Diseases of the Urinary and Reproductive System

1. Diseases of the Urinary and Reproductive System Warning: Some images may be disturbing

2. Urinary System

3. Female Reproductive Organs

4. Male Reproductive System

5. Normal Flora of the Urinary and Reproductive Systems • Normal urine is STERILE – external skin contamination possible • Most common bacterial in the vagina is lactobacillus • Acid production keeps pH low and prevents other bacteria from growing • Candida albicans normal flora of the vagina • Male urethra is usually sterile

6. Diseases of the Urinary System • Urethritis – inflammation of the urethra • Cystitis – bladder infection • Ureteritis – infection of the ureters • Pyelonephritis – kidney infection

7. Cystitis • Inflammation of bladder • Symptoms are often difficult, painful, urgent urination • Female urethra is only 2 inches long and close to anal opening – E. coli is most common infective agent • Rate of bladder infection is 8 times higher in women than men • 100 CFU’s or more in urine sample is over the limit • Treatment – trimethoprin-sulfamethoxazole

8. Pyelonephritis • Untreated cystitis can lead to inflammation of the kidneys • Fever and back pain • Causative agent is usually E. coli • Potentially life threatening condition • IV antibiotics

9. Bacterial Diseases of the Reproductive System • New terminology STD or STI? • STI – Sexually transmitted infections is now the preferred terminology • More than 30 bacterial, viral or parasitic infections that are identified as STI’s • In US 15,000,000 new cases of STI’s per year

10. Gonorrhea • Neisseria gonorrhoeae Gram – diplococcus • 700,000 cases reported each year in the US • 60% of the patients are ages 15-24 • It’s easy to get • Men – single unprotected exposure results in infection 20-35% of the time • Women – single unprotected exposure results in infection 60-90% of the time

11. Infection rates by age

12. Gonorrhea in men • Painful urination • Pus containing discharge from the penis • Symptoms appear in a few days • Treatment with cephalosporin antibiotics • REMEMBER it’s now a superbug!

14. Gonorrhea in women • Difficult to diagnose • Only the cervix is infected • Few women know that they are infected • Abdominal pain from complications of PID may be present

15. Cervix infection from gonorrhea

16. Infection rates by state

17. Chlamydia trachomatis • Common cause of PID in women • Five times as many cases in women than men • Most are unaware of the infection because symptoms are mild in men and asymptomatic in women • Complications of Chlamydia associated PID in women can be: • Infection of cervix • Uterine tubes – SALPINGITIS and tubal pregnancy • Ovaries and uterus

18. Salpingitis

19. Syphilis Treponema pallidum Gram negative spirochete Produces inflammatory immune response to damage host tissue Treponema probably evolved from a tropical skin disease called yaws and was imported into the new world by European explorers Three stages to the disease

20. Primary Stage Syphilis • Initial sign is a small sore called a CHANCRE • Usually painless but exudes a very infective fluid • Women may not know they are infected because the cervix is the site of the chancre • Sore disappears in a few weeks • Bacteria enter the bloodstream and lymphatic system

21. Secondary stage syphilis • Several weeks after the primary stages skin rashes appear that are characteristic of secondary syphilis • Palms and soles of feet • Lesions from the rash are very infective • Difficult to diagnose at this stage • Symptoms usually resolve in 3 months

22. Latent period • After secondary stage the disease enters the latent phase • No symptoms present • After 2-4 years the disease is no longer infectious • Most cases treated or not do not progress past this stage

23. Tertiary stage syphilis • Up to 25% of untreated case enter this phase • Skin lesions called gummas are this in this stage • Neurologic symptoms may also appear • This stage is very rare today

24. Treatment • Penicillin is still used with good results for primary and secondary stage disease

26. Vaginosis

27. Genital Herpes • Caused by HSV-2 • HSV-1 causes cold sores can can cause genital herpes • IN THE UNITED STATES ONE IN FOUR PERSON OVER THE AGES OF 30 IS INFECTED WITH HSV-2!!!!!!! • Most are unaware they are infected • Remember Herpes is forever • No cure only management of the condition

28. Genital herpes

29. Incidence of genital herpes

30. Genital warts • Caused by papillomaviruses • Million new cases in the US each year • Common infection 25% of women ages 14-59 may be infected • Papillomavirus types 16 and 18 cause cervical cancer, types 6 and 11 genital warts • HPV vaccine – Gardasil

31. Genital warts