ࡱ> dfc :%bjbj 4Pxx:LLd(LMtttttOOOMMMMMMM$;OQ4MOOOOO4MttIMOttMOM<0(@0w8R=$L_M0M >R#RH(@(@R zLOOO4M4MOOOMOOOOROOOOOOOOOL* v:   Chapter 23: Infectious Diseases of the Genitourinary System 23.3 Urinary Tract Diseases Caused by Microorganisms A. Urinary Tract Infections (UTIs) 1. Urine is a good growth medium for many microorganisms 2. Reduced urine flow or accidental introduction of bacteria into the bladder can result in 3. If the infection also affects the kidneys it is called 4. An infection only in the urethra is known as B. Bacterial Cystitis 1. Common urinary infection that involves the inflammation of the bladder = cystitis A) About 30% of all women develop cystitis at some time during their life 2. Most urinary tract infections originate from normal intestinal flora such as (80-90%), Staphylococcus saprophyticus, and Klebsiella & Proteus sp. 3. Nosocomial urinary tract infections are commonly caused by Pseudomonas, Serratia, and Enterococcus which commonly grow on catheters 4. Characterized by a sudden onset of symptoms A) Pain in the pubic area B) Frequent urges to urinate even when the bladder is empty C) Burning pain accompanying urination D) E) Orange tinge to the urine F) Fever and nausea G) Back pain indicates kidneys may also be involved 23.4 Reproductive Tract Diseases Caused by Microorganisms A. Vaginitis and Vaginosis 1. Common infections of the vagina; not considered STDs A) Vaginal itching to varying degrees B) Burning and sometimes a discharge occurs C) Symptoms depend on the causative agent 1) a) Vulvovaginal candidiasis (vaginitis) is the second most common cause of vaginal symptoms which include: itching, burning, thick white vaginal discharge, redness and inflammation b) A yeast that is part of the normal vaginal flora in 35% of women c) Considered non-contagious and is usually not sexually transmitted 2) a) Causes vaginosis (as opposed to vaginitis) as inflammation in the vagina does not occur b) Is the most common cause of nonSTD vaginal symptoms c) Vaginal discharge with a pungent fishy odor, especially after sex d) Itching is common B. Three broad categories of sexually transmitted diseases 1. Discharge diseases 2. Ulcer diseases 3. Wart diseases C. Discharge Diseases 1. Increase in fluid discharge in male and female reproductive tracts 2. Includes trichomoniasis, gonorrhea, and chlamydia A) Trichomoniasis 1) Causative agent is 2) Asymptomatic infections in approximately of females and males 3) Symptoms include the production of a B) Gonorrhea (clap) 1) Caused by also known as the gonococcus 2) Number of reported cases has greatly reduced since the 1970s (more than 1 million down to less than 350,000) 3) Men usually develop painful urination and a thick yellow discharge from the penis a) Can occasionally spread from the urethra to the prostate gland and epididymis 4) Women tend to have less severe symptoms or are asymptomatic and more likely to be unknowing carriers a) Symptoms include