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UROGENITAL DISEASES (Urinary tract infection (UTI) (Diagnosis (first…

- - - - Symptoms - continued dysuria, frequent and urgent urination, sometimes pus in the urine
  - - - back flow of contaminated urine
      - passage of fecal organisms from lymphatics to the prostate
      - descent of blood borne organisms
      - ascent through the urethra
  - - - antigen-antibody complexes - filter out in kidney
      - complements activated - inflammation
      - antibodies produced - cannot differentiate
      - inflamed vessel leak blood and protein into urine
      - attraction of phagocytic cells - engulf new complexes
      - immune system process the cell wall - resemble tissue components in glomerular tissue
      - DAMAGE THE GLOMERULI OF THE KIDNEYS
      - S. pyogenes' cell wall
- - - - present in 20 to 40% healthy female
    - - Normal pH 3.8 - 4.4
        
        If increases to pH 5 to 6, G. vaginalis interacts with Bacteroides and Peptostreptococcus
- - - - Primary stage
        
        chancre can develop on lips or hands
        
        female - chancres on cervix or another internal location
        
        formation of chancre (1 or more) hard, painless non-discharging lesion
        
        disappear after 4-6 weeks
        
        3 weeks - inflammation at the site of entry
      - Primary latent period
        
        blood test positive
        
        spirochete is spreading through circulation
        
        all external signs disappear
      - Incubation stage - 2-6 weeks post-infection (spread throughout the body)
      - Secondary stage
        
        copper colored rash - palms, feet soles
        
        various pustular rashes and skin eruptions
        
        highly contagious
        
        female cervix - lesions
        
        symptoms (appear-disappear-reappear up to 5 years)
        
        painful, whitish mucous patches swarming with spirochetes appear on tongue, cheeks and gums
        
        kissing spreads
        
        lesions heal uneventfully
      - Secondary latent stage
        
        persist for life
        
        only some patient progress to tertiary stage
        
        blood test can be negative
        
        transmission through placenta to fetus
        
        all symptoms disappear
      - Tertiary stage
        
        involve the cardiovascular - blood vessel and heart valves are damaged
        
        Nervous systems
        
        Ataxia - unsteady gait or inability to walk
        
        Paresis - paralysis and insanity
        
        Neurosyphilis - thickening of the meninges
        
        Permanent damage occurs throughout various systems of the body
        
        Symptoms due to gummas - formation of granulomatous inflammations
        
        Internal gummas - destroy neural tissue
        
        External gummas - destroy skin tissue
    - - Fluorescent antibody
      - VDRL (veneral disease research lab)
      - DNA analysis
      - Rapid plasma region (RPR) test
      - Dark field microscope
    - - Sexual contact
      - Body fluid - saliva
      - Kissing
      - Congenital - treponema cross the placenta from mother to baby
    - - caused by Treponema pallidum (active motile organism with fastidious growth requirements
    - - treponema cross the placenta from mother to fetus
      - shortly after birth, infant show signs
        
        Perforated palate
        
        Saber shins
        
        Hutchinson's teeth
        
        Aged - looking face with saddle nose
  - - - Microscopy
        
        scraping from lesion
        
        fluid from bubo
      - No blood test
    - - burning sensation after urination
      - chancres - occur in tongue and lips (too infectious)
      - Male - penis
      - 1/3 patients developed buboes - enlarged masses of lymphatic tissues
      - Female - labia and clitoris
      - appear 1 week post infection - swell to great size and can break through the skin discharging pus
      - painful lesions, soft chancroid which bleed easily - 3 to 5 days after sexual exposure
    - - antibiotics - tetracycline, erythromycin, etc
      - lesion heal rapidly but leave deep scars
    - - caused by Haemophilus ducreyi
      - gram negative, rod
      - soft chancre
      - frequently seen in developing countries
  - - - Anorectal infection
        
        in homosexual men - occurs in the last 5-10 cm in the rectum - constipation, pus or rectal bleeding
        
        in female - spreads from vaginal gonorrhea due to contamination
      - Pelvic inflammatory disease (PID) - infection spreads throughout the pelvic activity in half infected females
      - Pharyngeal infection - those perform oral sex - bacteremia
      - Disseminated infection - bacteremia, fever, joint pain (arthritis), skin lesion, endocarditis
    - - Contaminated hands, fomites - eye infection - scarring of cornea and blindness
      - Newborns - ophthalmia neonatorum
      - Sexual contact
    - - Males - 95% have pus dripping from urethra within 14 days or sooner, burning sensation while pissing
      - Females - change in vaginal discharge, yellow or greenish colour, strong smell, pain while pissing
    - - molecular probes
      - culturing techniques
    - - transmitted by carriers
      - 40% males and 60-80% females remain asymptomatic after infection
        
