4. Urogenital infections and STIs

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4. Urogenital infections and STIs
2011-08-11 04:21:01
PH162A midterm3

public health microbiology midterm 3 lecture 4
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  1. defenses of the urogenital tract
    • urinary tract - flow of urine, normally sterile
    • vagina - IgA, endogenous organisms, especially Lactobacillus
  2. Situations that impair urinary flow
    • constricted/ compressed ureters
    • compressed bladder
    • inability to void completely
    • foreign object inserted
  3. Urethrocystitis
    inflammation of tissue in the urethra and bladder
  4. Urethrocystitis etiology
    usually bacteria coming from the GI tract

    • Escherichia coli
    • Proteus vulgaris
  5. Urethrocystitis transmission
    • in females, usually self contamination from wiping
    • in hospitals, from inserting catheters
  6. Urethrocystitis clinical manifestations
    • burning sensation upon urination
    • sometimes fever and fatigue, malaise
  7. Urethrocystitis diagnosis
    culturing a sample of urine and identifying the bacteria that grow
  8. Urethrocystitis prevention
    • improved hygiene in urogenital area
    • correcting anatomical abnormalities
    • increasing urine flow by drinking more
    • avoiding use of catheters when possible
  9. vaginitis
    inflammation of the vagina
  10. vaginitis host factors
    • vagina has many endogenous organisms
    • must maintain balance
    • lactobacillus are most important - gram + bacteria maintain normal acid pH through the acid they produce
  11. situations which upset balance of normal flora of the vagina
    • excessive antibiotics, douches or spermicidal contraceptives
    • fluctuation in levels of steroid hormones - pH rises, other organisms can flourish
    • untreated diabetics - vagina secretions may contain increased amounts of glucose
    • immunosuppression
  12. vaginitis etiology
    candida albicans (yeast) is prime cause - always present, usually kept in check by lactobacilli

    gardernella vaginalis - gram negative cocco-bacillus - endogenous

    trichomonas vaginalis - flagellated protozoan, can be transmitted sexually or environment
  13. vaginitis clinical manifestations
    • soreness
    • itching
    • frothy or thick discharge
  14. vaginitis diagnosis
    direct smear of vaginal secretions
  15. vaginitis prevention
    avoiding practices/situations that upset balance of vaginal flora
  16. Do men get infected with vaginitis organisms?
    may occasionally get infected in urethra, mostly in women
  17. Toxic Shock Syndrome etiology
    staphylococcus aureus with use of exotoxin C
  18. Toxic Shock Syndrome clinical manifestations
    • high fever
    • vomiting
    • rash
  19. Toxic Shock Syndrome prevention
    • mandate that tampons cannot use wood pulp or polystyrene that caused abrasions
    • time warnings on tampon box
  20. previous names of sexually transmitted infections
    • venereal diseases
    • sexually transmitted diseases
  21. sexually transmitted infections transmission
    • humans are the only reservoir
    • close, direct contact, usually sexual intercourse, is required to transmit the disease
    • incidence is greatest during the ages of greatest sexual activity
    • multiple partners greatly enhances probability
    • pregnant woman can infect the baby through two ways =
    • neonatally - by passage through the vagina with direct contact with microorganisms
    • transplacentally or congentially - passage of microorganisms from the mother's blood into the fetus' blood across the placenta
  22. sexually transmitted infections immune response
    generally does not protect against subsequent infections
  23. sexually transmitted infections prevention
    • abstinence, virginity of both partners
    • monogamous state of person and partner
    • condoms
    • early diagnosis and treatment
    • health education
    • contact identification
    • only vaccine for human papillomavirus
  24. Gonorrhea etiology
    Neisseria gonorrhoeae - gram negative bacteria
  25. Gonorrhea epidemiology
    • incidence is high
    • highly transmissible
  26. Gonorrhea pathogenesis
    virulent strains have attachment pili -penetration of epithelial cells, will not be washed away by urine, resist phagocytosis

    IgA protease - enzyme breaks down IgA
  27. Gonorrhea clinical manifestations
    • asymptomatic carriers - more common in women
    • urethritis - inflammation of the urethra
    • pelvic inflammatory disease - infertility, ectopic pregnancy
    • discharge from area of sexual contact
    • arthritis
    • neonatal gonorrhea
  28. Gonorrhea diagnosis
    gram stain of direct smear of the discharge
  29. Gonorrhea prevention
    antibiotic into eyes of newborns
  30. Chlamydial disease etiology
    Chlamydia trachomatis - gram negative bacteria
  31. Chlamydial disease epidemiology
    most common STD in the US
  32. Chlamydial disease pathogenesis
    obligate intracellular parasite - destroys cells they multiply in
  33. Chlamydial disease clinical manifestations
    • burning on urination
    • discharge in males
    • chronic cervicitis in females
    • can lead to infertility
    • neonatal pneumonia and ocular infections
  34. Chlamydial disease diagnosis
    • direct smear of discharge reacted with reagent antibodies
    • growth in tissue culture
    • PCR
  35. Chlamydial disease prevention
    • usual strategies
    • antimicrobial eye ointment for newborns
  36. Syphilis etiology
    Treponema pallidum - gram negative spirochaete bacteria
  37. Syphilis epidemiology
    • not highly transmissible
    • can be transmitted transplacentally and through breast milk
  38. Syphilis pathogenicity
    • penetrates cells
    • gets into blood - multiples and spreads
    • damage by cell destruction
  39. Syphilis clinical manifestations
    primary stage - hard, red, nonpainful lesions (chancres)

    secondary stage - has spread through blood, fever, sore throat, body rash, very contagious

    tertiary stage - lesions (gummas) with no living bacteria, neurologic problems, cardiovascular problems

    congenital syphilis
  40. Syphilis diagnosis
    serological test
  41. Syphilis host's immune response
    cell mediated immunity, helps prevent tertiary
  42. Syphilis prevention
    • screening of population
    • checking prostitutes
  43. Genital Herpes etiology
    human herpes virus type II
  44. Genital Herpes epidemiology
    • transmission primarily sexual
    • not reportable disease
    • transmissible only when there are blisters
  45. Genital Herpes pathogenesis
    • multiples in skin cells and destroys them
    • infects nearby nerves and remains latent in them until triggered
  46. Genital Herpes clinical manifestations
    • multiple, painful, itching blisters at site of infection
    • neonatal herpes - even with no apparent lesions
  47. Genital Herpes diagnosis
    tissue culture
  48. Genital Herpes prevention
    • avoidance of intercourse or use of condom when active lesions
    • caesarean section for infected pregnant women
  49. Genital Warts etiology
    human papilloma virus
  50. Genital Warts epidemiology
    • transmission is by sexual intercourse or close sexual contact
    • fomites can be involved
    • neonatal transmission
  51. Genital Warts pathogenesis
    alters growth pattern of cell it infects causes abnormal growth
  52. Genital Warts clinical manifestations
    • warts in the genital area
    • may infect the larynx in newborns
  53. Genital Warts diagnosis
    • appearance of lesions
    • test for immune response with acetic acid
  54. Genital Warts treatment
    • remove wart
    • topical ointments
  55. Genital Warts prevention
    • typical precautions
    • vaccination