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Micro Chapter 26 — Transcript

by RICHARD MATTHEWS · 7,644 words · 1,340 segments · language en · Watch on YouTube

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0:00All right, so welcome to the last
0:02chapter of the semester. So, we made it
0:04through.
0:05Uh this chapter is about the microbial
0:07diseases of the urinary and genital
0:09systems. So, do want to warn you, you're
0:11going to see pictures of human
0:13reproductive parts, you know, as we go
0:15through here. So, just a little
0:17disclaimer. So, we're adults. We're
0:19going to We're going to We're going to
0:20do what we need to do.
0:21Um but just make make sure that you are
0:23aware of that, you know,
0:25uh as we go through.
0:29All right, so
0:30this is a picture
0:32of Leptospira interrogans.
0:35This is a type of spiro- spiral-shaped
0:38bacterium
0:39and is sometimes involved in uh
0:43reproductive system diseases.
0:47And uh
0:50is transmitted in the urine of infected
0:52animals.
0:55Our first objective, we're going to talk
0:57about anatomy of the uh urinary system
1:00and the antimicrobial features of that.
1:04All right, so the anatomy of the urinary
1:05system, you've got your
1:08It's not very much to it, actually.
1:10Uh you got two kidneys. One is uh you'll
1:13see in the picture in a second.
1:14One is The right one is lower than the
1:16left one cuz of the position of the
1:18liver.
1:19Two ureters, which are really small
1:21little tubes that transport um urine
1:24from the kidneys to the bladder.
1:27And then the bladder, which can expand
1:29enough to take urine inside of it. And
1:31then the urethra, which is actually much
1:33much shorter in females than it is in
1:35males, which actually And we'll talk
1:36about this later on as we go through. It
1:38actually does mean that females are a
1:41little more prone to get urinary tract
1:42infections because of the length of the
1:44of the urethra.
1:45Usually, infection of the urinary system
1:48is prevented by valves that prevent back
1:50flow to the kidneys.
1:52And urine is slightly acidic. It's about
1:546 pH.
1:56It can be like 4.5. Uh
1:583 4.5 to 8 is really the the um the
2:01range, but it can be uh
2:04acidity of of urine. And of course, just
2:06having urine kind of push push stuff
2:08out, mechanical flushing is is is the
2:10way that usually infections prevented.
2:12Again, the length of the urethra is a
2:14little bit shorter in females, so it's
2:17mechanical flushing isn't quite as
2:18effective as it is in males.
2:22So, this is what it looks like. Again,
2:23you see the position of the right kidney
2:26is lower than the left one because
2:27that's the liver is like hanging out up
2:29there on top of that. All right. Here's
2:31your urethra, which your ureter, which
2:33I'm sorry, ureter, which is really kind
2:34of they're not really large.
2:37The the the they're not, you know, they
2:40can become clogged pretty easily, which
2:42is unfortunate. And then the bladder.
2:47All right. So, the next part we're going
2:48to talk about uh the portal of entries,
2:50places where
2:52uh you can have infection in these in
2:54these areas.
2:57So,
2:58the female genital system, again, you
3:00have which is different than the male
3:01genital system in the fact that you got
3:02two ovaries,
3:04uh two fallopian tubes, sometimes
3:06they're called uterine tubes, the uterus
3:08itself, including the cervix, the
3:10vagina,
3:11and then the outside of the vagina,
3:12external genitalia, the vulva.
3:18So, it looks like on the So, here's your
3:20your ovary here, your uterine tube here.
3:23The the uh
3:24uterus kind of looks like an upside down
3:26pear. It's kind of what it's likened to.
3:28And then of course, the the uh
3:31vagina itself.
3:35And then the uh outside of the vagina.
3:39So, those are the parts.
3:44The male genital system is a little bit
3:45different. Two testes, and then you got
3:48really a lot of ducts, things that take
3:50sperm from the the testes to the the
3:53term um um ejaculation. So epididymis,
3:56the vas deferens, very long one,
3:58ejaculatory duct, and the urethra, which
3:59is again which is much longer in males
4:01than it is in females.
4:02You also have accessory glands like the
4:03bulbourethral gland, you know, or
4:05sometimes called the Cowper's gland,
4:07sometimes referred to as
4:08and then of course the penis itself is
4:09which is the copulatory organ.
4:15It looks like all right, so the major
4:17difference between the male and female
4:19actually they're made out of the same
4:20stuff. Like here, the scrotum, the sack
4:22of the
4:23where the testes that's made out of the
4:25same uh
4:26tissue as the labia and the vagina. The
4:29the glans penis, this part right here,
4:31this is made out of the same tissue as
4:33the clitoris and and so uh it's erectile
4:35tissue. So again, you see that the
4:37urethra
4:39is longer in males
4:41because of because of the uh
4:44the length of the penis.
4:47Okay, we're going to talk about the
4:49normal microbiota of the upper urinary
4:53tract, the male urethra, and the female
4:55urethra. Like what things should be
4:56there and what things should you know,
4:57we'll talk about what things should not
4:58be there.
5:01Now, normal urine probably is not
5:03sterile because when it passes out of
5:07the uh urinary tract, it gets stuff on
5:10it, bacteria from the from the you know,
5:12penis or vagina whatever wherever it's
5:14coming out from. Um it is more sterile
5:17towards the beginning of that tract
5:19because it's not coming in contact with
5:20that, but it's not going to be sterile
5:22when you put it in the you know,
5:23container.