        can act as carriers for 5 -15 years
    - - solfonamides, penicillin, cephalosporin
    - - caused by Neisseria gonorrhoeae
        
        gram negative, diplococcus
        
        drying kill the organisms in 1 to 2 hrs
        
        can survive hours on fomites (clothes, utensils, and furniture)
        
        improper laundering - dried masses of pus - bacteria can survive for 6 to 7 weeks
        
        fimbriae - attcahment to epithelial cells and sperm
        
        endotoxin - damage mucosa in fallopian tubes
        
        Gonococci adhere to neutrophils, phagocytosis and replicate in it
    - - no vaccine is available
  - - - Mycoplasmal infection
        
        more than half adults have antibodies against it
        
        sometimes cause pelvic inflammatory disease (PID)
        
        very common infection
        
        opportunistic urethritis in men
        
        normal urogenital microflora
        
        cause spontaneous abortions, premature births, and low birth rate
        
        caused by Mycoplasma hominis
      - Ureaplasma urealyticum
        
        infertile couples - low sperm counts or poor mobility
        
        tightly binds to sperm and transmit
        
        50-80% STDs patients carry it
        
        fetal death, recurrent miscarriage, pre-maturity and low birth weight - neonatal death
      - Chlamydia trachomatis
        
        tingling sensation in the penis
        
        asymptomatic
        
        a scanty watery urethral discharge
        
        pelvic inflammatory disease (complication of chlamydial NGU)
        
        symptom milder than gonorrhea
        
        pneumonias in children under 6 months
        
        incubation period - 1 to 3 weeks
        
        Erythromycin, tetracycline useful in treating Chlamydia infection
- - - - Vesicles are painful but they heal completely in 2 to 3 weeks without scarring unless there is a secondary bacterial infection. Adjacent lymph nodes enlarge and are sometimes tender.
    - - Cold sores - 90% HSV 1, 10% HSV 2
      - Genital Herpes - 15% HSV 1, 85% HSV 2
    - - After reactivation, virus moved along the nerve axon to epithelial cells. there it replicate, causing recurrent lesions. These lesions, which always recur in exactly the same place as the original infection, are smaller, shed fewer viruses, contain more inflammatory cells, and heal more rapidly than primary lesions.
        
        succesive recurrences usually becomes milder until they finally cease
        
        while the virus is in a neuron, neither humoral nor cellular immunity can combat it
        
        once the virus reaches target epithelial cells and starts to replicate, antibodies can neutralize the viruses, and T cells can eliminate virus-infected cells
    - - in females - the vesicles on the mucous membranes of the labia, vagina and cervix. ulceration sometimes spread over the vulva and can even appear on the thigh
      - in males - tiny vesicles on the penis and foreskin and are accompanied by urethritis and a watery discharge. the prostate gland and seminal vesicles also can be affected
      - the virus can survive for short periods of time in moist areas such as hot tubs
      - Symptoms - intense pain and itching at the sites of lesions and swelling of lymph nodes in the origin
        
        shedding always occurs when active lesions are present and usually starts a few days before lesions appear
        
        it can occur continuously even when lesions are not present
        
        abstention from sexual contacts when lesions are present does not always prevent spread of the disease
      - transmitted mainly by sexual contact
      - Woman infected with genital herpes
        
        during delivery, has to undergo Caesarean section
        
        increased risk of infected with HIV
        
        miscarriage
    - - contaminated equipment and hospital procedures
      - 2/3 infected of infected infants have skin vesicles, the others already disseminated infection with neural or visceral lesion
        
        disseminated infections - poor appetite, vomiting, diarrhea, respiratory difficulties, hypoactivity
        
        some have neurological symptoms, jaundice, eye disoders
        
        usually die within 10 days or have CNS and eye damage
      - infected by delivery through birth canal contaminated with HSV 2
      - appear at birth or up to 3 weeks after birth
    - - Keratoconjuctivitis
        
        eyes, vesicles on cornea and eyelids
      - Herpes meningoencephalitis
        
        virus at ganglion, move into the brain
        
        fever, headaches, menigingeal irritation, convulsions, altered reflexes
        
        most died in 8 to 10 days
      - Gingivostomatitis
        
        lesion on mouth
      - Herpes pneumonia - rare
        
        burn patients, alcoholics, AIDS patient