills and severe myalgia
Eye redness
Due to dilation of small blood vessels
½ of patients develop nausea, vomiting and diarrhea

16. Bacteria enter body through mucous membranes and breaks in skin
Requires direct contact with urine or urine contaminated waters or soil
Bacteria enter body through mucous membranes and breaks in skin
Organism multiplies and travels to kidneys in blood stream

17. Epidemiology Worldwide distribution
Infects many wild and domestic animals
Asymptomatic carriers
Organism is excreted in urine
Survives in water or moist soil for weeks
Farmers, ranchers, butchers, vets at high risk
Rarely fatal

18. Prevention Treatment Avoid water contaminated with animal urine
Swimming accounts for a large number of cases
Maintain sanitary conditions for animals
Vaccine available for livestock and pets
Rodent control
Treatment
Oral doxycycline, chloramphenicol, erythromycin
IV penicillin in severe cases

19. Non-venereal diseases of reproductive tract
Toxic Shock Syndrome
May affect males and females
Bacterial Vaginosis
Vaginal Candidiasis

20. Staphylococcal Toxic Shock Syndrome
Causative agent: Staphylococcus aureus
Virulent strains produce Toxic Shock Syndrome Toxin (TSST1 or TSST2)
binds cells of immune system and triggers excess immune related chemicals be released

21. Signs & Symptoms
Sudden onset fever, chills, vomiting, diarrhea, extremely low blood pressure, mental confusion and a severe red rash
50% mortality if untreated

22. Most cases involve menstruating women
25% of cases involved wound infection
New mothers and surgical patients also at risk

23. Prevention
Avoid highly absorbent tampons, diaphragms, contraceptive sponges or use them for shorter periods of time
Treatment
Remove foreign matter or drain infected wound immediately
IV fluids to support blood pressure
Vancomycin and anti-TSST immunoglobulin

24. Bacterial Vaginosis Causative agent: Change in vaginal flora
May be caused by multiple anaerobic bacteria
Gardnerella vaginalis
Change in vaginal flora
pH increases and allows
overgrowth of pathogen

25. Signs & Symptoms Thin, grayish-white vaginal discharge
Can be slightly bubbly
Pungent ‘fishy’ odor
Some itching and irritation
50% asymptomatic

26. Prevention Treatment No proven prevention
Associated with multiple sexual partners, vaginal douching, anti-microbial therapy
Treatment
Metronidazole
Vinegar douche
Reestablishment of lactobacilli

27. Vaginal Candidiasis Causative agent Candida albicans
Normal flora for up to 80% of women
Opportunistic pathogen
Dimorphic

28. Signs & Symptoms
White mucoid colonies on vaginal mucus membranes and labia
Severe itching and burning
White curd-like discharge

29. Epidemiology Can be spread person to person Mother to newborn
Rarely sexually transmitted
Antibacterial medications increases risk
Other risk factors include birth control, hormone therapy, AIDS, diabetes, invasive hospital procedures and cancers
Changes in vaginal flora and pH

30. Prevention Treatment minimizing risk factors
Intra-vaginal treatment with nystatin and clotrimazole
Cream azoles may weaken latex condoms
Oral fluconazole