a mucopurulent or bloody vaginal discharge often accompanied by a UTI b) 15-30% of untreated cases ascend beyond the vagina and cervix to infect higher reproductive organs resulting in pelvic inflammatory disease (PID) i) The associated damage and inflammation increases the risk for ectopic pregnancies 5) Inflammatory responses to infection can cause scarring which can partially obstruct the urethra or cause sterility in both men and women 6) N. gonorrhoeae can also cause other problems including proctitis resulting from anal sex, pharyngitis & gingivitis resulting from oral sex, and conjunctivitis in newborns of infected mothers C) Chlamydial Infections 1) The causative agent is 2) of females and of males are asymptomatic a) In males the bacteria causes urethritis, a gray-discharge from the penis and painful testes b) In women it results in cervicitis accompanied by white drainage, abdominal pain, endometritis, and pelvic inflammatory disease 3) The bacteria enters through tiny nicks or breaks in the perigenital skin or the mucus membranes a) The surrounding lymph nodes may become infected causing them to enlarge and harden i) The nodes may then burst and heal resulting in scarring that can inhibit functionality of surrounding structures 4) Babies born to mothers with infections can develop eye infections and pneumonia D. Genital Ulcer Diseases 1. Two common infectious conditions resulting in lesions on a persons genitals are syphilis and genital herpes A) Having one of these diseases increases the chances of infection with HIV because of the open lesions 2. Syphilis A) Caused by the spirochete B) Syphilis is often called the great imitator because it symptoms resemble many other diseases C) There are three stages of syphilis 1) Primary syphilis a) A , usually painless, forms at the site of inoculation on the internal or external genitalia b) Usually heals without treatment in 3-6 weeks but the disease is still present 2) Secondary syphilis a) Usually begins about 6 weeks after the chancre heals b) Initial symptoms are fever, headache, and sore throat c) These progress into infection of the lymph nodes and a d) Symptoms usually disappear in a few weeks e) About 30% of infected individuals enter into a period of latency following secondary syphilis i) Can last for many, many years 3) Tertiary syphilis a) If the patient enters the tertiary stage the complications are serious i) Cardiovascular syphilis results in the small arteries of the heart becoming weak & rupturing causing heart failure ii) Syphilitic tumors can form on the liver, skin, bone, and cartilage iii) can infect the brain, cranial nerves, and dorsal root of the spinal cord 4) Syphilis that infects pregnant women can spread across the placenta to involve the fetus = congenital syphilis a) Symptoms can range from mild to extreme depending on when exposure occurred 3. Genital Herpes A) Caused by herpes simplex viruses (HSVs); usually B) Symptoms: