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Normal Microflora found

In the distal urethra, E. coli, Staphylococcus, Corynebacterium, Haemophilus, Streptococcus & Lactobacillus are most common

Female vagina is heavily

populated with microbes (Those above E. coli, Staphylococcus, Corynebacterium, Haemophilus, Streptococcus & Lactobacillus) + Lactobacillus, Clostridium, Bacteroides, Candida albicans, Fusobacterium

Normal Defenses

Urine flow flushes out microbes
Sphincters keep most pathogens out
Epithelial cell junctions are tightly joined
Other mechanisms: Anti-microbial chemicals and Low pH of urine & vaginal environment

Ascending UTI

Begin in the distal urethra & ascend to the kidneys

Descending UTI

Usually originate outside of the urinary tract.
-Organisms can enter the blood stream from a focal infection (Ex. abscessed tooth) can be filtered by the kidneys to cause infection

Pyuria

+/- pus in the urine (UTI)

Urethritis

urethra inflammation (UTI)

Cystitis

bladder inflammation (UTI)

dysuria

Painful urination (UTI)

Polyuria

Frequent urination (UTI)

Diagnosis for UTI

Urine dipstick -
Positive nitrates (Metabolite produced by bacteria)
Presence of large #s of bacteria
Presence of WBCs & RBCs
-Leukocyte esterase positive (Enzyme from WBCs)

Positive nitrates

Metabolite produced by bacteria- UTI

Protatitis

Inflammation of the prostate gland
Urgent & frequent urination, fever, lower back pain, +/- joint/muscle pain
Possible routes of infection
Back-flow of contaminated urine
Descent of blood-borne pathogens
Ascent through urethra
Passage through lymphatics of fecal organisms from the rectum
Can cause infertility

Pyelonephritis

Kidney inflammation
Usually caused by ascent of microbes
E. coli causative agent in > 90%
Occasionally Candida
Symptoms
May be asymptomatic
Similar to cystitis +/- chills & fever
Dilute urine & polyuria
Nocturia - Nighttime urination

Glomerulonephritis (Bright's disease)

Damage/inflammation the glomerulus of the nephrons
Immune complex disease +/- following streptococcal (S. pyogenes) or viral infection
Nephrogenic strains of S. pyogenes have similar cell wall components as found in glomerular capsule components
Results in Ag-Ab complexes being formed & filtered by the kidney
Activates inflammatory response of glomerular capillaries initiated
Inflamed vessels leak protein, blood & pus in the urine

Leptospirosis

Leptospira interrogans (Gram negative motile spirochete)

Nocturia

Nighttime urination
happens in Pyelonephritis

proteases

A breakdown of Antibodies
virulence factor in Neisseria gonorrhoeae

Treatments for Gonorrhea and Chlamydia

Ciprofloxin / Tetracyclines / Penicillins
Drug resistance is becoming a problem
Some areas 20% of Gonorrhea infections are multidrug resistance

Treponema palladium

Syphilis
Gram negative, highly motile, spirochete
Only parasitic to humans
Must be grown in the testicles of rabbits in vivo
Killed by drying & cooling & is transmitted almost exclusively by sexual or oral contact
3 stages

Acyclovir

Herpesvirus Outbreaks treated with______
Virus can be shed even if skin outbreaks not seen.
Blocks viral DNA polymerase

Herpes simplex virus type 1 (HSV-1)

Fever blisters or cold sores

Herpes simplex virus type 2 (HSV-2)

Genital herpes
-dsDNA, enveloped virus
-Sexually transmitted, but rarely can be spread through hot tubs

Condylomas

Genital warts
Human papillomaviruses
Small, non-enveloped, dsDNA viruses
> 60 HPVs with ~ 15 sexually transmitted
Occur around the anus, vagina, penis, or on the cervix
Types 16 and 18 associate with cervical cancer in females & throat anal cancer in males
Vaccine available

Cytomegalovirus (CMV)

Herpesvirus
Often asymptomatic (an estimated 80% of adults carry the virus)
Spread via body fluids
Most infections occur in older children & older adults
Symptoms include generalized malaise, myalgia, fever, abnormal liver function tests, swollen lymph nodes
Symptoms are more severe in immune compromised patients
Again, can remain latent (episomal form)

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