Transcript Chapter 26
Structure and Function of Urinary System
Urinary system
: Two kidneys Two ureters One urinary bladder One urethra Infection prevented by: Valves prevent backflow to kidneys Acidity of urine Mechanical flushing
Female Urinary System
Predisposition to infection Short urethra Proximity to anus Figure 26.1
The Female Reproductive System
Female: Two ovaries Two uterine (fallopian) tubes The uterus, including the cervix; the vagina External genitals
Female Reproductive Organs
Figure 26.2a
The Male Reproductive System
Male: Two testes Accessory glands Penis Epididymis Ductus (vas) deferens Ejaculatory duct Urethra
Male Reproductive and Urinary Organs
Figure 26.3
Normal Microbiota
Urinary bladder and upper urinary tract are sterile Lactobacilli are predominant in the vagina Produce H 2 O 2 Grow on glycogen secretions Infection is indicated by: >10,000 bacteria/ml 100 coliforms/ml Positive urine leukocyte esterase (LE) test
Urinary System Infections
Cystitis
An inflammation of the urinary bladder
Urethritis
An inflammation of the urethra
Pyelonephritis
An inflammation of one or both kidneys
Cystitis
Usual causative agents
:
E. coli S. saprophyticus
Symptoms
: Dysuria (difficult or painful urination) Pyuria (pus in urine)
Diagnosis
: >100 CFU/ml potential pathogens and + LE test
Treatment
: Trimethoprim-sulfamethexazole
Pyelonephritis
Causative agent
: Usually
E. coli
Symptoms
: Fever; back or flank pain
Diagnosis
: 10 4 CFUs/ml and + LE test
Treatment
: Cephalosporin
Leptospirosis
Causative agent
:
Leptospira interrogans
Reservoir
: Dogs and rats
Transmission
: Skin/mucosal contact from urine-contaminated water Figure 26.4
Leptospirosis
Symptoms
: Headaches, muscular aches, fever, kidney failure a possible complication
Diagnosis
: Serological test
Treatment
: Doxycycline
Sexually Transmitted Infections (STIs)
Prevented by condoms Bacterial infections are treated with antibiotics
Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention
Chlamydia —Rates by Sex, United States, 1990–2010 Rate (per 100,000 population)
750 625 Men Women Total 500 375 250 125 0 1990 1992 1994 1996 1998 2000
Year
2002 2004 2006 2008 2010
NOTE:
As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases.
Chlamydia —Rates by Age and Sex, United States, 2010 Men
3,700 2,960 2,220 1,480
Rate (per 100,000 population)
774.3
740 0
Age
15 –19 0 740 1,187.0
598.0
20 –24 25 –29 309.0
153.2
91.3
30 –34 35 –39 40 –44 220.1
94.7
530.9
39.3
10.9
45 –54 55 –64 32.8
9.3
233.7
2.8
65+
Total
2.1
610.6
1,480 1,236.1
2,220 2,960
Women
3,700 3,378.2
3,407.9
Chlamydia —Rates by Race/Ethnicity, United States, 2001 –2010 Rate (per 100,000 population)
1500 1200 900 600 300 0 2001 American Indians/Alaska Natives Asians/Pacific Islanders Blacks Hispanics Whites 2002 2003 2004 2005
Year
2006 2007 2008 2009 2010
Gonorrhea
Caused by
Neisseria gonorrhoeae
Attaches to oral or urogenital mucosa by fimbriae Opa proteins prevent CD4 +
Anal gonorrhea
, T-cell proliferation
pharyngeal gonorrhea
If left untreated, may result in Endocarditis Meningitis Arthritis
Ophthalmia neonatorum
Gonorrhea
Symptoms
: Men: Painful urination and discharge of pus Women: Few symptoms but possible complications, such as PID
Diagnosis