groups of vesicles with itching, burning, or painful sensations and local lymph node enlargement C) Many persons have no symptoms while others have frequent recurrences (generally less severe than original outbreak) 1) A latent form of the virus establishes itself in the ganglia of sensory neurons and cannot be cured D) Transmission can occur in the absence of symptoms but the risk is much higher when lesions are present E) Drugs of choice include F) In the neonate and fetus, HSV infections are very destructive and can be fatal E. Wart Diseases 1. A) Causative agents of genital warts B) An individual can be infected with HPV without having warts, however 2. A) Caused by a virus of the pox family B) Can take the form of skin lesions similar to HPV (usually have smooth instead of a rough surface) !#stw" ( 6 7 8 = t u v {  ! " f m t v  Ȼֱ֎րրրրhzhz6CJ]aJh|6CJ]aJhzh%eCJPJaJhz>*CJPJaJhbCJPJaJhzhzCJPJaJhzhzCJPJ\aJhzhzCJaJhbCJaJh *CJPJaJhzhKhCJPJaJ2=s# 7 8 u v   g r   \  h8p @ gdz h8p @ L^Lgdz      [ a x {  < = > D h i j q r x  # ; @ Q _ u v | ɿ皍yyh\+CJPJaJh%u7CJPJaJhzhKhCJPJaJhbhbCJaJhzh|CJPJaJhzhbCJPJaJhbCJPJaJhzCJaJhbCJaJh|hz6CJ]aJhzhzCJaJhzhz6CJ]aJ/ = > i j q r  ; v  h8p @ gdz h8p @ gdg h8p @ gdb h8p @ gdbm$  &2LU Xalm˾߄yqyqyqyiyyyyahKhCJaJh\+CJaJhe/CJaJhSh%u7CJaJh%u7CJaJh] h JCJPJaJhKh6CJPJ]aJh%u7CJPJ]aJh%u76CJPJ]aJhzh JCJPJaJhKhCJPJaJhgCJPJaJh%u7CJPJaJhzhKhCJPJaJh] CJPJaJ" MYmnvwh h8p @ gd!D0 h8p @ gd%u7 h8p @ gdzmnruvw &?F^chpùzpcYh!D0CJPJaJhzhbCJPJaJh_CJPJaJh%u7h%u7CJaJhSh%u7CJaJh%u7CJaJhKhCJPJaJhzhKhCJPJaJhe/CJPJaJh%u7CJPJaJhzh JCJPJaJhKh6CJPJ]aJh%u7CJPJ]aJh%u76CJPJ]aJh%u7h JCJaJ!^_czۭΈzlaTh!D0h%u7CJPJaJh!D0CJPJ]aJh!D0h!D0CJPJ]aJh!D0h%u7CJPJ]aJh%u76CJPJ]aJhpkhKhCJPJaJhpkCJPJ]aJhNQ$CJPJaJh%u7CJPJaJhzhKhCJPJaJhzh JCJPJaJh!D0CJPJaJhzh!D0CJPJ\aJhzh!D0CJPJaJ^ DE^_ h8p @ gd!D0 h8p @ gd J h8p @ gd%u7 h8p @ gdz  '.CEK]^_c涬yqi^y^VKiihSh!D0CJaJh JCJaJhSh%u7CJaJh!D0CJaJhQ CJaJh%u7CJaJh JCJPJaJhzh%u7CJPJaJh!D0CJPJaJhQ CJPJaJh%u7CJPJaJhzh JCJPJaJh_CJPJ]aJh!D0CJPJ]aJh!D06CJPJ]aJh%u76CJPJ]aJh!D0h JCJPJaJcpvyTZep~!)RWcj  BKflo]ekorԫhSh JCJaJhNQ$CJaJh_CJaJh!D0CJaJh!D0hgCJPJaJh!D0CJPJaJh JCJPJaJhzh!D0CJPJaJh!D0CJ]aJh J6CJ]aJhSh!D0CJaJ8f"RCf^kABC_` h8p @ gd!D0r  ABCG^_`d~',py %&+fo X`os߫hzhKhCJPJaJh!D0CJPJaJhShgCJaJh!D06CJ]aJhSh JCJaJhShNQ$CJaJh JCJaJh!D0CJaJhSh!D0CJaJhSh!D06CJ]aJ:'q&gYnNtu h8p @ gdz h8p @ gd!D0MTstuz9:;@RSTZ^cv{|%&',Ƚ駜~~h JCJaJhSh JCJaJh!D06CJ]aJhSh!D0CJaJh!D0CJaJhzhKhCJPJ\aJh!D0CJPJ\aJhzh JCJPJaJhKhCJPJaJh!D0CJPJaJhzhKhCJPJaJh] CJPJaJ1:;ST&'A~/y'7~ h8p @ gd J h8p @ gd!D0,AG~/5x&/7=>}       ! & M W z } ~ :!C!U!Z!i!o!!!!hKhCJPJaJhzhKhCJPJaJh ^CJPJaJhSh JCJaJh ^CJaJhShgCJaJh JCJaJh!D0CJaJhSh!D0CJaJ<   N z ;!U!i!!!"]"""#Z## h8p @ gd ^ h8p @ gdzm$ h8p @ gdz h8p @ gd!D0!!!!!!"!"<"c"n"p"""""""""##G#n###############$$$$ $$$$$$ζ驟驕}h ^CJPJ]aJh ^6CJPJ]aJh JCJPJaJhKhCJPJaJhzhKhCJPJaJhSh JCJaJhzh ^CJPJaJh] CJaJhSh ^CJaJh ^CJaJh ^CJPJaJhzh JCJPJaJ/#####$$$$$$G$$$$$$$%:% h8p @ gdz h8p @ gdzm$ h8p @ gd J h8p @ gd ^$$$%$G$M$$$$$$$$$$$$$$$9%:%ݹhzhaCJPJaJhKhCJPJaJhzhKhCJPJaJh ^CJPJaJhzh JCJPJaJhKhCJPJ]aJ21h:pa/ =!"