5:25Now, the predominant microbes that we
5:27find in the uh vagina, lactobacilli,
5:31which produces hydrogen peroxide and
5:32lactic acid.
5:34That's intentional
5:36um because what lactobacillus does it
5:38makes the vagina a little bit acidic so
5:41that yeast can't grow there.
5:44And
5:46and that growth of that is permitted by
5:48is permitted by estrogens.
5:50You also have some streptococcus, some
5:52anaerobes, some gram negatives, and of
5:54course candida albicans yeast does grow
5:56there, but it's kept in check by uh
6:00lactobacillus.
6:02Now, the male urethra does introduce
6:04bacteria into the semen because, you
6:07know, it's so far and down. Uh and there
6:09are some microbes of of the seminal
6:11vesicles. Propionibacterium,
6:15uh prevotella, and lactobacillus are
6:17also present in males.
6:19So, again, urine really isn't sterile.
6:24You know, that came from the idea that
6:25you could use it to clean wounds, stuff
6:27like that, but some of the slow-growing
6:29bacteria wouldn't even really show up in
6:30those kind of tests. So, uh this is what
6:32it looks like. It's kind of you see it's
6:33kind of clear and yellow.
6:36Um
6:38it's
6:39uh never should be cloudy. If it's
6:40cloudy, that doesn't indicate infection,
6:43but that you may see, you know, it's
6:45clear cuz it it's clear because there's
6:47not a whole lot of bacteria in it, but
6:48it's not really ever going to be 100%
6:50sterile. Like, I mean, I've cultured
6:52this before, too, and it always
6:54you always find something.
6:56Right?
6:58Okay, we're going to start the
6:59discussion of diseases with bacterial
7:01diseases.
7:02So, we're going to talk about how we can
7:04get them, and then the different types
7:05of organisms that can cause different
7:07diseases. Cystitis,
7:09uh pyelonephritis, leptospirosis, and
7:11then, you know, what the predisposing
7:13factors for those diseases are.
7:17All right. So, the first one we're going
7:18to talk about is urethritis.
7:22That's the inflammation of the urethra.
7:24Um again, the bacteria These are These
7:27are just your kind of your general
7:28terms, and they can be caused by certain
7:30different things. Um but most commonly,
7:33it does say at the bottom here it's
7:34caused by E. coli. So, urethritis,
7:36inflammation of the urethra. Infections
7:38of the urinary bladder called cystitis.
7:41The
7:41infection of the ureters, which is not
7:43quite as common is called ureteritis.
7:45And then the kidneys which I've had this
7:48before actually.
7:50Pyelonephritis
7:51is a nephron is the unit of the kidneys
7:54so that's why it's called nephritis.
7:56And then again most of them are caused
7:58by E. coli. So we'll talk about that as
8:00we go through.
8:02Now cystitis which again is the
8:05inflammation of the bladder
8:07is most commonly caused by E. coli which
8:10is a gram-negative rod bacterium.
8:13It can also be caused by Staphylococcus
8:16saprophyticus.
8:18All right.
8:21So that's a coagulase-negative bacteria.
8:23Symptoms of cystitis include things like
8:25dysuria which is painful urination,
8:28pyuria pus in the urine you can see that
8:30and when it's kind of cloudy.
8:32That's a bladder infection.
8:34Again it is eight times more common in
8:37women than it is in men. All right,
8:39because of the the short length of the
8:42urethra and how close it is to the anal
8:44opening which is where the E. coli comes
8:45into play. Most of the time it's E. coli
8:47because of the way that we wipe. All
8:50right.
8:51So how do we diagnose cystitis? Well we
8:54see a thousand more than a thousand
8:56colony-forming units per milliliter of a
8:58single species and a positive leukocyte
9:01esterase test. That means
9:03basically you got the bacteria and you
9:05got the white blood cells to prove the
9:06infection. That's what that is, right?
9:09You can treat cystitis most commonly
9:13with nitrofurantoin
9:15or a fluoroquinolone.
9:17Um
9:18that's often helpful if the drug
9:20resistance is encountered. So bladder
9:22infections that's really common. This is
9:24something you see. Many people have had
9:25one. They're very very very common.
9:30So pyelonephritis
9:32um
9:35uh this is this is usually um
9:38caused by untreated
9:41um cystitis. Basically, it it backs up
9:43basically. So, 70% of these are caused
9:46by E. coli.
9:48Uh, it can be inflammation of one or
9:50both of the kidneys and can result in
9:52fever, back pain.
9:55Uh, in females, it's also a complication
9:56of urinary tract infections. Generally
9:58results in, you know, bacteria in the
10:00blood because that's where the kidneys
10:01are close to.
10:03Um, it can
10:04I had this one time, you know, it was
10:06about
10:07um 18 years ago.
10:09Uh, it can form scar tissue
10:12in the kidneys and become
10:13life-threatening.
10:15The diagnosis for this is a little bit
10:17more stringent over 100,000 colony
10:18forming units per milliliter of a single
10:20species. That's kind of That's how they
10:22know it's it's uh
10:24an infection because it's a single
10:26species and a positive, you know,
10:28leukocyte test.
10:29Um
10:31I had to go I had to go I had to go back
10:33I had to go twice cuz it was it was
10:35cuz I went when I was
10:36in Virginia when I was living in
10:37Virginia. They didn't really do
10:39anything. Then I had to go again when I
10:41when I got home to Georgia cuz it was
10:43you know, it was in the same week
10:44actually as my uncle one of my uncles
10:45passed away actually that week.
