Yellow causative agent Green symptoms unique to disease Light Blue toxins virulence factors Purple vaccine Violet specific medicine Genitourinary infections Urinary tract infections Bacterial Cystitis bladder infection Causative agent 80 of cases are strains of E coli Usually originate from normal intestinal microbiota Klebsiella Proteus Staphylococcus saprophyticus Many antibiotic resistant Symptoms Sometimes asymptomatic Otherwise start suddenly burning pain during urination urgent need to urinate frequent release of small amounts of urine Urine cloudy from leukocytes may be pale red from blood Often has smell Area above pubic bone may be painful Sometimes pyelonephritis fever chills vomiting back pain tenderness over kidneys Pathogenesis Pathogens generally move up urethra to reach bladder Uropathogenic E coli UPEC have fimbriae o Attach to receptors on epithelial cells death sloughing off cells allowing bacteria to enter underlying epithelium via endocytosis o Create intracellular bacterial communities IBC o Bacteria detach move into bladder lumen and create IBC o UPEC established chronic intracellular reservoir within epithelium that resists antibiotics undetected by immune o Filamentous forms help avoid innate immune response Epidemiology Most common type of UTI Women predisposed due to short urethra birth control devices sexual intercourse Prevention and Treatment Few days of antimicrobial Pyelonephritis Drink enough water Urinating following intercourse Wipe from front to back usually required hospitalization Genital tract diseases Bacterial Vaginosis BV Causative agent unknown Most cases show significant decrease in vaginal lacterobacilli Discharge contains many bacteria including Gardnerella vaginalis anaerobic streptococci Symptoms Pathogenesis Thin greyish white slightly bubbly vaginal discharge with strong fish like smell Bacteria may spread to uterus or fallopian tubes causing pelvic inflammatory disease can lead to sterility About half of cases are asymptomatic Characteristic changes in vagina including loss of acidity secretions disruption of normal microbiota and substantial increase in clue cells epithelial cells that have sloughed off vaginal wall and are covered with bacteria No inflammation unless other infection present Fishy odor caused by metabolic products of anaerobic bacteria Epidemiology Pregnant women at increased risk Most common among sexually active women No proof of sexual transmission Infected women at higher risk of getting other STI Prevention and treatment Most cases respond quickly to antibiotics Treatment important in pregnant women may cause premature Can recur birth Vulvovaginal Candidiasis VVC Causative agent Candida albicans A yeast that is part of normal microbiota in about 1 3 of all women Symptoms Constant intense itching and burning of vagina or vulva Thick clumpy whitish discharge Vaginal mucous usually red swollen may have patches of cottage cheese appearing clumps Pathogenesis Normally colonization causes no symptoms Growth usually limited by immune system and normal vaginal lactobacilli Disruption of balance can allow multiplication menstration pregnancy oral contraceptives and antibiotics Epidemiology Prevention and Treatment Late pregnancy poor controlled diabetes use of oral contraceptives or antibiotics predisposes Hormone replacement therapy may increase risk Most patients have no predisposing factors Does not spread person to person Antifungals such as nystatin clotrimazole fluconazole Self diagnosis and over the counter treatment can lead to development of drug resistance Minimizing use and duration of antibacterial meds Effective treatment of underlying conditions diabetes Staphylococcal Toxic Shock Syndrome Causative agent Staph aureus Symptoms Strains that produce toxic shock syndrome toxin 1 TSST 1 or related exotoxins Sudden development of high temperature headache muscle ache bloodshot eyes vomiting diarrhea sunburn like rash and confusion Skin peels about a week after development Without treatment blood pressure can drop leading to multi organ failure coma and sometimes Pathogenesis 2 3 days after start of menstruation when tampons used Bacteria grow on blood soaked tampon o Rarely spread throughout body but produce TSST 1 and other exotoxins that are absorbed into bloodstream o Superantigens that cause activation of T cells leading to massive release of cytokines Epidemiology Prevention and Treatment Can occur after infection with exotoxin producing strain Not spread person to person Use of tampons contraceptive sponges increases risk Severe disease requires hospitalization Antibacterial IV fluid other measure to prevent shock Most recover within 2 3 weeks Can be fatal within a few hours Appropriate use of tampons Sexually Transmitted Infections Bacterial STIs Gonorrhea Causative agent Gonococcus Neisseria gonorrhoeae Symptoms Gram Requires rich medium Outer membrane has typical LPS of gram except lipid has highly Some produce pili branched oligosaccharide structure Lipooligosaccharide LOS Produces membrane proteins that take iron from transferrin and lactoferrin Incubation period 2 5 days frequently asymptomatic Men o Urethritis with pain during urination and thick pus containing discharge from penis o Noticeable unpleasant men who have usually seek treatment o Inflammation can produce scar tissue that obstructs urethra slows urination increased risk of UTIs o Infection may spread to prostate glands and testes o Can result in infertility Women o Painful urination and vaginal discharge o Bacteria grows on cervix and fallopian tubes in glands in vaginal wall and other areas of genital tract causing inflammation pain and possible scarring o Can spread to fallopian tubes cause pelvic inflammatory disease PID sometimes infertility o Scaring of fallopian tube can lead to ectopic pregnancy o Infection occasionally spread to abdominal cavity Untreated can lead to complications Disseminated gonococcal infection Ophthalmia neonatorum DGI infection in newborns Pathogenesis Human specific pathogen Attachment by fimbriae and Opa outermembrane proteins to receptors on non ciliated epithelial cells Cannot colonize squamous epithelium such as that lining adult vagina or ciliated cells Entry via endocytosis mediated by porin protein in LOS LOS and peptidoglycan released by autolysis of cells cause complement activation triggers inflammatory response that leads to most symptoms Avoiding innate immunity o Proteases destroy IgA of