1.  High volume urine flushcing out of bladder and urethrua
2. Exfoliation of uroepithelial cells
3. Structures to prevent backflow of urine
4. Antimicrobial properties of urine
5. Presence of normal microflora

Symptoms of 

Urethritis

Symptoms of Bladder infection

(Cystitis)

Pelvic pressure

Lower abdomen discomfort

Frequent, painful urination

Low-grade fever

Symptoms of Kidney infection

(Pyelonepheritis)

Upper back and side (flank) pain

High fever

Shaking, chills

Nausea

Vomiting

• Urethra
  • Lactobacilli
  • Streptococci
  • Coag NEG Staph
• Vagina
  • More diverse, influenced by hormones
  • Newborns-lactobac, becomes diverse over time
  • Lactoback become more prom. @ puberty

Uncomplicated UTI 

vs.

Complicated UTI

• Uncomplicated UTI
  • No predisposing factor
  • No structural anomolies
• Complicated UTI
  • predisposing anatomic, funct., metabolic abnormality
  • Requires fore agressive eval. and follow-up

40% of HAIs!!

Obstruction w/ bacterial glycocalyx

Encourages infecion, stones

Can spread to epidymis, prostate

E. Coli !!

UPEC- Uropathogenic E. Coli

• Type I  - fimbriae (cystitis)
• P Pilli (pyelonephritis)
• Hemolysin alpha - lyses cells-->cytokines-->inflamm
• Serotypes O, K, F
• Siderophores  --ureases--  IgA proteases !
• Pathogenicity islands

UTI

Staphylococcus saprophyticus

• Cause of UTI in young, sexually active women
• Infrequent asymtomatic UT colonizer
• SEASONALITY - Summer

UTI

Proteus mirabilis

G-rod

Elongates when it makes TONS of flagella

Rings on petri dish due to EXTREME MOBILITY

Virulence factors:

1. proteases
2. haemolysins
3. biofilm
4. Urease production: differential from std. E. coli!
   urine smells like amonia.  toxic to kidneys, --> urine struvite crystals
   

• Clean catch - DON'T LEAVE OUT AT ROOM TEMP !!
• WBC and RBC and Bacterial counts
• Need to request if want culture and sensitiity tests
• > 10E5 CFU's--> infection    10E2 in some cases

UTI infection

Prostatasis

• E. coli most common
• Reflux of urine into prostate ducts

UTI infections

Epididymitis

Organs enter from prostate into Ejaculatory Duct

Pathogens vary

More in catheterized males

UTI - may or may not be xmitted by Sex

STI - more specific

oral, genital

exchange of body fluids

19M new cases/yr in USA

Women more affected

Sex

Diaphram

Recurrent infection

Catheters

Nisseria gonorrhea

Clinical Sx

• Humans onlly, obligate intracellular

• M: urethral discharge: 
• F: ascending infection -->vag dischg, disuria, abd pain or often asymptomatic:  chronic--> scarring/stricture of fallopian tubes or urethra
  
• Neonate- cnjnctvitis

Nisseria gonorrhea

Tell me about the bacteria

• G- diplococ., non-motile, no spore, Ox+ Cat+
• Attach to columnar epith of urethra/cervix w/ pili+ memb proteins. 
• POR protein, LOS (TNF), Siderophores
• HUGE multiplicaion
• Grow: choc, blood, Thayer-Martin (has abiotix)

Chlamidia

trachomatis

Sx

• Most commonl reported disease in US -F 18-24
• May ↑ HIV transmission
• Usually asymptomatic
• discharge (mucoid) burningw. urination, LGV
• neonatal conjunctivitis
  
• 40% w/o Tx--> PID 
  
  • Infertility, ectopic preg, chroinic pelvic pain

Chlamidia tracomatis

Tell me about the bacteria

• Atypical:"G-",
• 2 phases  EB: infectious   RB noninfectious
• Receptors for EB only on mucous memb of endocervix, endometrium, fall tubes, anorectum, resp tract, conjunctiva
  
• obligate intracellular:  needs host ATP!