10:47Um
10:49it was bad, you know, it's just very
10:51bad stuff.
10:53You can treat treat this with second or
10:55third generation cephalosporins.
10:58Um
10:59broad-spectrum antibiotics.
11:01So, the next bacterial disease is
11:03leptospirosis
11:05which is caused by Leptospira
11:06interrogans. Leptospira interrogans is a
11:09spirochete which unfortunately is not
11:12easily seen on a microscope but stains
11:14very poorly. It's an obligate aerobe.
11:18It can be passed to humans and sometimes
11:20causes severe uh
11:22kidney or liver disease.
11:24Um it's transmitted by skin or mucosal
11:29contact with water that's been
11:30contaminated with urine. So, it lives
11:33in, you know, reservoirs or, you know,
11:36animals in the urine. And basically,
11:38that's why it's, you know, in this
11:39chapter.
11:40Um it is probably the most common
11:42zoonosis worldwide. It's found all over
11:44the place. Uh
11:45most of the cases in the United States
11:47are in Hawaii and Puerto Rico, more more
11:49kind of tropical
11:51areas. Urine contaminates uh water from
11:53fresh water lakes, streams, soil, stuff
11:56like that.
11:57Um
11:58symptoms of leptospirosis include your
12:00your muscle aches, headaches, fever.
12:03Sometimes it can be severe in a small
12:04number of cases. The kidney and liver
12:06can become seriously infected. In that
12:07case, you get Weil's disease, which is
12:09kidney failure. And a newer one that's
12:11been kind of coming up is pulmonary
12:14hemorrhagic syndrome,
12:16which has a kind of appeared all all
12:18over the planet, you know.
12:19Um you can diagnose leptospirosis pretty
12:21easily with a rapid serological test.
12:24Um
12:26most of them are are
12:28um This is a This is a preliminary
12:31diagnosis.
12:32And a doxycycline is the is the
12:34recommended treatment for leptospirosis.
12:39So, it looks like kind of a
12:40corkscrew-shaped uh spirochete bacteria.
12:45All right. So, first one, this will be
12:47your first discussion question. So, you
12:49do need to write this one down.
12:5020-year-old woman feeling a stinging
12:53sensation when urinating. It feels an
12:55urgent need to urinate even if very
12:57little urine is coming out. So, when
13:00they culture it, here's a clue.
13:01Lactose-fermenting, gram-negative rods.
13:05And that's that's how you know what this
13:06is, all right? Our culture from her
13:09urine. So, what type of infections could
13:11cause you something? That's your first
13:12discussion question for the chapter.
13:15And this is what a culture of that
13:16bacteria would look like. So, you can do
13:18this. You can test a person's culture to
13:21see if this grows on This is a special
13:23type of medium called McConkey's agar.
13:26And it shows the ability for the for the
13:28cells to ferment lactose. If they do, it
13:30turns that uh which you probably already
13:32know this cuz this is this is in your
13:33lab. It turns that pinkish color. So,
13:36you probably know what this is you know
13:37basically on the lab that you've been
13:38doing, uh
13:40what type of bacteria is going to turn
13:43you know, pinkish color in McConkey's
13:45auger that's gram negative rods. You
13:47know, this is
13:48the most common cause of urinary tract
13:49infections actually. So, um that's how
13:51they test.
13:55So, again your your your major one is
13:57cystitis, pyelonephritis. And most of
13:59them are caused by E. coli. Some staff
14:01can cause cystitis.
14:02Um leptospirosis again caused by
14:05Leptospira interrogans.
14:09>> [snorts]
14:09>> Okay, so a couple of diseases of the the
14:12general systems, sexually transmitted
14:14diseases, STIs or STDs, right? They call
14:17them STIs now. Sexually transmitted uh
14:21infections is what they call it now. At
14:23least call them STDs, right?
14:25Um a lot of times
14:27you don't know you have these and that's
14:29why they continue to be such a problem
14:31cuz a person can transmit an STI to a
14:34partner cuz they don't know that they
14:36have it. All right? There are over 30
14:39types of them. It's not just one or two
14:40things. 30 different types of things.
14:42There is 60 million new cases in the
14:44United States every year.
14:47Um
14:48half of which occur in 18 to
14:5024-year-olds.
14:52Um because they're sexually active and
14:54don't know you know, things you should
14:57you should not be doing. Most of the
14:58time these are prevented with with
15:00condom usage. Um
15:02people
15:04sometimes don't realize they need to do
15:05that or don't care about it. I don't
15:07know. Whatever the you know, um but most
15:10of the time these can be prevented.
15:14Now, when speaking about STIs, there are
15:17some take-home kits you can use to
15:21screen for and it you know, the presence
15:24of these things. So, you collect the
15:26samples at home
15:28and test it. And the reason you do this
15:30is because, you know, a lot of times
15:32STIs go unnoticed. And
15:36you know, you can do this at home
15:37instead of having to go to a lab. And
15:40so, and you know, you could maybe save
15:41yourself, you know, embarrassment or
15:43whatever it is the reason why you want
15:44to do it. But, it can it can screen for
15:47chlamydia, gonorrhea, trichomoniasis
15:49using nucleic nucleic acid amplification
15:52test. You get results in a couple weeks.
15:54And then you get if you get positive,
15:56you get referred to a clinic. All right.
15:58You can also do a test for HIV very
15:59quickly,
16:01uh oral test.
16:02Um
16:04so
16:06yeah.
