1M I C R O B I O L O G YWITH DISEASES BY BODY SYSTEM SECOND EDITIONChapter 24Microbial Diseases of the Urinary and Reproductive SystemsStructures of the Urinary System• Kidneys– Remove waste from the blood and excrete it in urine– Nephrons are the functional unit of the kidneys– Responsible for filtering the blood to form urine• Ureters – urine travels via these to the urinary bladder• Urinary bladder – stores urine until it can be eliminated• Urethra – site of urine excretionStructures of the Female Reproductive System• In females the urinary and reproductive systems are distinct• Ovaries – site of egg production• Uterine tubes – eggs travel toward the uterus through the uterine tubes• Uterus – develops a blood-rich wall in preparation for pregnancy• Vagina – unfertilized eggs pass through the vagina during menstruation• External genitalia – includes the clitoris and labia• Microorganisms can enter the reproductive tract through the vagina2Structures of the Male Reproductive System• In males the urinary and reproductive systems share some components• Testes – site of sperm production• Scrotum – external structure that contains the testes• System of ducts – pass sperm to the prostate gland• Accessory glands – such as the prostate gland, add fluid to sperm to form semen• Penis – semen passes from the penis out of the body• Microorganisms can enter the reproductive tract through the urethra, skin of the penisDefenses that Protect the Reproductive and Urinary Systems• Urethra may be portal of entry in females– Females – 4 cm– Males – 20 cm• Flow of urine (“pee hard”)• Acidic pH of urine• Mucosal epithelial cell layer• Normal flora of vagina maintain pH ~4.5Normal Microbiota of the Urinary and Reproductive Systems• Urethra – Supports colonization by some microorganisms– Primary species include Lactobacillus, Staphylococcus, and Streptococcus– Remainder of the urinary organs and the urine in them are axenic• Male reproductive system– The regions above the prostate are sterile• Female reproductive system – The vagina is colonized by various microorganisms depending on hormone levels• Microorganisms infecting the urethra can move up to infect the kidneys• Opportunistic and sexually transmitted microbes can infect the reproductive system3Gonorrhea – Pathogen and Virulence Factors• Neisseria gonorrhoeae– Gram negative diplococci with adjacent sides flattened• Fimbriae• Polysaccharide capsule• Lipooligosaccharide (LOS) containing lipid A• Cells that lack fimbriae, a capsule, and LOS are typically avirulent• IgA protease• Survive and multiply within neutrophils• Susceptible to drying and extremes of temperatureGonorrhea - Pathogenesis• As few as 100 pairs of cells can result in disease• Gonococci adhere to mucous membranes of genital, urinary, and digestive tracts of humans– Fimbriae and capsules mediate– Cannot attach to cells in vagina• Attach to sperm via fimbriae • Can result in pelvic inflammatory disease leading to ectopic pregnancies or sterility• Infections of the urethra in women are common• Oral and anal infections can occur– More common in men who have sex with menGonorrhea - Pathogenesis• As organisms multiply, they invade deeper connective tissues• Organisms phagocytosed but survive and multiply within neutrophils– Travel throughout the body – Can enter blood and travel to joints, meninges, or heart– Arthritis, meningitis, and endocarditis• Infection during childbirth – ophthalmia neonatorum or blindness4Gonorrhea – Signs and Symptoms•Men– Begin after 2-5 day incubation period– Urethritis – Thick, purulent, creamy-yellow discharge from penis– Organism can invade prostate or epididymis– Scar tissue can result in infertilityGonorrhea – Signs and Symptoms• Women– Begin after 2-5 day incubation period– 50-80% asymptomatic– Lack of treatment results in infertility or pelvic inflammatory disease (25%)– Mistaken for vaginal yeast infection or bladder infection– Burning and frequency of urination– Yellow or bloody vaginal dischargeGonorrhea – Signs and Symptoms• Ophthalmia neonatorum (inflammation of the conjunctiva in newborns)5Gonorrhea - Epidemiology• Humans are the only reservoir• Transmitted by direct contact with an infected host• Any sexually active person can be infected• Most cases in adolescents who have multiple sexual partners in several southeastern states• Infection 4X more common among blacks than non-blacks• More common among females– Women have a 50% chance of becoming infected during a single sexual encounter with an infected man– 20% chance for men• Risk increases with increasing frequency of sexual encounters• Infection of children strong evidence of sexual abuseGonorrhea - EpidemiologyGonorrhea — Rates by state: United States and outlying areas, 2009Gonorrhea - EpidemiologyGonorrhea — Age- and sex-specific rates: United States, 20096Gonorrhea – Diagnosis and Treatment• Presence of Gram-negative diplococci in pus from an inflamed penis from symptomatic male patient is diagnostic– Asymptomatic men and women diagnosed by commercially available genetic probes• Treatment is complicated by spread of multidrug resistant strains– CDC currently recommends broad-spectrum oral cephalosporinsGonorrhea – Prevention• Immunity does not exist; reinfection is common– Surface antigens are highly variable• No gonorrhea vaccine available due to existence of many different strains• Control difficult except in newborns• Preventative strategies– Abstinence– Monogamous relationships with a faithful partner– 100% consistent use of condoms during intercourse– Prompt identification and treatment of all sexual contacts of diagnosed patientChlamydia – Pathogen and Virulence Factors• Chlamydia trachomatis– Obligately intracellular and nonmotile– Gram negative– Only grow and multiply within vesicles in host cells• Were once thought to be viruses, but are cellular and do have DNA, RNA, and functional 70S ribosomes– Lack cell walls (no peptidoglycan)• All strains pathogenic for humans– Infect conjunctiva, lungs, urinary tract, or genital tract• Unique developmental cycle– EBs– RBs7Chlamydia – Pathogen and Virulence FactorsChlamydia – Pathogenesis • Organism enter body through abrasions or lacerations• Infects cells of