#$% .~666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66PJ_HmH nH sH tH @`@ aNormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List PK!pO[Content_Types].xmlj0Eжr(΢]yl#!MB;.n̨̽\A1&ҫ QWKvUbOX#&1`RT9<l#$>r `С-;c=1g3=KjK爉ŬʉaqHwo?x}>6!N J?6v?w_Z3tç$y/,YVϲYLcDt~q"9⧣E"g 36AxgKA,ƉwV=&D-䧘a"FEG<+)/騳2YfEA5i5r{F2rhnz*kU̘aby&Z4MtoKnwu[K@Y5Fm3AM2ޕaŨ; uۭ=: ުv|TV_>%^/*!C!=I.pŭG2#=u{A*?xMVfȯ׆h,"N~e /w$wmBTRUzcn5fwЪtq:nT=q k:V=*^&whv3om <"^PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-!pO[Content_Types].xmlPK-!֧6 -_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Atheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] :P mcr,!$:%!#%' #:% "$&8@0( >@:@ B S  ?l z l m =><=J`e27<333333&2LU^^9<7|zƑ.9! p֮\u ]L=7P?Ne?LvN1I8Ϣ9V\ 2q^r(6b$ln\kx^LTPo(~vsw | ^`OJQJo( 8^8`OJQJo(^`OJQJ^Jo(o  p^ `OJQJo(  @ ^ `OJQJo( x^x`OJQJo(H^H`OJQJ^Jo(o ^`OJQJo( ^`OJQJo( ^`OJQJo("  ^`OJQJo("  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo("  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo(  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo(  pp^p`OJQJo("  @ @ ^@ `OJQJo(  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo("  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo(  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo(  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo("  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo(  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo(  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo(  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo(  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo("  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo("  ^`OJQJo("  ^`OJQJo(  pp^p`OJQJo("  @ @ ^@ `OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  ^`OJQJo("  PP^P`OJQJo(" Po]L6bu 2q^zw 1I9V~9! n\ke?=7ͰP^ 䛲>.4k(J#$BBRr~O J x"|D7н@<@f\)P2q(Gܔ` ܁:mn^VPs={(@Z)= "•&ӴxՄw\|~Ă`,͢:#݊<@AP`U8u4\,$wD5idjd@7(q[pQ;XQb{ SW4t]wV2f'&].vH`;0^Xd2R<3&v ΖlrR z`:R<=zp>\@"P(vc8)N b8۴':$6Z2|Hv6,~ںIifL[fLi!fL4H=OM= fLd[9fL\*UfL(=OM.@:fL/ =OM fL. =OM?tm fLb fL& fLJ fL3 fL:fL$t=OMR=OMQfLo%fL3=OM#Uz=OM>fLm@=OMH=OMLkk=OM<fL6fLP=OM`=OMf=OMHgfL^mv=OMAr=OM8=OMN4=OM1fLC=OM$L=OM\fLcAafLh}fL|G=OMfLfLJ4=OM>=OM =OM\ =OMZ fLNu}!fLX!=OM;"<"fL1 a"fLS#fLr%fLp'=OM 'fL'Hd(fLDE:)fL_*fLCb+=OMM,=OMV8-=OM3.fLc.fL_RI/fLi/fL/fLCG1fL!3=OM1@4=OM h4fL@4fL)5=OMi`5=OMr06=OMrT6fLw7=OMj7fLi:=OM:fLU(>=OM>=OM?fL 1s@fLNMB=OM)C=OM\ CfL86C=OMpD=OM D=OMY F=OMBFfLkFfLFfL)ZGfLZG=OMm1GfLH=OM6H=OMv>I=OM uVIfL:tIfL;^I=OMXI=OMKIfL9rK=OM!&LfLPLfL=OMIdM=OMB MfLpN=OMsIO=OM^qOfLNPfLo\=OM \fLIa\fL%W]=OM P)`=OMK/`=OM#,a=OMAa=OMwebfLPxbfL|]b=OMvQcfLW~cfL<0efL'e=OMBcf=OM|f=OMmGgfLjg=OM3h=OM)Dh=OM Qi=OMWmi=OM*Oj=OMoDkfLUm=OMDmfL ?@ABCDEFGHIJKLMNOPQRTUVWXYZ\]^_`abeRoot Entry F8g1Table) SWordDocument4PSummaryInformation(SDocumentSummaryInformation8[CompObjr  F Microsoft Word 97-2004 Document MSWordDocWord.Document.89q