16:07It's pretty good. It it's
16:09clinical studies show that the test
16:10produces one false positive every near
16:125,000 individuals and one false negative
16:14in every 12 individuals.
16:17You know, or
16:19um
16:22the urinary tract infection, you got you
16:24can have the urine dipstick test or a
16:26test dipstick test, which is pretty
16:28good. Uh it can tell you kind of what's
16:30going on.
16:33So, here we go. Here's what it kind of
16:34looks like. So,
16:37this is if you're female test contents.
16:39And you basically pee on a stick. It's
16:41kind of like a pregnancy test.
16:44And here's the urine dipstick test to
16:46see if you got a urinary tract
16:47infection.
16:50So, again, of course, the the pros of
16:52at-home testing,
16:54you know, more cases are diagnosed,
16:55which means you can get treatment,
16:57better access, quicker treatment. The
16:59cons, sometimes they're expensive. Um
17:04of course, the you know, your privacy
17:05concerns. And then, of course, the
17:07concerns I just mentioned about about
17:08accuracy.
17:10Um
17:11not every home test kit is necessarily
17:13effective. And users should seek ones
17:15that are
17:19Um Um
17:21this little on the left picture of HIV,
17:23all right?
17:24Um
17:26and then it shows you kind of how if you
17:28get the negative result, there's no
17:29there's no line. If it's positive, then
17:32there's a a line.
17:33Uh it contains a synthe- synthetic uh GP
17:37protein. If the sample contains
17:38antibodies against that, it's going to
17:40cause the strip to to change color.
17:43And if the sample's not
17:45contain it, then it's not. So, this is
17:47an oral test.
17:49Something that you take, you swab your
17:50mouth, and stick it on there. All right?
17:55So, next section we're going to talk
17:57about the symptoms, methods of
17:58diagnosis, and treatments for a couple
18:00more diseases: gonorrhea,
18:02uh non-gonococcal urethritis,
18:05uh pelvic inflammatory disease,
18:07syphilis, uh lymphogranuloma venereum,
18:10chancroid, and bacterial vaginosis.
18:13Now, gonorrhea is caused by Neisseria
18:16gonorrhoeae.
18:18Uh the genus Neisseria actually is found
18:19in us. Uh we have it in our mouth and
18:21everything, but gonorrhea is a different
18:22one. Gonorrhea is a gram-negative
18:24diplococcus, which is not that common
18:26for disease-causing. Um in the United
18:28States, the incident reported cases
18:30increased in 2020
18:32to 206.5
18:34cases per 100,000 people.
18:38Now, the actual number is probably two
18:39or three times higher than that because
18:40it's actually asymptomatic
18:42uh in a lot of people. And the reason
18:45why the number is increasing is because
18:46people are not using condoms they used
18:48to.
18:49So, that's that's a problem, all right?
18:51Now, how it works, it attaches to the
18:53epithelial mucosa uh by the fimbriae,
18:56which are are things that the cell can
18:57stick to other surfaces. And it invades
19:00the spaces between the columnar
19:01epithelial cells, the pharynx, eyes,
19:04rectum, urethra, cervix, external
19:06genitalia, preputia of uh females.
19:10So, basically, you can get this other
19:11places than just your, you know, your um
19:14your genitals.
19:15Uh
19:16it causes inflammation, forms pus. I'm
19:19going to show you a picture that's
19:20coming up in just a moment. It's It's a
19:21little
19:22It's a little shocking, just FYI. Um
19:25And so, you can may have a couple of
19:27different forms, pharyngeal gonorrhea,
19:28which is in your throat, and anal
19:30gonorrhea, also in the anus. It's not
19:31just just in the in the genitals. It's
19:35also in the areas around that or in the
19:36mouth.
19:39Now, looking at uh the incidence of
19:41gonorrhea, you saw that in the
19:43between the
19:45area here in the in the late '70s, early
19:47'80s, there was a spike. People were,
19:49you know,
19:50not really realizing what you need to do
19:51to prevent that. And now it's kind of
19:53gone up down, but you see here it's kind
19:54of got up a little bit, you know, in
19:56recent times cuz decreased condom usage.
20:02So, the incidence and distribution of
20:04gonorrhea, um it's it's all over. I
20:06mean, it's it's it's not as common as
20:08some of your western states, and and
20:10that on y'all, that's because these
20:11these are not as commonly populated
20:13anyway. So, and then if you're also uh
20:16it's it's a little less common here
20:18also. West Virginia's less common. But,
20:20in your in your places where you have
20:21big I mean, look at all the rest of
20:22them, you know, all is all red. It's
20:24very common.
20:28Now, in gonorrhea, the symptoms in men
20:30include painful urination, discharge of
20:32pus, and inflammation of the epididymis
20:34and the testes.
20:35Um
20:37it's very unlikely that you're a male
20:39and you're not going to know you have
20:40gonorrhea. It's more likely that um in
20:43females you may not know you have fewer
20:45symptoms.
20:46Pelvic inflammatory disease uh may
20:48develop also from untreated gonorrhea.
20:52It may disseminate and become systemic,
20:54unfortunately. Endocarditis, meningitis,
20:56and arthritis could develop if it's
20:58untreated, and that's a very real
20:59possibility because a lot of people
21:00don't know they have it.
21:01Um also, it can be passed uh from mother
21:05to child during birth. So, ophthalmia
21:08neonatorum
21:10is an infection due to
21:12gonorrheal infection of the eyes.