: Gram stain, ELISA, PCR
Treatment
: Fluoroquinolones
Neisseria gonorrhoeae
Figure 26.7
Gonorrhea —Rates, United States, 1941–2010 Rate (per 100,000 population)
500 400 300 200 100 0 1941 1946 1951 1956 1961 1966 1971 1976
Year
1981 1986 1991 1996 2001 2006
Gonorrhea —Rates by Sex, United States, 1990–2010 Rate (per 100,000 population)
400 300 200 100 Men Women Total 0 1990 1992 1994 1996 1998 2000
Year
2002 2004 2006 2008 2010
Gonorrhea —Rates by Age and Sex, United States, 2010 Men
750 600 450 421.0
300 253.4
241.3
146.5
Rate (per 100,000 population)
150 0
Age
0 150 15 –19 20 –24 85.1
25 –29 30 –34 35 –39 48.2
107.5
64.2
23.8
34.1
11.0
40 –44 45 –54 55 –64 9.0
1.9
94.1
2.4
65+
Total
0.5
106.5
300 226.3
450 600
Women
750 570.9
560.7
Gonorrhea —Rates by Race/Ethnicity, United States, 2001 –2010
300 200 100 0
Rate (per 100,000 population)
600 500 400 American Indians/Alaska Natives Asians/Pacific Islanders Blacks Hispanics Whites 2001 2002 2003 2004 2005
Year
2006 2007 2008 2009 2010
Gonococcal Isolate Surveillance Project (GISP) — Percentage of Neisseria gonorrhoeae Isolates with Resistance or Intermediate Resistance to Ciprofloxacin, 1990 –2010 Percentage
20 Resistance Intermediate Resistance 15 10 5 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Year
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
NOTE:
Resistant isolates have ciprofloxacin minimum inhibitory concentrations (MICs) > 1 µg/ml. Isolates with intermediate resistance have ciprofloxacin MICs of 0.125
–0.5 µg/ml. Susceptibility to ciprofloxacin was first measured in GISP in 1990.
Gonococcal Isolate Surveillance Project (GISP) — Penicillin, Tetracycline, and Ciprofloxacin Resistance Among GISP Isolates, 2010 6.9% 0.6% 2.0% 1.8% 2.9% 9.4% 3.5% 72.8%
Susceptible PenR TetR QRNG PenR/TetR PenR/QRNG TetR/QRNG PenR/TetR/QRNG
NOTE:
PenR = penicillinase producing
Neisseria gonorrhoeae
and chromosomally mediated penicillin resistant
N. gonorrhoeae
; TetR = chromosomally and plasmid mediated tetracycline-resistant
N. gonorrhoeae
; and QRNG = quinolone-resistant
N. gonorrhoeae
.
Antibiotic Resistance in N. gonorrhoeae
Clinical Focus, p. 751
Nongonococcal Urethritis (NGU)
Nonspecific urethritis
Chlamydia trachomatis Mycoplasma hominis Ureaplasma urealyticum
Symptoms
: Painful urination and watery discharge; in women, possible complications, such as PID
Diagnosis
: Culturing, PCR
Treatment
: Doxycycline, azithromycin
Pelvic Inflammatory Disease (PID)
Polymicrobic, usually
N. gonorrhoeae C. trachomatis
Salpingitis (infection of uterine tubes)
Symptoms Treatment
: Chronic abdominal pain : Doxycycline and cefoxitin
Syphilis
Caused by
Treponema pallidum
Invades mucosa or through skin breaks Figure 26.9
Syphilis
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:
Neurological damage
Lesions of Primary Stage Syphilis
Figure 26.11a
Lesions of Secondary Stage Syphilis
Figure 26.11b
Lesions of Tertiary Stage Syphilis
Figure 26.11c
Diagnosis of Syphilis
Direct diagnosis Staining with fluorescent-labeled monoclonal antibodies Indirect, rapid screening
VDRL
,
RPR
,
EIA
Confirming FTA-ABS tests for anti-treponemal antibodies
Syphilis —Reported Cases by Stage of Infection, United States, 1941 –2010 Cases (in thousands)