Treponema pallidum

Sx

• Primary: hard, painless chancre 9-90d post infec.
• Sec: macropopular rash (face, palms, soles) + flu-like sx    2-8wks post-ulcer
• Tertiary: diffuse chronic inflammation: neurosyph- dimentia, meningitus, gummatous lesions
• Easy to cure in pri, sec: penicillin ..tertiary dam dne
  
• Organism not found btwn sec and tertiary stages
• ↑ HIV infection chances

Treponemum pallidum

Organism Details

• Spirochete: 3 flagella @ ea. end, very slow repl.
• See in fluid from primary chancres Use darkfield
• Hyaluronidase -perivascular infiltration
• Fibronectin coat anti phago
• Unusual outer membrane: no LPS, no porins

Hemophilis ducrei

Symptoms

• Obligate human.....Africa, S. amer, Asia primarily
• F may be asympt
• "CHANCROID"
• Soft painful genital ulcers 5-10d post infection
  
• Buboes w/ thin red rim,
  
• Swollen LN, Ulcers fill with pus then rupture
  
• Treat with erythromycin
  

Hemophilus ducreyi

Tell me about the bacteria

• Obligate EXTRAcellular, resists phagocytosis
• two toxins: HEMOLYSIN and CYTOTHELIAL DISTENDING TOXIN which destroy tissue
• ↑ HIV
• Need to culture to dx:  poor accuracy
• treat with erythromycin

Bacterial Vaginosis / vaginitis

Symptoms

• Most - asympt
• Creamy homognus dischg w/ unpleasant odor
• Thin white, gray: 
• Pain, itch, burning outside vagina
• most com vag infection in F of childbearing age 
• Distinguish from candida/tricho. via CLUE CELLS
• ↓ lactobacilli   pH<4.5
• ↑ HIV

Trichomonas vaginalis

Tell me about the organism

• Single-celled protozoan parasite
• 4 flagella and short undulating membrane (motile)
• Worldwide
• Transferred via SEX and FOMITES
• AIDS pts have more
• M - urethra
• F - vagina

Trichomonas vaginalis

Sx

• MOST COMMON, most curable STD in young, sexually-active women
• More common in F-------------Most asymptomatic
• 5-28d : frothy vaginal discharge
• extensive inflamm, epith. erosion, burning
• painful urination
• strawberry appearance on cervix
• Tx with metronidazole
  

Candida Albicans 

STD

• Yeast overgrowth of normal flora: 
• Common:  most women have at least one
• Risk ↑ during preg, broad spec abiotix, steroids, DM
• F - cottage-cheese-like vaginal discharge
  
•      itching and burning genitalia
• M - Itchy rash on penis
• AIDS - oral thrush
• Has a PH sensing pathway
• Primary site of colonization:  GIT

HHV-1

HHV-2

Epidemiology and Sx

• Sexual contact or breaks in skin
• 1 in 5 us women, 1:8 M
• virus released from sores or during outbreaks from skin w/o sores
• 1 or more blistes near genitals/rectum/lips
• Worse 1st time: 2-4 wks to heal
• Stress/sun/hormones --> ↑ breakouts

HHV-1

HHV-2

Pathogenesis

• LYTIC ..............Cowdry tpe a syncitia
  
• PERSISTENT.....lympho, plasma cells
  
• LATENT...........Neurons
• virus blocks ifn, cd8, t-cell recognition, ab neutralization - hides during latent infection
  
• Dx: vis inspec, sample from sore, Ab (not 100%)
  

HHV-1

HHV-2

Treatment

Antivirals shorten/prevent outbreaks

Daily supressive therapy to  ↓ transmission to partners

HPV 

Epidemiology and oveview

• Genital warts -condyloma accuminata: HPV 6,11
•  Kids can get via vaginal delivery
• #1 VIRAL STI.......most people have at least one
• ↑ cancers

HPV

Symptoms

• Asympt. genital warts, small bumps, or cauliflower-shaped groups of bumps
• Raised flat single/multiple
• Untreated: may dissapear on own or ↑ or ↓ 
• Kids: recurrent respiratory papillomatois
• Oral sex--:> THROAT CANCER

HPV

Virus details

• Infects ONLY BASAL LAYER KERATINOCYTES
• CPEs- subversion of host signalling system via protein-protein (viral-host) interactions
• infect thru small breaks in skin
• E6, E7 proteins xfm RB, p53...↑prolif,↓repair
• Integrates, terminates cell life cycle
  
• NO insertional mutagenesis:  E6, E7 retained

HPV

DX

GENITAL WARTS

VISUAL INSPECTION:  ACETI ACIT-FLAT WARTS, NOT SENSITIVE

PAP

PCR

HPV

COMPLICATIONS

• HPV ↑ cancer risk more than smoking or alcohol
• 90% body clears HPV on it's own in 2 yrs
• CIN-1.....mild dysplasia + condyloma
• CIN-2.....moderate dysplasia 
• CIN-3.....severe dysplasia: includes CIS