21:14Uh it's used to be prevented by doing
21:16silver nitrate drops. Now, it's more
21:17likely it's going to be prevented by
21:19doing erythromycin drops in the
21:20neonate's eyes.
21:22Um that's a little bit more safe than
21:24the silver nitrate drops.
21:26Uh warning in the next slide is of a
21:27male that's got gonorrhea. So, if you
21:29are not interested, you can skip through
21:31that.
21:32Um
21:32I'm not going to ask you a discussion
21:34question on that slide. So,
21:37All right, so this is what it looks
21:37like. This is a
21:39a man, the urethra of a man with an
21:41acute case of gonorrhea.
21:45There is no adaptive immunity to
21:47gonorrhea. So, that means there's no
21:48there's no vaccine. There's not ever
21:50going to be a vaccine for it because the
21:52the antigens on the
21:54they vary so much. So, the the proteins
21:58upper protein is bonded to cell
21:59receptors, and that prevents activation
22:01immunological memory. So, it's it's not
22:03going to can ever do a vaccine for it.
22:06It's not going to work. You know.
22:08Um
22:12uh
22:13if you have
22:15uh
22:17immune suppression,
22:19it may also explain why gonorrhea people
22:21are more susceptible to to other STIs
22:23like like, you know, HIV.
22:25Uh gon- gonorrhea is diagnosed with a
22:27gram stain. It's very easy to diagnose
22:29because most uh urinary tract infections
22:32are not gram negative um coccus, but
22:35this is. So, it's very easy to see.
22:37A culture
22:39or our our uh
22:42NAATs.
22:45And then uh the treatment for gonorrhea
22:47is uh
22:48uh
22:49a ceftriaxone is is a is a um
22:53is a a treatment. I will tell you also
22:55though it is becoming more and more
22:57resistant to antibiotics because
22:59it is uh
23:00you know, becoming so rampant.
23:07And this is a smear of it. So, you can
23:10see the bacteria is that red kind of
23:12round shape, which is that's not that
23:14common. So, it's kind of easy to tell
23:15this is pretty quickly.
23:21Now,
23:22we can see from
23:24this graph, we're looking at the
23:25antibiotic resistance in gonorrhea, and
23:27we see
23:28that the resistance has
23:31grown over time. Look at it. Look at the
23:33resistance.
23:35You know, you we have to keep kind of
23:37changing what we treat this with because
23:39it's not going to work. You see the
23:40resistance has grown in the
23:41fluoroquinolones.
23:43Um,
23:44azithromycin, you know, resistance has
23:46actually decreased a little bit. Um, but
23:49it's it's a thing, you know. So, again,
23:50that this is a huge issue. Gonorrhea is
23:53a huge thing, and it does continue to be
23:55an issue because of antibiotic
23:57resistance.
24:00We also have urethritis that can be
24:02caused by something other than Neisseria
24:05gonorrhoeae. So, this is non-specific
24:07urethritis or non-gonococcal urethritis.
24:10It can be caused by um, Chlamydia
24:12Chlamydia trachomatis, which is the most
24:14common
24:16uh, where this can be can be a kind of
24:18caused. Mycoplasma genitalium and
24:20Ureaplasma urealyticum, which is those
24:22aren't
24:23those aren't really they're not really
24:24so much STDs. Chlamydia Chlamydia is.
24:27Um,
24:29uh, it's a very common pathogen.
24:31Um, mild symptoms.
24:34But, you also do have the the others as
24:37well. Uh, so, the the kind of symptoms
24:39the painful urination,
24:41watery discharge, but often it's
24:43asymptomatic, which is, you know, but it
24:46can result in pelvic inflammatory
24:47disease in women.
24:49Uh, the diagnosis of these is usually
24:52NAATs. That's the most common way that
24:54we do that.
24:57Um, you can treat chlamydia
25:00Chlamydia really hasn't
25:02um
25:04gotten the resistance. Some of it has,
25:06but it's most of it has not gotten
25:07resistance that some of the other
25:09uh diseases have. So, you can still
25:11treat uh chlamydia with azithromycin and
25:13doxycycline.
25:18Now, pelvic inflammatory disease, what
25:19that is,
25:20um usually it's for the extensive
25:23bacterial infection of the female
25:26pelvic organs, particularly the uterus,
25:29the cervix, uterine tubes, ovaries.
25:32Um, it's basically it's a polymicrobial
25:34infection, which means you got more than
25:36one microbe working on it. So, it's
25:37usually uh the causative agents of
25:39gonorrhea and chlamydia that are going
25:41to be doing it. Most common ones are you
25:43know those, um Neisseria gonorrhoeae and
25:45Chlamydia trachomatis.
25:47Um, it can be very serious in the fact
25:49that it can cause infertility and does
25:51cause chronic abdominal pain.
25:53Um, the uterine tubes can also become
25:55infected. We call that salpingitis. This
25:58is the most serious form because the
25:59scarring can cause infertility and or
26:02ectopic pregnancy. So, it's very
26:03important that we you know fix that.
26:05Again, these types of things can be
26:07treated with uh doxycycline,
26:08ceftriaxone, and metronidazole.
26:13This is salpingitis. This is kind of
26:15what it looks like. Um, this is kind of
26:16as you can tell uh this is because it's
26:18inflammation of the uterine tube.
26:22Now, the next
26:24bacterial infection of the urogenital uh
26:26system is syphilis. All right? Syphilis
26:29has been around as long as humans have.