600 500 400 300 200 100 Primary and Secondary Early Latent Total Syphilis 0 1941 1946 1951 1956 1961 1966 1971
Year
1976 1981 1986 1991 1996 2001 2006
Primary and Secondary Syphilis —Rates by Age and Sex, United States, 2010 Men
25 20 21.9
19.2
15 15.8
12.7
13.8
10 8.5
7.9
5.6
Rate (per 100,000 population)
5 0
Age
0 5 15 –19 3.0
20 –24 25 –29 3.0
4.5
2.0
2.7
30 –34 35 –39 40 –44 45 –54 55 –64 1.0
0.8
0.2
1.4
0.6
65+ 0.0
Total
1.1
10 15 20
Women
25
Primary and Secondary Syphilis —Rates by Race/Ethnicity, United States, 2001 –2010 Rate (per 100,000 population)
25 20 15 10 American Indians/Alaska Natives Asians/Pacific Islanders Blacks Hispanics Whites 5 0 2001 2002 2003 2004 2005
Year
2006 2007 2008 2009 2010
Lymphogranuloma Venereum (LGV)
Causative agent
:
Chlamydia trachomatis
Initial lesion on genitals heals Bacteria spread through lymph
Symptoms Diagnosis
: Swelling in lymph nodes in groin : Microscopic and culture
Treatment
: Doxycycline
Chancroid (Soft Chancre)
Causative agent
:
Haemophilus ducreyi
Symptoms
: Painful ulcers of genitals swollen lymph nodes in groin
Diagnosis Treatment
: Culture : Erythromycin; cetriaxone
Chancroid —Reported Cases, United States, 1981–2010 Cases (in thousands)
5 2 1 4 3 0 1981 1983 1985 1987 1989 1991 1993 1995
Year
1997 1999 2001 2003 2005 2007 2009
Bacterial Vaginosis
Causative agent
:
Gardnerella vaginalis
Symptoms
: Copious fishy, gray-white, thin, frothy discharge
pH
: >4.5
Diagnosis Treatment
: Clue cells : Metronidazole
How common is genital herpes?
• Nationwide, 16.2%, or about one out of six, people 14-49 years of age have • genital HSV-2 infection. Genital HSV-2 infection is more common in women (approximately one out of five women 14-49 years of age) than in men (about one out of nine men 14-49 years • of age). Transmission from an infected male to his female partner is more likely than from an infected female to her male partner.
Genital Herpes
Caused by herpes simplex virus 2 (human herpesvirus 2, or HSV –2) Painful vesicles on genitals Neonatal herpes transmitted to fetus or newborns Recurrences from viruses latent in nerves Suppression: Acyclovir
Herpes Simplex Virus Type 2 —Seroprevalence in Non-Hispanic Whites and Non-Hispanic Blacks by Age Group, National Health and Nutrition Examination Survey, 1976 –1980, 1988–1994, 1999–2004, 2005 –2008 Percentage
100 80
Non-Hispanic Whites Percentage
100 80
Non-Hispanic Blacks
60 40 60 40 20 0 All Ages* 14 –19 20 –29
Age
30 –39 1976 –1980 20 40 –49 1988 –1994 0 All Ages* 1999 –2004 14 –19 2005 –2008 20 –29
Age
30 –39 40 –49 * Age-adjusted by using the 2000 U.S. Census civilian, non-institutionalized population aged 14 –49 years as the standard.
NOTE:
Error bars indicate 95% confidence intervals.
Genital Warts
Human papillomaviruses Warts in genital area HPV 16 causes cervical cancer and cancer of the penis Treatment: Podofilox; imiquimod Prevention: Vaccination against HPV strains
Human Papillomavirus —Prevalence of High-risk and Low-risk Types Among Females Aged 14 –59 Years, National Health and Nutrition Examination Survey, 2003 –2006 Prevalence, %
60 50 Low-risk HPV* High-risk HPV* 40 30 20 10 0 14 –19 20 –24 25 –29 30 –39 40 –49
Age
* HPV = human papillomavirus.
