Infections of the Urinary & Reproductive Tracts
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The urinary tract removes
Waste Excess water Electrolytes
Act as a filter to eliminate unwanted small molecules from the blood
Kidneys
Infections of the urinary tract
• Asymptomatic bacteriuria • Cystitis • UTIs in children • Recurrent UTI infections • Hospital-acquired UTIs • Pyelonephritis
Urinary bladder anatomy
• Triangular-shaped muscular organ • collect & store 400-600 ml urine • lined w transitional epithelium (accommodates changes in bladder volume)
Can invade & form a biofilm & serve as a source for recurrent bladder infection
Uropathogenic E. coli
UTI stats
Most cases are in women 50% of getting one in woman’s lifetime 20-40% women will have recurrent infections Perineum 1/2 as long in women
Most common nosocomial infection
UTIs
2 types of UTIs
Cystitis (bladder infections) Pyelonephritis (kidney infections)
Infection from urethra to the bladder
Urogenital membranes ascend into bladder More common in women
Ascending infection to the kidney
Organisms from an established infection in the bladder Ascend along the ureter to infect kidney
Descending infection from the kidney
Infected kidney sheds bacteria into bladder infection of kidney may arise when microbes deposited in the kidneys from the blood
Bacterial infections of the Urinary Tract
Cystitis (bladder) & Pyelonephritis (kidney) - caused by organisms w similar signs & symptoms Urethritis - signified by pain or burning upon urination - urethral discharge - contracted from sexual intercourse
Cystitis (bladder)
Diagnosed when # bacteria >10^5/ml Symptoms = sudden dysuria, increased urination, nocturia Less common symptoms = fever & lower abdominal pain
UTIs in children (risk factors)
Incomplete emptying of bladder Postponing emptying of bladder
UTIs in children (consequences & trends)
Can lead to damage of kidney if not treated Prevalence of UTI in children decreases with age
Recurrent UTIs (definition)
2+ UTIs in 6 months OR 3+ UTIs in 12 months
Recurrent UTIs (causes)
incomplete emptying of bladder sexual activity use of spermicides
Recurrent UTIs (treatment)
Prophylactic (preventative) continuous antibiotic therapy Postcoital antibiotic prophylaxis alternative to continuous therapy (for some)
Hospital-acquired UTIs
*most common developed nosocomial infection - E. coli - P. mirabilis - P. aeruginosa - E. faecalis - S. epidermidis Associated with urinary catheterization - likely to be antibiotic resistant
Pyelonephritis (kidney)
More prevalent in females Symptoms = high fever (104+), chills, oliguria (less than normal urine production), flank pain, costovertebral tenderness*, nausea Bacterial flagella & pili allow bacteria to access ureters Treated with antibiotics
Viral infections of the reproductive tract
• Genital warts (HPV) • Genital herpes • Neonatal herpes • HIV • Hepatitis B & C infections
Genital Warts
Condylomata acuminata *Most common sexually transmitted viral infection Appearance = cauliflower-shaped, soft, flesh colored lesions on infected patient’s genitals or rectum Symptoms = itching, pain, tenderness
Genital warts
Subtypes 6 & 11 - low risk - responsible for nearly 90% of all cases Subtypes 16 & 18 - high risk - linked to cervical, penile, anal, throat cancers
Vaccine for HPV
Recombinant - Gardasil - protects against 9 types of HPV - 2013, 50% decrease in rate of cervical cancer in vaccinated individuals