Chapter 23, Genitourinary Diseases
1. Gonorrhea – most prevalent STD in the world
(not in the US though, here its Chlamydia)
A. Gram (-) diplococci, Neisseria gonorrhea
B. Virulent strains have pili (fimbrae) for attachment,
and outer membrane proteins and lipids help
the bacteria escape phagocytosis
C. Also produce endotoxin – gram (-)
D. Types of infection
i. Purulent (pus forming) urethritis in males –
painful urination often called the “clap” old std
films in the services
Chapter 23, Genitourinary Diseases
1. 2 –3 days after exposure, 80% show
symptoms
2. Before antibiotics, some serious problems,
scarring and blockage of urethra
or
testicular infection, sterility
results from
blockage of vas
deferens
ii. Often asymptomatic in females – only the cervix is
infected
1. Common cause of “PID” pelvic inflammatory
disease, Chlamydia is often also
associated with gonorrheal PID
2. Serious problem in untreated cases later on
– PID , other infection
complications
and sterility
3. Rare cases, systemic and then can cause
gonorrheal arthritis, gonorrheal
endocarditis, even meningitis
Fig.
23.8
Chapter 23, Genitourinary Diseases
E. Prevention and treatment
iii. Infants can acquire during birth, neonatal
gonorrhea
1. Can cause blindness
2. All babies eyes are treated with
antibiotics at birth
iv. Anal and pharyngeal gonorrhea are also
quite common
Chapter 23, Genitourinary Diseases
E. Prevention and treatment
i. Good diagnostic test, genetic probe
ii. No good antibody response and no lasting
immunity
iii. Drug resistance is a problem, usually treated with
now with ceftriaxone – a type of cephalosporin
iv. Since Chlamydia is often also associated with
gonorrhea – antibiotics for it are also administered
(tetracycline)
v. Prevention: sex education, condoms
vi. Drug resistance, beta lactamase oriented in GC
infections
vii. Also lipid coat changes rapidly and may be reason
the antibody produced is not effective
Chapter 23, Genitourinary Diseases
viii. Culture of GC is tough – special media required,
but culturing is helpful in determining antibiotic
sensitivity (nutritional fastidious bacteria – survive
poorly outside of the body – so much for the “I got it
off the toilet seat or in the swimming pool”
Fig. 23.9 Neonatal gonococcal opthalmia
Fig. 23.10
Chapter 23, Genitourinary Diseases
2. Syphilis – causative agent – Treponema
pallidum, a spirochete, gram negative,
appears as a tightly coiled helix, very
difficult to culture (only cell cultures)
A. STD, disease progresses through
discernable stages
B. Primary Syphilis
i. 2-6 weeks after exposure, small
hard chancre (sore) at site of
exposure, painless, fluid
excreted
is highly contagious,
easier to id
chancre in
males, often missed in
females
Chapter 23, Genitourinary Diseases
ii. Darkfield microscopy of lesion exudate
shows many spirochetes
iii. The microbe enters blood stream and
lymphatic system and is
disseminated
throughout the body
iv. RPR test, non-treponemal diagnosis test,
tests for “reagin” – an antigenic
response test (inflammatory)
reaction
C. Secondary Syphilis – several weeks later, skin
rash can occur, lymph nodes swell, sometimes fever.
Patient will still test positive for RPR test and
sometimes even spirochetes (these lesions can be
highly contagious)
Chapter 23, Genitourinary Diseases
i. Symptoms subside after a few weeks
ii. Latent phase occurs, if untreated can last for years,
in about 50% of the cases, that is the end of it
iii. But can progress to tertiary stage
D. Tertiary syphilis – many years later (30?),
organisms lies dormant in tissues of the body
i. Infective in early latent period and will test
positive for syphilis
ii. Old fluorescent Ab test (now use quick test
kits) would be positive early in the
latent period (note: like gonorrhea, syphilis
can be acquired over and over again – the Ab
are not effective)
Chapter 23, Genitourinary Diseases
iii. Disease is activated, serious damage to
heart, brain – can lead to dementia,
seizures, and blindness
iv. Skin lesion and lesions in organs are gross
looking (gummas) – see page 750
v. Congenital syphilis – spirochete crosses
placental barrier and fetus is harmed,
birth defects (one reason for detection and
treatment)
E. Treatment is with penicllins. Sex
education and condom use is also
important
Fig. 23.15 Gumma on patients arm
Fig. 23.14 Secondary syphilis rash
Fig. 23.16 Congenital
syphilis. Pg 751
Fig. 23.17
Fig. 23.18 Spirochete - darkfield
Chapter 23, Genitourinary Diseases
3. Chlamydia – small gram(-) obligate intracellular
parasite, C. trachomatis, the most prevalent
STD in US, cause of NGU (non gonococcal
urethritis)
A. Mild disease, not as serious as gonorrhea or syphilis
B. Urethritis or vaginits and can cause PID (lead to
sterility)
C. Since symptoms are so mild often goes untreated
D. Can cause blindness in infants, reason for treating
babies eyes as they are born
E. Actual leading cause of blindness in developing
countries, a different strain? Spread on contact with
secretions, flies, fomites
F. Rapid tests now available
G. Treat with doxycycline or erythromycin
Fig. 23.12 Chlamydia on mucosa of fallopian tube
Chapter 23, Genitourinary Diseases
4. Herpes – causative agent is herpes simplex ii virus, DNA virus,
transmitted by sexual contact
A. Incubation period about a week, then burning sensation at the
site of infection followed by eruption of lesions (vesicles)
B. Painful and irritating, but problem is that the disease can
reoccur and can be a problem for life – life long latent state in
the peripheral nerves
C. Neonatal herpes – serious complication – cause for C section
delivery
D. Virus can cross placental barrier and cause spontaneous
abortion, birth defects, and retardation
E. No cure, some management of symptoms with drugs like
acyclovir and some newerones)
Fig. 23.19 Neonatal Herpes simplex
Fig. 23.21 Electron photo of herpes
Chapter 23, Genitourinary Diseases
5. HPV – human papilloma virus, can causes
genital warts, also linked to cervical cancer.
Controversial vaccine for hpv
6. E. coli – causes UTI infections – usually normal
flora, treat with sulfonamides and trimethoprim
together
7. Gardnerella - G. vaginalis – causes foul smelling
vaginal infection, often associated with other
pathogens – polymicrobial infection, diagnosed by
symptoms and treated with broad spectrum
antibiotics
Chapter 23, Genitourinary Diseases
HPV vaccine
Chapter 23, Genitourinary Diseases
8. Candida infections – yeast can infect when there is a ph
imbalance (due to broad spectrum antibiotic treatment
for other diseases)
9. Trichomonas –T. vaginalis – flagellate protozoan, causes
painful infection of urethra or
vagina, copious discharge - treat with metronidazole
10. Group b Strep – bacterial inhabitants of vaginal tract can
infect newborn if fetal membranes are broken – causes
pneumonia and septicemia even meningitis in newborn
Chapter 23, Genitourinary Diseases
Chapter 23, Genitourinary Diseases
Group b Strep in newborn
Chapter 23, Genitourinary Diseases
11. Cytomegalovirus – (CMV) DNA virus in the
herpes family, very common virus transmitted
by close contact or sexually, mild disease but can
cross placental barrier and cause fetal death
or birth defects – infected cells fuse to form giant
cells – great big cells