NOTE:
Error bars indicate 95% confidence intervals. Both high-risk and low-risk HPV types were detected in some females.
SOURCE: Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et al. Prevalence of genital HPV among females in the United States, the National Health and Nutrition Examination Survey, 2003 –2006. J Infect Dis. 2011;204(4):566-73 50 –59
Genital Warts —Initial Visits to Physicians’ Offices, United States, 1966 –2010 Visits (in thousands)
500 400 300 200 100 0 1966 1969 1972 1975 1978 1981 1984 1987
Year
1990 1993 1996 1999 2002 2005 2008
NOTE:
The relative standard errors for genital warts estimates of more than 100,000 range from 18% to 30%. SOURCE: IMS Health, Integrated Promotional Services™. IMS Health Report, 1966–2010.
Genital Herpes —Initial Visits to Physicians’ Offices, United States, 1966 –2010 Visits (in thousands)
400 350 300 250 200 150 100 50 0 1966 1969 1972 1975 1978 1981 1984 1987
Year
1990 1993 1996 1999 2002 2005 2008
NOTE:
The relative standard errors for genital herpes estimates of more than 100,000 range from 18% to 30%. SOURCE: IMS Health, Integrated Promotional Services™. IMS Health Report, 1966–2010.
Candidiasis
Causative agent: Candida albicans Grows on mucosa of mouth, intestinal tract, and genitourinary tract NGU in males Vulvovaginal candidiasis, yeasty discharge
pH
: <4
Diagnosis Treatment
: microscopic and culture : Clotrimazole; fluconazole
Trichomoniasis
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 Treatment
: Microscopic identification, DNA probe : Metronidazole
Trichomonas vaginalis
Figure 26.16
Trichomoniasis and Other Vaginal Infections —Women— Initial Visits to Physicians’ Offices, United States, 1966– 2010 Visits (in thousands)
4,500 3,600 2,700 1,800 900 Trichomoniasis Other Vaginitis 0 1966 1969 1972 1975 1978 1981 1984 1987
Year
1990 1993 1996 1999 2002 2005 2008
NOTE:
The relative standard errors for trichomoniasis estimates range from 16% to 27% and for other vaginitis estimates range from 8% to 13%. SOURCE: IMS Health, Integrated Promotional Services™, IMS Health Report, 1966–2010.
The TORCH Panel of Tests
T
oxoplasmosis
O
ther (such as syphilis, hepatitis B, enterovirus, Epstein-Barr virus, varicella-zoster virus)
R
ubella
C
ytomegalovirus
H
erpes simplex virus
STDs in Racial and Ethnic Minorities
Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention
Chlamydia —Rates by Race/Ethnicity and Sex, United States, 2010 Men
2,500 2,000 1,500 1,000
Rate (per 100,000 population)
500 0
Race/ Ethnicity
0 500 276.4
AI/AN* 1,000 898.7
1,500 2,000
Women
2,500 761.8
59.7
A/PI* Blacks 184.4
Hispanics 69.9
Whites 233.7
Total
167.2
205.1
567.6
610.6
1,536.5
* AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacific Islanders.
Gonorrhea —Rates by Race/Ethnicity and Sex, United States, 2010 Men
750 600 450 433.6
300
Rate (per 100,000 population)
150 0
Race/ Ethnicity
0 150 77.0
AI/AN* 133.5
300 17.1
A/PI* 14.0
Blacks 48.7
Hispanics 51.1
19.5
Whites 26.6
94.1
Total
106.5
450 600
Women
750 430.8
* AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacific Islanders.
Primary and Secondary Syphilis —Rates by Race/Ethnicity and Sex, United States, 2010 Men
35 28 28.2
21 14 7
Rate (per 100,000 population)
0
Race/ Ethnicity
0 7 4.3
AI/AN* 0.7
8.5
7.9
2.6
4.0
A/PI* 0.1
Blacks Hispanics 0.5
Whites 0.3
Total
1.1
6.4
14 21 28
Women
35 * AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacific Islanders.