26:32It is the Treponema pallidum is the is
26:34the spirochete bacteria that actually
26:35causes this, and it's been in humans as
26:37long as humans have been around. So,
26:38it's it's not going anywhere. It's going
26:40to be there, you know, forever.
26:41It grows very slowly in cell culture.
26:44Um, it invades the mucosa through breaks
26:45in the skin and enters the bloodstream.
26:47It does induce inflammatory response.
26:49It's very unlikely you're going to have
26:50this and not, you know, have some kind
26:52of symptom of it at some point.
26:55Uh some strains
26:58of Treponema pallidum do cause something
26:59called yaws,
27:01which is not particularly common in the
27:03United States, but it does happen in
27:04other places.
27:05Um and that's not really an STD. It's a
27:07skin disease. It's It's not actually an
27:09STD.
27:11Um
27:12the increasing number of cases of
27:14syphilis have actually increased
27:16uh in throughout the United States
27:17population
27:19uh since 2001.
27:21Um it's likely because of decreased
27:23condom usage uh in in certain
27:26populations.
27:29This is the spirochete that causes
27:31syphilis. This is Treponema pallidum.
27:35And um
27:37what we see
27:39is
27:41a rapid decline in the cases of
27:43syphilis. Reported cases, you see
27:48down here is it's going down around this
27:50time. And I can tell you why. Around
27:51this time in 1947,
27:53penicillin became widely available.
27:56That's why. That's the That's the reason
27:57why you see that. And it's dropped kind
27:59of gone up a little bit and up in the
28:02kind of late '80s, but um and you can
28:04see on the right it tells you the
28:06distribution where it's common. Again,
28:10places with high populations. Georgia's
28:12pretty common.
28:15Now again, y'all, this is by a state
28:16map.
28:18All right? It's It's kind of done by by
28:20rate per 100,000 population. Remember,
28:23you're talking about metro areas, too.
28:24So So this is a little bit more densely
28:27populated regions have it. You see New
28:28York's got it, California, of course
28:30they're going to have it. And
28:34syphilis has got a couple different
28:36stages to it.
28:37You got your primary stage where you got
28:39a a a
28:41lesion called a canker
28:43at the site of infection.
28:45Um it's usually painless and highly
28:47infectious and if you are not doing
28:49routine checks of your genitalia, you
28:51may not even know you you may not even
28:53see that.
28:54It disappears after a couple weeks and
28:55then the bacteria enter the blood and
28:56lymphatic system.
28:59Um, the secondary stage of syphilis
29:02where you've got skin and mucosal rashes
29:04especially on the palms and soles.
29:05That's going to be your kind of your
29:06telltale sign if you have this and
29:07didn't know it.
29:08Um, the rash lesions are infectious, you
29:11know, so you can't you can't spread it
29:13and this is due to inflammatory
29:15response.
29:17The latent there's latent period where
29:19you have no symptoms and that can last
29:20for years actually which is it's a
29:22little scary.
29:26And then the tertiary stage of syphilis
29:30uh, appears years after latency and this
29:32is due to
29:34um,
29:35cell-mediated immune responses. Then you
29:37have gummatous syphilis where you got
29:38gummas in many organs. Sometimes you can
29:40see
29:41uh, like the the pupils of the eyes kind
29:44of start to change shape.
29:46And it's it's going to be quite
29:48unsightly. You also
29:50um, have weakening of the aorta
29:52cardiovascular syphilis and then some
29:56Yeah, some of this is kind of it hasn't
29:58really told you this. It can be really
29:59bad. It says it affects the central
30:00nervous system. It does but and causes
30:02dementia, seizures, loss of coordination
30:04of voluntary movements but really it can
30:06cause like psychosis also like
30:09where you start in paranoid and start
30:13you know, it can basically turns your
30:14brain to Swiss cheese
30:15you know, for lack of a better word.
30:17Um,
30:18it can be congenital. It can pass from
30:20the placenta to the fetus. So,
30:21neurological damage can occur and of
30:23course this is prevented by treating,
30:25you know, pregnant patients with
30:26antibiotics so get rid of it. Syphilis
30:29the thing about syphilis
30:31it's not as common as some of your other
30:34STDs so it hasn't really developed the
30:37bacteria hasn't really developed
30:38immunity or the resistance to that
30:41antibiotics some of the other ones. So,
30:43if you take like something for like a
30:45sinus infection,
30:47you know, or something else, you
30:48probably cure it if you had it, you
30:50know, which is which is good. Now, I do
30:52want to ask you another discussion
30:53question about syphilis. This is um
30:56I don't think I read this in your book.
30:59Um but there was a study that was
31:01conducted about syphilis.
31:03Uh it was called the Tuskegee study.
31:06A native written in Alabama where it was
31:08done actually. And it was very
31:10controversial about syphilis. So, for
31:13your second discussion question,
31:15describe in a in a paragraph or so what
31:17the Tuskegee study was and why it was so
31:20controversial and why it was actually
31:22um
31:22not right to do that, you know, to
31:25people. So, explain what Tuskegee
31:27syphilis study was, when it was, and why
31:29it was wrong to do that to people.
31:35So, here's a couple of uh
31:37lesions and so there's the primary stage
31:40and there's a chancre formed and then
31:42the lesions in the secondary stage and
31:44then the gummas can develop
31:46uh in the skin later on so you can kind
31:47of see what's going on.
