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Sturcture and Function of the Urinary System

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Urinary system
Two kidneys
Two ureters
One uniary bladder
One urethra
Infection prevented by
Valves that prevent backflow to kidneys
Acidity of urine
Mechanical flushing

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Female Reproductive System

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Two ovaries
Two uterine (fallopian) tubes
The uterus, indlucing the cervix; the vagina
External genitals

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Male Reproductive System

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Two testes
Accessory glands
Penis
Epididymis
Ductus (vas) deferens
Ejaculatory duct
Urethra

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Normal Microbiota

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Urinary bladder and upper urinary tract are strerile
Lactobacilli are predominant in the vagina
Produce hydrogen peroxide
Grow on glycogen secretions
Infection is indicated by
>10,000 bacteria/ml
100 coliforms/ml
Positive urine leukocyte esterase (LE) test

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Cystisis

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An inflammation of the urinary bladder

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Urethritis

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An inflammation of the urethra

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Pyelonephritis

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An inflammation of one or both kidneys

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Cystitis

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Usual causative agents
E. coli
S. saprophyticus
Symptoms
Dysuria (difficult or painful urination)
Pyuria (pus in urine)
Diagnosis: >100 CFU/ml of potential pathogens and positive LE test
Treatment: trimethoprim-sulfamethexazole

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Pyelonephritis

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Causative agent: usually E. coli
Symptoms: fever, back or flank pain
Diagnosis: 10,000 CFU/ml and positive LE test
Treatment: cephalosporin

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Leptospirosis

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Causative agent: leptospira interrogans
Reservoir: dogs and rats
Trasmission: skin/mucosal contact from urine-contaminated water
Symptoms: headaches, muscular aches, fever, kidney failure is a possible complication
Diagnosis: Serological test
Treatment: Doxycycline

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Sexually Transmitted Infections (STI's)

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Prevented by condoms
Bacterial infections are treated with antibiotics

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Gonorrhea

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Caused by Neisseria gonorrheae
Attaches to oral or urogenital mucosa by fimbriae
Opa proteins prevent proliferation of CDF+ T cells
Anal gonorrhea, pharyngeal gonorrhea
If left untreated, may result in
Endocarditis
Meningitis
Arthritis
Opthalmia neonatorum
Symptoms
Men: painful urination and discharge of pus
Women: few symptoms but possible complications, such as PID
Diagnosis: Gram stain, ELISA, PCR
Treatment: cephalosporins

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Nongonococcal Urethritis (NGU)

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Nonspecific urethritis
Chlamydia trachomatis
Mycoplasma hominis
Ureaplasma urealyticum
Symptoms: painful urination and watery discharge; in women, possible complications, such as PID
Diagnosis: culture, PCR
Treatment: doxycycline, azithromycin

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Pelvic Invlammatory Disease

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Polymicrobic, usually:
N. gonorrhoeae
C. trachomatis
Salpingitis (infection of uterine tubes)
Symptoms: chornic abdominal pain
Treatment: doxycycline and cefoxitin

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Syphilis

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Caused by Treponema pallidum
Invades mucosa or through skin breaks
Primary stage: chancre at site of infection
Secondary stage: skin and mucosal rashes
Latent period: no symptoms
Tertiary stage: gummas on many organs
Treatment: benzathine penicillin
Congenital syphilis: neurological damage

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Diagnosis of Syphilis

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Direct diagnosis
Staining with fluorescent-labeled monoclonal antibodies
Indirect, rapid screening
VDRL, RPR, EIA
Confirming
FTA-ABS tests for anti-treponemal antibodies

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Lymphogranuloma Venereum (LGV)

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Causative agent: Chlamydia trachomatis
Initial lesion on genitals heals
Bacteria spread through lymph
Symptoms: swelling in lymph nodes in groin
Diagnosis: microscopic identification and culture
Treatment: doxycycline

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Chancroid (Soft Chancre)

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Causative agent: Haemophilus ducreyi
Symptoms: painful ulcers of genitals, swollen lymph nodes in groin
Diagnosis: culture
Treatment: erythromycin; ceftriaxone

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Bacterial Vaginosis

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Causative agent: Gardnerella Vaginalis
Symptoms: copious fishy, gray-white, thin, frothy discharge
pH: ;4.5
Diagnosis: clue cells
Treatment: metronidazole

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Genital Herpes

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Caused by herpes simplex virus 2 (human herpes virus 2, or HSV-2)
Painful vesicles on genitals
Neonatal herpes transmitted to fetus or newborns
Recurrences from viruses latent in nerves
Suppression: Acyclovir

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Genital Warts

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Human papillomaviruses
Warts in genital area
HPV serotype 16 causes cervical cancer and cancer of the penis
Treatment: podofilox; imiquimod
Prevention: vaccination against HPV strains

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Candidiasis

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Causative agent: Candida albicans
Grows on mucosa of mouth, intestinal tract, and genitourinary tract
NGU in males
Vulvogavinal candidiasis, yeasty discharge
pH: ;4
Diagnosis: microscopic and cultuer
Treatment: clotrimazole; fluconazole

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Trichomoniasis

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Causative agent: Trichomonas vaginalis
Found in semen or urine of male carriers
Vaginal infection causes irritation and profuse foul, greenish yellow frothy discharge
pH: 5-8
Diagnosis: microscopic identification, DNA probe
Treatment: metronidazole

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TORCH

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Toxoplasmosis
Other (such as syphilis, hepatitis B, enterovirus, Epstein-Barr virus, varicella-zoster virus)
Rubella
Cytomegalovirus
Herpes simplex virus

Micro: Chapter 26 – Flashcards

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