Transcript CHAPTER 5 -UROGENITAL AND SEXUAL TRANSMITTED DISEASES

CHAPTER 5 -UROGENITAL AND
SEXUAL TRANSMITTED DISEASES
By Miss Rashidah binti Hj Iberahim
Content
Urogenital Diseases
 Sexually transmitted disease (STD)
 - Gonorrhear
 - Syphilis
 - Herpesvirus infection
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BACTERIAL UROGENITAL INFECTIONS
Bacterial infection
Urinary tract infections (UTIs)
 Prostatitis
 Pyelonephritis
 Glomerulonephritis
 Leptospirosis
 Vaginitis
 Toxic shock syndrome (TSS)
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1. Urinary Tract Infections (UTIs)
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burning with urination (dysuria), frequency of urination, an urge to
urinate, no vaginal discharge, and no significant pain.
An upper urinary tract infection or pyelonephritis may also present
with flank pain and a fever. Healthy women have an average of 5 days
of symptoms.
In young children, urinary tract infection symptoms may
include diarrhea, loss of appetite, nausea and vomiting, fever, and
excessive crying that cannot be resolved by typical measures.
Older children on the other hand may experience abdominal pain, or
incontinence.
Lower urinary tract infections in adults may manifest with symptoms
including hematuria (blood in the urine), inability to urinate despite
the urge, and malaise.
Symptoms
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foul-smelling urine and urine that appears cloudy.
Urethritis, meaning only the urethra has been affected,
does not usually cause any other symptoms besides dysuria.
However, if the bladder is affected (cystitis), the patient is
likely to experience more symptoms, including lower
abdomen discomfort, low-grade fever, pelvic pressure, and
frequent urination, all together with dysuria.
Whereas in newborns the condition may
cause jaundice and hypothermia, in the elderly, symptoms
of urinary tract infections may includelethargy and a
change in mental status, signs that are otherwise
nonspecific.
What is this?
Hematuria
Causes
Intercourse
 In young sexually active women, sex is the cause of 75–90% of bladder
infections, with the risk of infection related to the frequency of sex. The
term "honeymoon cystitis" has been applied to this phenomenon of
frequent UTIs during early marriage.
 In post menopausal women sexual activity does not affect the risk of
developing a UTI. Spermicide use, independent of sexual frequency,
increases the risk of UTIs.
Sex
 Among the elderly, UTI frequency is roughly equal proportions in women
and men. This is due, in part, to an enlarged prostate in older men. As
the gland grows, it obstructs the urethra, leading to increased difficulty
in micturition. Because there is less urine flushing the urethra, there is a
higher incidence of colonization.
Causes
Urinary catheters
 Urinary catheters are a risk factor for urinary tract infections. The risk of
an associated infection can be decreased by only catheterizing when
necessary, using aseptic technique for insertion, and maintaining
unobstructed closed drainage of the catheter.
Genetics
 A predisposition for bladder infections may run in families.
Others
 Other risk factors include diabetes, sickle-cell disease, or anatomical
malformations of the urinary tract such as prostate enlargement.
 While ascending infections are, in general, the rule for lower urinary
tract infections and cystitis, the same is not necessarily true for upper
urinary tract infections like pyelonephritis, which may originate from
a blood-born infection.
Catheterization
General prevention
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A prolonged course (six months to a year) of low-dose
antibiotics (usually nitrofurantoin or TMP/SMX) is effective
in reducing the frequency of UTIs in those with recurrent
UTIs.
Cranberry (juice or capsules) may decrease the incidence of
UTI in those with frequent infections. Long-term tolerance,
however, is an issue. Subsequent research has questioned
these findings.
For post-menopausal women intravaginal application of
topical estrogen cream can prevent recurrent cystitis.This
however is not as useful as low dose antibiotics.
Studies have shown that breastfeeding can reduce the risk
of UTIs in infants.
Cont.
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the use of birth control pills or condoms, voiding
after sex, the type of underwear used, personal
hygiene methods used after voiding
or defecating, and whether one takes a bath
instead of a shower
Microbial causing infections
E.coli
 Proteus mirabilis
 Klebsiella pneumoniae
 Chlamydia / Ureaplasma
 Staphylococcus epidermidis
 Staphylococcus saprophyticus
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Diagnosis
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Make sure that the sample should be ‘ clean catch urine’
and ‘mid stream urine’
In straight-forward cases, a diagnosis may be made and
treatment given based on symptoms alone without further
laboratory confirmation.
In complicated or questionable cases, confirmation via
urinalysis, looking for the presence of nitrites, leukocytes,
or leukocyte esterase, or via urine microscopy, looking for
the presence of red blood cells, white blood cells,
and bacteria, may be useful.