31:51>> [snorts]
31:51>> Now, treatment of syphilis
31:53uh and diagnosis, the uh you got the
31:56dark field microscopy test, uh the
31:58direct fluorescent antibody test that
31:59that lets you know that you've got
32:01Treponema pallidum.
32:02And then you got some of your non uh
32:04treponemal
32:05uh tests. So, if they the agglutination
32:08slide, the rapid plasma reagin test,
32:10ELISA, um you can kind of tell what's
32:13going on.
32:14And then of course your Treponema
32:15antigen test, ELISA, that actually will
32:18test for the presence of Treponema. And
32:20you have fluorescent treponemal antibody
32:21absorption test.
32:23You know, so you can do that.
32:24Now, uh syphilis again, because it is
32:27not as common as it, you know,
32:31uh once was,
32:32uh benzathine penicillin, which is a
32:34long a long-acting formation, remains in
32:37the body for about 2 weeks. This is the
32:38usual antibiotic treatment of syphilis.
32:41This is most commonly how you're going
32:42to get that. If you can't take
32:45penicillin, there are several other
32:47antibiotics such as erythromycin,
32:48doxycycline, tetracycline. Again, those
32:51are things you would take for a sinus
32:52infection or chlamydia or something like
32:55that. So, it's probably going to get the
32:56syphilis, too, if you
32:59take those if you have it. So,
33:01which is, you know, I guess good. I
33:02don't I don't know if it's a good thing.
33:07Now, lymphogranuloma
33:09venereum, which is caused by tropical uh
33:14tropical serovars of chlamydia
33:16trachomatis, often most seen in the
33:18tropical areas. And what happens is that
33:20the chlamydia bacteria infects the
33:22lymphoid tissue,
33:24and the lymph nodes become larger and
33:27tender. They can discharge pus, and
33:29scarring can occur.
33:31Um
33:33inflammation of lymph nodes results in
33:34these issues, and a blockage sometimes
33:36leads to massive enlargements of
33:38external genitaliasm and and narrowing
33:40of the urethra in women.
33:43To diagnose lymphogranuloma venereum,
33:45you have to do a direct NAAT for
33:47chlamydia trachomatis.
33:48And the good thing is you can treat it
33:50with doxycycline.
33:53Now, the STI known as
33:56chancroid or soft chancre
33:58occurs most frequently in tropical
33:59areas, where it's seen more often than
34:01syphilis, actually.
34:03And the number of reported cases in the
34:04United States has been declining from a
34:06peak in about 5,000 cases in 1988.
34:10It's caused
34:11by uh Haemophilus ducreyi,
34:14which is a gram-negative rod.
34:16Uh and you have painful ulcers of the
34:19genitals and swollen lymph nodes in the
34:20groin.
34:21Um this is a factor in the in the in the
34:24uh diagnosis and treatment or or
34:27submission
34:28uh of uh transmission of HIV.
34:31Um especially in Africa.
34:34All right.
34:35Um,
34:36the lesions, basically,
34:39they contain HIV in them, so you can you
34:41can you know get them that way.
34:43Uh, the diagnosis is based on the
34:45symptoms and the culture. You can treat
34:48uh, chancroid with uh,
34:50azithromycin or ceftriaxone.
34:56Bacterial vaginosis,
34:59um, this is another type of disease.
35:01This is caused by Gardnerella vaginalis.
35:03Gardnerella vaginalis is a pleomorphic
35:05gram variable rod.
35:07So, it's not exactly a positive or
35:09negative.
35:11Um,
35:14vaginosis,
35:15um,
35:18or vaginitis, uh,
35:20uh, can inflammation of the vagina due
35:22to infection,
35:23uh, can be caused,
35:25uh, by yeast, Chlamydia trach-
35:29can- Candida albicans,
35:31or protozoa, Trichomonas vaginalis.
35:34Vaginosis is when you don't have any
35:35sign of inflammation.
35:37Now, uh,
35:38vaginosis often occurs
35:40because you have a decrease in the
35:42number of lactobacillus,
35:44which is what normally keep that in
35:45check.
35:46So,
35:47um, a pH above 4.5, a fishy odor,
35:50copious frothy discharge, kind of you
35:52can tell that. And then clue cells,
35:55clue cells may be observed, uh,
35:57microscopically. These are sloughed off
35:58vaginal epithelial cells covered with a
36:00biofilm of Gardnerella vaginalis, kind
36:02of how you can tell.
36:03You can use your NAATs for your
36:05diagnosis.
36:07And then, of course, your your treatment
36:09is an antibiotic, metronidazole.
36:14So, here's the clue cells. It's got uh,
36:16layers of Gardnerella vaginalis bacteria
36:18on them, kind of so I can kind of tell
36:20that this is what this is what you got.
36:25Okay, next we're going to learn about
36:26viral diseases of the reproductive
36:28system. So, we're going to talk about
36:30herpes and warts. There's really not
36:31that many. Herpes, warts. We talked
36:33about HIV already in the in the immune
36:35system. We're not going to really focus
36:36on that. We're going to focus on these
36:38viruses, genital herpes and genital
36:39warts.
36:42So, genital herpes is caused by herpes
36:44simplex 2, HSV2.
36:46Um and it's pretty common in the United
36:48States, one in four over the age of 30
36:50are infected with this. Um
36:53Here's the thing, it may also be caused
36:56by HSV1.
36:57You can get either one of these either
36:58place. Most often
37:01HSV1 is associated with like cold sores,
37:03fever blisters, things like that, but it
37:05can occur on the genitalia as well, as
37:07well as HSV2 can occur on the mouth. All
37:09right?
