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Microbial Disease of the Urinary and

Reproductive Systems

Jin-Hwan Kwak, Ph.D.

School of Life Science

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Microbial Disease of the Urinary and Reproductive Systems

The urinary system regulates the chemical composition of the blood and excretes nitrogenous waste.

The reproductive system produces gametes for reproduction and, in the female, supports the growing embryo.

Microbial diseases of these systems can result from infection from an outside source or from opportunistic infection by members of the normal microbiota.

Microbes usually enter the urinary system through the urethra

Microbes usually enter the reproductive system through the:

Vagina (females) or urethra (males)

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The female reproductive system consists

of two ovaries, two uterine tubes, the

uterus, the cervix, the vagina, and the

external genitals.

The male reproductive system consists of

two testes, ducts, accessory glands, and

the penis; seminal fluid leaves the male

body through the urethra.

Structure and Function ofthe Reproductive System

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The urinary bladder and upper urinary

tract are sterile under normal conditions.

The male urethra is normally sterile.

Urinary bladder and upper urinary tract sterile

Lactobacilli dominate the vaginal

microbiota during the reproductive years.

Pregnancy and menopause are factors

that increase the risk of URIs, which are

probably related to lowered acidity.

Normal Microbiota

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Diseases of the Urinary System

Probably 90% of nosocomial UTI are

associated with urinary catheters.

More than 50% of UTI are caused by E. coli.

And Proteous, Klebsiella, Enterococcus, and

Pseudomonas are key pathogens of UTI.

Pyelonephritis can result from lower urinary

tract infections or from systemic bacterial

infections.

Opportunistic gram-negative bacteria from the

intestines often cause urinary tract infections.

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Urethritis(요도염), cystitis(방광염), and ureteritis(요관염) are terms describing inflammations of tissues of the lower urinary tract.

Nosocomial infections following catheterization occur in the urinary system.

E. coli causes more than half of these infections.

More than 1,000 bacteria of one species per milliliter of urine, or 100 coliforms per milliliter of urine, indicates an infection.

Treatment of urinary tract infections depends on the isolation and antibiotic sensitivity testing of the causative agents.

Diseases of the Urinary System

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Pyelonephritis

In 25% of untreated cases, cystitis may

progress to pyelonephritis.

Inflammation of the kidneys, or pyelonephritis,

is usually a complication of lower urinary tract

infections.

About 75% of pyelonephritis cases are caused

by E. coli.

Can be life-threatening condition ( 3rd

generation cephalosporins)

Diseases of the Urinary System

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Bacterial Diseases of the Reproductive System

Most diseases of the reproductive system

are sexually transmitted diseases(STDs).

Most STDs can be prevented by the use of

condoms and are treated with antibiotics.

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Gonorrhea

Neisseria gonorrhoeae causes gonorrhea.

N. gonorrhoeae attaches to mucosal cells of the oral-pharyngeal area, genitals, eyes, and rectum by means of fimbriae.

Symptoms in males are painful urination and pus discharge.

Blockage of the urethra and sterility are complications of untreated cases.

Females might be asymptomatic unless the infection spreads to the uterus (womb) and uterine tubes.

Ophthalmia neonatorum is an eye infection acquired by infants during passage through the birth canal of an infected mother.

Treatment with antibiotics

Untreated may result in

Endocarditis, Meningitis, Arthritis, Ophthalmia neonatorum

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Nongonococcal urethritis (NGU), or nonspecific urethritis (NSU), is any inflammation of the urethra not caused by N. gonorrhoeae.

Most cases of NGU are caused by Chlamydia trachomatis.

C. trachomatis infection is the most common STD.

Symptoms of NGU are often mild or lacking, although uterine tube inflammation and sterility may occur.

C. trachomatis can be transmitted to infants’ eyes at birth.

Diagnosis is based on the detection of chlamydial DNA in urine.

Ureaplasma urealyticum and Mycoplasma hominis also cause NGU.

Nongonococcal Urethritis (NGU)

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Pelvic Inflammatory Disease (PID)

N. gonorrhoeae

C. trachomatis

Can block uterine tubes

Chronic abdominal pain

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Syphilis is caused by Treponema pallidum, a spirochete that has not been cultured in vitro.

Laboratory cultures are grown in cell cultures.

T. pallidum is transmitted by direct contact and can invade intact mucous membranes or penetrate through breaks in the skin.

Congenital syphilis, resulting from T. pallidumcrossing the placenta during the latent period, can cause neurological damage in the newborn.

Direct diagnosis:Darkfield microscopic identification of bacteria

Staining with fluorescent-labeled, monoclonal antibodies

Indirect, serological diagnosis:VDRL, RPR, ELISA test for reagin-type antibodies using cardiolipid (Ag)

FTA-ABS tests for anti-treponemal antibodies

Syphilis

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Primary stage: chancre at site of infection

Secondary: Skin and mucosal rashes

Latent period: No symptoms

Tertiary: Gummas on many organs

Congenital: Neurological damage

Primary & secondary stages treated with

penicillin

Syphilis

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Chancroid, a swollen, painful ulcer on the

mucous membranes of the genitals or

mouth, is caused by Hemophilus ducreyi.

Ulcer on genitalia

May break through surface

Infection of lymph nodes

Treatment: erythromycin and ceftriaxone

Chancroid (Soft Chancre)

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Viral Diseases of the Reproductive System

Genital Herpes Herpes simplex virus type 2 (HSV-2) causes genital herpes.

Symptoms of the infection are painful urination, genital irritation, and fluid-filled vesicles.

Neonatal herpes is contracted during fetal development or birth.

It can result in neurological damage or infant fatalities.

Recurrences from viruses latent in nerves

Acyclovir (or valacyclovir) has proven effective in treating the symptoms, but it does not cure the disease.

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Genital Warts

Papillomaviruses cause warts.

The papillomaviruses that cause genital warts have been associated with cancer of the cervix (pap smearing) or penis.

Treatment: Imiquimod to stimulate interferon

HPV 16 causes cervical cancer and cancer of the penis

DNA test to detect cancer-causing strains

Vaccination against HPV strains

AIDS

AIDS is a sexually transmitted disease of the immune system

Viral Diseases of the Reproductive System

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HPV vaccine

The human papilloma virus (HPV) vaccine prevents infection with certain species of human papillomavirus associated with the development of cervical cancer, genital warts, and some less common cancers.

Two HPV vaccines are currently on the market: Gardasil® and Cervarix® .

Gardasil and Cervarix are preventative vaccines and do not treat HPV infection or cervical cancer.

They are recommended for women who are 9 to 25 years old who have not been exposed to HPV.

Both vaccines protect against the two HPV types (HPV-16 and HPV-18) that cause 70% of cervical cancers.

Gardasil® also protects against the two HPV types (HPV-6 and HPV-11) that cause 90% of genital warts.

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Fungal Diseases of the Reproductive System

Candidiasis Candida albicans causes NGU in males and

vulvovaginal candidiasis, or yeast infection, in females.

Grows on mucosa of mouth, intestinal tract,

genitourinary tract

Vulvovaginal candidiasis is characterized by lesions

that produce itching and irritation.

Predisposing factors are pregnancy, diabetes, tumors,

and broad-spectrum antibacterial chemotherapy.

Diagnosis is based on observation of the fungus and its

isolation from lesions (by microscopic identification

and culture of yeast)

Treatment: clotrimazole or miconazole