4. Urogenital infections and STIs

• urinary tract - flow of urine, normally sterile
• vagina - IgA, endogenous organisms, especially Lactobacillus

• constricted/ compressed ureters
• compressed bladder
• inability to void completely
• foreign object inserted

inflammation of tissue in the urethra and bladder

usually bacteria coming from the GI tract

• Escherichia coli
• Proteus vulgaris

• in females, usually self contamination from wiping
• in hospitals, from inserting catheters

• burning sensation upon urination
• sometimes fever and fatigue, malaise

culturing a sample of urine and identifying the bacteria that grow

• improved hygiene in urogenital area
• correcting anatomical abnormalities
• increasing urine flow by drinking more
• avoiding use of catheters when possible

inflammation of the vagina

• vagina has many endogenous organisms
• must maintain balance
• lactobacillus are most important - gram + bacteria maintain normal acid pH through the acid they produce

• 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

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

• soreness
• itching
• frothy or thick discharge

direct smear of vaginal secretions

avoiding practices/situations that upset balance of vaginal flora

may occasionally get infected in urethra, mostly in women

staphylococcus aureus with use of exotoxin C

• high fever
• vomiting
• rash

• mandate that tampons cannot use wood pulp or polystyrene that caused abrasions
• time warnings on tampon box

• venereal diseases
• sexually transmitted diseases

• 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

generally does not protect against subsequent infections

• 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

Neisseria gonorrhoeae - gram negative bacteria

• incidence is high
• highly transmissible

virulent strains have attachment pili -penetration of epithelial cells, will not be washed away by urine, resist phagocytosis

IgA protease - enzyme breaks down IgA

• 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

gram stain of direct smear of the discharge

antibiotic into eyes of newborns

Chlamydia trachomatis - gram negative bacteria

most common STD in the US

obligate intracellular parasite - destroys cells they multiply in

• burning on urination
• discharge in males
• chronic cervicitis in females
• can lead to infertility
• neonatal pneumonia and ocular infections

• direct smear of discharge reacted with reagent antibodies
• growth in tissue culture
• PCR

• usual strategies
• antimicrobial eye ointment for newborns

Treponema pallidum - gram negative spirochaete bacteria

• not highly transmissible
• can be transmitted transplacentally and through breast milk

• penetrates cells
• gets into blood - multiples and spreads
• damage by cell destruction

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

serological test

cell mediated immunity, helps prevent tertiary

• screening of population
• checking prostitutes

human herpes virus type II

• transmission primarily sexual
• not reportable disease
• transmissible only when there are blisters

• multiples in skin cells and destroys them
• infects nearby nerves and remains latent in them until triggered

• multiple, painful, itching blisters at site of infection
• neonatal herpes - even with no apparent lesions

tissue culture

• avoidance of intercourse or use of condom when active lesions
• caesarean section for infected pregnant women

human papilloma virus

• transmission is by sexual intercourse or close sexual contact
• fomites can be involved
• neonatal transmission

alters growth pattern of cell it infects causes abnormal growth

• warts in the genital area
• may infect the larynx in newborns

• appearance of lesions
• test for immune response with acetic acid

• remove wart
• topical ointments

• typical precautions
• vaccination