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Reproduction (Pharmacology and Treatments (Genital Warts
Treatment not…
Reproduction
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Pathology
Inflammatory Disorders (female)
- Pelvic Inflammatory disease (PID)
Causes: Viral Fungal, Parasites, Bacterial (most often)
Pathogen moves up from vagina and cervix and infects pelvic organ
- Endometriosis
Causes: Cells from the lining of the utereus grow outside the uterine cavity
Reflux of menstrual endometrium back up fallopian tubes into pelvic cavity and transplants at ectopic sites
Spread of cells via lymphatic system or blood to distant sites Endometrial implants throughout the body but mostly in ovaries but also in sigmoid colon, sntestine, rectum, bladder, uterus, vulva, vagina, lymph nodes; rarely: pleural cavity, lungs, kidneys, bones
Ectopic endometrial tissue responds to hormonal fluctuations of the menstrual cycle →cyclic proliferation, degeneration and bleeding each month; inflammation
- Cervicitis
Inflammation of the cervix Causes: STIs, Devices and allergy to spermicides and latex
- Vulvovestibulitis
Inflammation of the vulva or vestibule of the genitalia or both Causes: Allergies, Skin disorders, Infection
- Bartholinitis
Bartholin’s glands or ducts are blocked causing a fluid filled cyst Causes: Infection, inflammation, physical blockage
Varicocele
Abnormal varicosities (dilation of veins) within the spermatic cord
Causes:faulty or absent valves in spermatic veins or compression of vein by nearby structure
Blood pools in veins, and flow into testes is decreased Reduced blood flow may impair spermatogenesis and produce infertility (common cause)
Inflammatory Disorders (male)
- Epidydmitis
Inflammation of epididymis
Common in young sexually-active males
Retrograde urine with bacterial pathogens from urethra into epididymis; via spermatic cord lymphatic
Causes: STIs: Chlamydia trachomatis, Neisseria Gonorrhea UTIs: Ecoli, Sterile urine reflux
- Orchitis
Acute inflammation of testis
Causes:Mumps (develops 4-6 days after Mumps), Infections of prostrate or epididymis, STIs
Inflammation of testes, incl seminiferous tubules
Atrophy of testes with irreversible damage to spermatogenesis in 30% of cases
Fertility diminished
Testosterone not affected
- Balanitis
Inflammation of glans penis (& foreskin)
Causes: Poor hygiene in uncircumcised men & Phimosis Infection, harsh soap and reactive arthritis
Mainly in men with diabetes mellitus and candidias
- Phimosis
Condition where foreskin cannot be fully retracted over the glans penis
Causes: Failure to loosen during growth, Poor hygiene, Infections such as balanitis, Trauma, Disease of genitals
infection → swollen lesions on foreskin → inability to retract infections may extend to penis
cause paraphimosis (strangulation of glans) if retracted force
- Prostatis
Inflammation of prostate
- Acute bacterial type
Causes/risks: Assoc. with UTI or STIs, Common pathogens: E. coli, Enterobacter, Klebsiella, Pseudomonas
Bacterial infection → acute inflammation & enlarged prostate May systemic infection
- Chronic prostatitis
Inflammation with recurrent UTI
- Non-bacterial prostatitis
Inflammation without evidence of infection
Causes:?Reflux of urine
Sexually Transmitted Infections
- Gonorrhea
Fragile intracellular diplococcus, sensitive to drying Bacteria invades mucosa of genitals, oro-pharyngeal region, joints, eyes, rectum
Pili used for attachment to epithelial cells ↑virulence
Mucosal cells damaged (Endotoxins ) , inactivates IgA Ab (enzymes- IgA protease)
Strong inflammatory response (white cells) Pyogenic infection (pus = dead white cells and debris) & fibrosis (scarring)
- Chamydia
Chlamydia bacteria enter via minute abrasions
Epithelial cells invaded & bacterium replicated
Limited acute infection followed by persistent low-grade infection Inflammation involving white cells
Severe scarring esp.with repeat infection
- Syphilis
Micro-organism enters through micro-abrasions in the skin or intact mucous membranes
Infection systemic
Incubation 2 wks – several month
- Herpes Simplex
Primary - Infects epithelium at site of contact
Virus replicates in cells
Destruction of basal epithelial cells →vesicles (blisters) or red spots at site of infection
Cell necrosis produces inflammatory response
Immune response →Healed lesions, but virus travels down sensory nerve to root ganglion where it stays for life
Secondary - Triggered by sun exposure, trauma, febrile illness, menstruation, emotional stress
Virus travels down axons to original site(s) of infection or site served by same ganglion
May or may not produce lesions
Infection usually milder & shorter than primary
- Genital Herpes
Secondary infection
Prodrome – tingling or itching, then pain preceding lesions
Lesions may appear but are less painful, less long-lived (~5 days), & heal more quickly 7-10 days
- Neonatal Herpes
Transmitted via birth canal or contaminated equipment Likely with primary infection of mother
Disseminated infection – organs include brain - encephalitis
Jaundice, bleeding problems,defective sight or hearing, respiratory distress, seizures, coma
High mortality
- Genital warts
HPV infects stratified squamous epithelium,
HPV replicates & produces proliferative lesions of squamous cells (warts)
Small papules, cauliflower shaped lesions on genitals, or microscopic `flat warts’
85% of cervical HPV lesions regress / resolve after 2 years – cell mediated immunity
15% may persist or progress to cervical, vulval and anal cancer
- Fungal infections (Candida)
Invades top layers of epithelium
Strong inflammatory response
In females, vulvovaginitis with
Vaginal & vulvar itching
Thick white vaginal discharge, yeasty odour
Reddened and sore vulvaIn
Males: C.albicans causes occasional non-gonorrheal urethritis
- Protozoal infections (Trichomoniasis)
Cause: Trichomonas vaginalis
Common sexually transmitted infection
Flagellum of protozoan adheres to epithelial cells
Invades squamous tissue, eg vagina, urethra,
Bartholin’s glands
Cells damaged, with strong inflammatory response
Results in urethritis and vaginitis
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