2. Microbial Diseases of the Urinary and Reproductive Systems Microbes usually enter the urinary system through the urethra. Microbes usually enter the reproductive system through the vagina (in females) or urethra (in males).
7. Normal Microbiota Urinary bladder and upper urinary tract sterile Lactobacilli predominant in the vagina >1,000 bacteria/ml or 100 coliforms/ml of urine indicates infection
8. Cystitis Usually caused by E. coli S. saprophyticus May also be caused by Proteus Klebsiella Enterococcus Pseudomonas E. coli usually causes pyelonephritis. Antibiotic-sensitivity tests may be required before treatment.
9. UTI Ureteritis = inflammation of ureter (maybe caused by stone in the ureter) Cystitis = inflammation of bladder (caused by ascending bacterial infection usually E. coli) Urethritis= inflammation of urethra (may lead to prostatitis and epididymitis)
11. FACTORS THAT CONTRIBUTE TO UTI FEMALE (PROXIMITY TO THE ANUS, SHORTER URETHRA) POOR HYGIENE UNSAFE SEXUAL PRACTICES BACK TO FRONT STROKE HIGH pH URINARY STASIS KIDNEY STONES OBSTRUCTION OF URINE OUTFLOW
12. S/Sx: PAIN assessment Pain during and after urination = cystitis Pain after urination = urethritis Inguinal pain = ureteritis Flank pain = pyelonephritis Inflammatory manifestations fever and chills Cx: Ascending infection Obstruction (stones/calculi)
13. Management E. coli (most common C.A.) Increase fluids Warm sitz bath EMPTY the bladder Good hygiene Observe safe sexual practice Front to back stroke Acidify urine (cranberry juice, prune, plums) C/S test before giving antibiotics For urosepsis give aminoglycosides Observe complications
14. Leptospirosis Leptospira interrogans Reservoir: Dogs and rats Transmitted by skin/mucosal contact from urine-contaminated water Diagnosis: Isolating bacteria or serological tests Figure 26.4
35. Gonorrhea Neisseria gonorrhoeae Attaches to oral or urogenital mucosa by fimbriae. Females may be asymptomatic; males have painful urination and pus discharge. Treatment is with antibiotics. If left untreated, may result in Endocarditis Meningitis Arthritis Ophthalmia neonatorum
38. Nongonococcal Urethritis Chlamydia trachomatis May be transmitted to a newborn's eyes Painful urination and watery discharge Mycoplasma hominis Ureaplasma urealyticum
41. SIGNS AND SYMPTOMS Females: usually asymptomatic or minimal urethral discharge w/ lower abdominal pain Male: Mucopurulent discharge, Painful urination 29 Rex Karl S. Teoxon, R.N, M.D
69. CHLAMYDIA Chlamydia trachomatis, gram (-) IP: 2-10 days 46 Rex Karl S. Teoxon, R.N, M.D
70. SIGNS AND SYMPTOMS Maybe asymptomatic Gray white discharge, Burning and itchiness at the urethral opening DX: Gram stain Antigen detection test on cervical smear Urinalysis 47 Rex Karl S. Teoxon, R.N, M.D
83. Syphilis Direct diagnosis Darkfield microscopic identification of bacteria Staining with fluorescent-labeled, monoclonal antibodies Indirect, serological diagnosis VDRL, RPR, ELISA test for reagin-type antibodies using cardiolipid (Ag) FTA-ABS tests for anti-treponemal antibodies
85. Syphilis Primary stage: Chancre at site of infection Secondary: Skin and mucosal rashes Latent period: No symptoms Tertiary: Gummas on many organs Congenital: Neurological damage Primary and secondary stages treated with penicillin
100. 10-90 days (usually 3-4 weeks) after initial contact the host mounts an inflammatory response at the site of inoculation resulting in the hallmark syphilitic lesion, called the chancre (usually painless)
131. DIAGNOSIS Dark-field examination of lesion- 1st and 2nd stage Non specific VDRL and RPR FTA-ABS Mgmt Primary and secondary - Pen G Tertiary - IV Pen G 85 Rex Karl S. Teoxon, R.N, M.D
132. Diagnostic Tests for Syphilis (Original Wasserman Test) NOTE: Treponemal antigen tests indicate experience with a treponemal infection, but cross-react with antigens other than T. pallidum ssp. pallidum. Since pinta and yaws are rare in USA, positive treponemal antigen tests are usually indicative of syphilitic infection.