Agar used for urine diagnosis
Oxoid clarity agar
Chromogenic Urine Agar
Diagnosis
Dip the strip
Compare with table
2. Prostatitis
4 routes of infections:
 By ascent thru the urethra
 By back-flow of contaminated urine
 By passage of fecal organisms from rectum thru
lymphatic and to the prostate
 By descent of blood-borne organism
Harmful effects
Usually occur in male
 Cause infertility
 2nd infection to prostate infection
 Attacking at least age 40 above
 Causing urgent and frequent urination, low fever,
back pain and sometimes muscles / joint pain
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3. Pyelonephritis
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Caused by Candida sp. or E.coli
Inflammation of kidney
Usually caused by anatomical defects / lower UT
blockage
Especially children (infant) faced back up urination
Symptoms similar to cytitis but this illness feels chills,
fever, diluted urine (frequent and nocturia)
difficult to treat compared UTIs
Limited drugs used as precaution of kidney failure
4. Glomerulonephritis
Also known as Bright’s disease
 Inflammation of glomeruli of kidney
 Caused either by staphylococcus / viral infection
 Along wt Rheumatic fever – Staphylococcus
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pyogenes
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Initiate antibodies production that enhance the
immune systems to activated but false distruction
– against cell wall of glomeruli
Cont.
Phagocytic cell leak out from b.v plus production
of hydrolytic enzymes – causing damage
 Appropriate antibiotic needed
 Cause infection in throat and additional infection
of streptococcal
 Heal either 3-12 months/ permanent damage of
kidney/die
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5. Leptospirosis
Caused by Leptospira interrogans
 Acquired from contact wt contaminated urine
 Diagnosis from microscopic observation of blood
 Treated by antibiotics and treated vaccination of
pets (as source of infection)
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6. Toxic Shock Syndrome (TSS)
Arises from superabsorbent tampon usage
 Treated by nafcilin
 Prevent such tampons
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FUNGAL UROGENITAL INFECTION
Candidiasis
Caused by Candida albicans
 About 75% woman experience it once in life
 Less common in girls before puberty and after
menopause
 Yeasty and white urine
 Treated by clotrimazole and fluconazole
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Diagnosis
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Culturation
Microscopic observation hyphae
Treatment
Topical antifungal
 Oral fluconazole
 Gentian violet can be used
for breastfeeding thrush
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SEXUALLY TRANSMITTED DISEASES (STD)
Bacterial STD
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Gonorrhea*
Syphilis*
Chancroid
Nongonococcal Urethritis
Lyphogranuloma Venereum
Granuloma Inguinale
1. Gonorrhea
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Caused by gram negative diplococcus Neisseria
gonorrheae
Confused between semen and pus
 Area of infection – heart, eyes, pharynx, anal and
ophthalmic
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Diagnosis
Using the discharge sample:
 Gram-negative diplococci
 Culturation
 ELISA
 Nucleic acid amplification test
2. Syphilis
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Caused by Gram negative spirochete, Treponema
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The m/org loses effectiveness outside the host body
Grow slowly (rabbit) about 30hrs
Culture in low oxygen concentration for few
generation
Cork-screw motility, no toxin but contain lipoprotein
that induce inflammatory immune response
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pallidum
Syphilis
Stages
Primary
 Secondary
 Tertiary
 Congenital
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Diagnosis
Primary stage – microscopic observation
Secondary stage
 using serological test – nontreponemal (that had
distributed generally)
 So called as reagin-type antibiotics
 Slide agglutination – Venereal Disease Research
Laboratory (VDRL) test, rapid plasma reagin (RPR) test,
ELISA
 Treponemal-type serological test (direct to the m/org)
 Such as enzyme immunoassay (EIA), simple Rapid
diagnostic tests (RDTs)
 For confirmation – flourescent treponemal antibody
absorption test (FTA-ABS)
Treatment
Benzathine penicillin act after 2 weeks
 In serum, m/org concentration low but sensitive
towards antibiotic
 For penicillin-sensitive people, use azithromycin,
doxycycline and tetracycline
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3. Chancroid
4. Lymphogranuloma venereum
(LGV) and 5. Granuloma inguinale
OTHER DISEASES
Bacterial vaginitis
Bacteria from vagina contaminating UT
 Gardnerella vaginalis identify via present of clue
cell
 Best treated by metronidazole
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Trichomoniasis
Caused by Trichomonas vaginalis (protozoan)
 Transmitted sexually
 Diagnosis thru discharge smear
 Antibiotic - metronidazole
 The urine – foul, greenish-yellow
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Viral STD
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2)
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4)
Herpesvirus Infection*
Genital Warts
Laryngeal Papillomas
Cytomegalovirus (CMV) infections
Herpes
Caused by herpes simplex type 1 / 2
 Forming cold sore and fever blisters
 Incubation period about 1 month and causing
burning sensation
 More in male than in female
 Transfer to infant – congenital herpes
 The virus either grow in amniotic fluid or in birth
canal
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