133. SYPHILISTREATMENT Patient and sexual partner(s) should be treated Antibiotic therapy Penicillin â preferred in pregnancy Doxycycline Tetracycline
141. CHLAMYDIALGV STD caused by serovars L1, L2, L3 Common in Asia, Africa, South America, and the Caribbean Incubation period 3 days to 3 weeks Painless vesicleï regional lymphaticsï inguinal and femoral adenitis and proctitis
142. Chancroid (Soft Chancre) Haemophilus ducreyi Ulcer on genitalia May break through surface Infection of lymph nodes Treatment: Erythromycin and ceftriaxone
144. DIAGNOSIS Viral culture Pap smear (shows cellular changes) Tzanck smear (scraping of ulcer for staining) 94 Rex Karl S. Teoxon, R.N, M.D
145. MANAGEMENT Anti viral â acyclovir (zovirax) CX: Meningitis â mild and self limiting Neonatal infection (vaginal birth) Disseminated with liver involvement Encephalitis Skin, eyes, mouth 95 Rex Karl S. Teoxon, R.N, M.D
146. Genital Herpes Herpes simplex virus 2 (Human herpesvirus 2 or HHVâ2) Neonatal herpes transmitted to fetus or newborns Recurrences from viruses latent in nerves Suppression: Acyclovir or valacyclovir
147. HERPES GENITALIS HSV 2 Envelop, icosahedral, dsDNA Latent â sacral nerve ganglia 97 Rex Karl S. Teoxon, R.N, M.D
151. SIGNS AND SYMPTOMS Painful sexual intercourse Painful vesicular lesions (cervix, vagina, perineum, glans penis) 101 Rex Karl S. Teoxon, R.N, M.D
152. Genital Warts Human papillomaviruses Treatment: Imiquimod to stimulate interferon HPV 16 causes cervical cancer and cancer of the penis. DNA test is needed to detect cancer-causing strains. Vaccination against HPV strains
153. GENITAL WARTS Condyloma Acuminatum HPV type 6 & 11, papilloma virus 103 Rex Karl S. Teoxon, R.N, M.D
154. SIGNS AND SYMPTOMS Single or multiple soft, fleshy painless growth of the vulva, vagina, cervix, urethra, or anal area, Vaginal bleeding, discharge, odor and dyspareunia DX: Pap smear-shows cellular changes (koilocytosis) Acetic acid swabbing (will whiten lesion) 104 Rex Karl S. Teoxon, R.N, M.D
159. MANAGEMENT Laser treatment is more effective CX: Neoplasia Neonatal laryngeal papillomatosis (vaginal birth) Rex Karl S. Teoxon, R.N, M.D 109
160. Candidiasis Candida albicans Grows on mucosa of mouth, intestinal tract, and genitourinary tract. NGU in males Vulvovaginal candidiasis Diagnosis is by microscopic identification and culture of yeast. Treatment: Clotrimazole or miconazole.
161. CANDIDIASIS Moniliasis (oral candidiasis) Vulvovaginal candidiasis Candida albicans (Yeast or fungus) 111 Rex Karl S. Teoxon, R.N, M.D
162. SIGNS AND SYMPTOMS Cheesy white discharge Extreme itchiness DX: KOH (wet smear indicate positive result) 112 Rex Karl S. Teoxon, R.N, M.D
167. Trichomoniasis Trichomonas vaginalis Found in semen or urine of male carriers Vaginal infection causes irritation and profuse discharge. Diagnosis is by microscopic identification of protozoan. Treatment: Metronidazole. Figure 26.15
169. SIGNS AND SYMPTOMS Females: itching, burning on urination, yellow gray frothy malodorous vaginal discharge, foul smelling Males: usually asymptomatic Dx: microscopic exam of vaginal discharge 119 Rex Karl S. Teoxon, R.N, M.D
179. HIV and AIDS Retrovirus (HIV1 & HIV2) Attacks and kills CD4+ lymphocytes (T-helper) Capable of replicating in the lymphocytes undetected by the immune system Immunity declines and opportunistic microbes set in No known cure Rex Karl S. Teoxon, R.N, M.D 129
181. MOT Sexual intercourse (oral, vaginal and anal) Exposure to contaminated blood, semen, breast milk and other body fluids Blood Transfusion IV drug use Transplacental Needle stick injuries 131 Rex Karl S. Teoxon, R.N, M.D
182. HIGH RISK GROUP Homosexual or bisexual Intravenous drug users BT recipients before 1985 Sexual contact with HIV+ Babies of mothers who are HIV+ Rex Karl S. Teoxon, R.N, M.D 132
184. SIGNS AND SYMPTOMS Acute viral illness (1 mo after initial exposure) â fever, malaise, lymphadenopathy Clinical latency â 8 yrs w/ no sx; towards end, bacterial and skin infections and constitutonal sx â AIDS related complex; CD4 counts 400-200 AIDS â 2 yrs; CD4 T lymphocyte < 200 w/ (+) ELISA or Western Blot and opportunistic infections 134 Rex Karl S. Teoxon, R.N, M.D
185. DIAGNOSIS HIV+ 2 consecutive positive ELISA and 1 positive Western Blot Test AIDS+ HIV+ CD4+ count below 200/ml 135 Rex Karl S. Teoxon, R.N, M.D
186. SIGNS AND SYMPTOMS Extreme fatigue Intermittent fever Night sweats Chills Lymphadenopathy Enlarged spleen Rex Karl S. Teoxon, R.N, M.D 136
187. SIGNS AND SYMPTOMS Anorexia Weight loss Severe diarrhea Apathy and depression PTB Kaposis sarcoma Pneumocystis carinii AIDS dementia 137 Rex Karl S. Teoxon, R.N, M.D