37:10You get these painful vesicles on the
37:11genitals, painful urination. Most often
37:14it's found towards the tip. Um
37:16They heal within 2 weeks and they can be
37:18transmitted even when when you're not
37:20having outbreak, you know, so it can be
37:22passed to others even if you're not
37:24actively having it.
37:26Recurrences are latent in the nerve
37:28cells, so it can be current later on.
37:30It's just like the ones in your mouth
37:31from illness, emotional stress,
37:32menstruation. So, when you get sick,
37:35they might pop up. All right? Uh the
37:37same way that some of your your other
37:38ones do. The diagnosis is via cell
37:40culture or PCR. There is no cure for
37:44genital herpes, okay? Um you can
37:47suppress their management with um
37:49acyclovir, famciclovir, and
37:50valacyclovir. You guys know that as
37:52Valtrex, you see it on commercials. Um
37:54but you can spread to others. There's no
37:56cure for it. Um
37:58it's hard It's hard to get that out of
38:00the of the
38:01the nerves. You can't, you know,
38:04difficult to get it out, all right?
38:05That's how it works.
38:08Here's what they look like. These are
38:09the vesicles on a on a on a penis. So,
38:13usually again they're towards the the
38:14top of it.
38:19Neonatal herpes
38:21um from, you know, the fetus herpes
38:23virus causes the placental barrier and
38:25affects the crosses the placenta and
38:26affects the fetus can cause spontaneous
38:28abortion and serious damage.
38:31Um
38:32it's very you know, you have
38:34considerable disabilities even if you do
38:35survive, you know.
38:37Um
38:39if a mother has
38:41uh HSV
38:43it's recommended that she has a
38:45C-section.
38:46Uh if you have active lesions
38:48if the neonate is infected that can't
38:50cause developmental delays, blindness,
38:52hearing loss.
38:53Um neo herpes is of course diagnosed by
38:55PCR test
38:57and you can treat it with a H
38:59intravenous acyclovir is the way you can
39:00kind of do that.
39:05Now
39:06warts
39:08um genital warts also known as condyloma
39:10acuminata um these are caused by human
39:14alpha papillomaviruses. Not every
39:16papillomavirus causes warts just to just
39:18be clear, but the ones that do cause
39:20them that's what they are, right?
39:22These are not only found on the genitals
39:24they can be found in any really any
39:26place the fingers and things like that,
39:28but the special one causes the one on
39:30the warts. So, there's about 350,000 new
39:33cases annually and there's about over 60
39:35types of HPV.
39:37Um invisible warts are caused by species
39:406 and 11. So, not all HPV causes warts.
39:44You can have HPV and not have warts, all
39:45right? And never have warts, you know.
39:48Species 7 and 9 can cause cervical
39:50cancer. So, you can have HPV and not
39:52have cervical cancer and you can have
39:54HPV and have it. So,
39:55HPV can cause cervical cancer in women
39:57and it's the way that you're diagnosed
39:58through a pap smear actually so you can
40:00kind of tell.
40:01And cervical cancer kills 4,000 women in
40:03the United States annually.
40:05Now, this is so common it's the most
40:08common STD.
40:10This is so common that it's unlikely
40:12you're going to
40:14like it's not really like a reportable
40:16like and you can't be like, "Oh, this
40:19person gave me genital warts." and get
40:20them in trouble. No, it doesn't work
40:21that way. As some of the other STDs, you
40:23could do that. No, if you've ever had
40:25sex at all, you've been you've possibly
40:27been exposed to this because this can
40:29remain latent and you don't ever you
40:30know get the symptoms. And most people
40:32that have had sex that, you know, have
40:34uh been exposed to it. It's very common.
40:37Um
40:38you can most commonly the way to get rid
40:40of this is to have them taken off. You
40:42get get it cryogenically frozen off.
40:44Removal of the warts. But, there are
40:46some uh
40:48things you can take. Podofilox and um
40:50imiquimod, those are those are things.
40:52There are um
40:55prevention options, treatment options,
40:57uh you know, nine-valent HPV vaccines.
41:00Those are usually recommended for people
41:02in young adulthood. It's not normally
41:03for people over a certain age, so it's
41:05very unlikely you would get that past a
41:07certain age, but uh yeah.
41:10The next slide is is a is a picture of a
41:12genital, so just, you know, be mindful
41:13of that.
41:15So, this is genital warts on on a
41:17person. You can again have these uh
41:19cryogenically frozen off. And um
41:22that doesn't I just FYI, that doesn't
41:24get rid of the virus. That gets rid of
41:26the
41:27the
41:29you know, the manifestation.
41:31It can come it can come back. All right?
41:32Doesn't mean you cured it.
41:36Fungal diseases of general urinary
41:38systems, uh candidiasis is what we're
41:40going to talk about first.
41:42Now, candidiasis or yeast infections is
41:45what we know this as. This is caused by
41:47Candida albicans and it grows on the
41:49mucosa of the mouth,
41:51uh the intestinal tract, the
41:52genitourinary tract, and
41:55usually this is an opportunistic
41:56infection and what that means
41:59is that it only really grows whenever
42:01there's something else going wrong. All
42:03right? So, antibiotic use can kill good
42:06bacteria which causes overgrowth like so
42:08it can it can kill lactobacillus in the
42:09vagina, which is where that kind of kind
42:11of comes from. Diabetes, which causes
42:13your immune system to go down, hormones,
42:15stress, that's not there but that that
42:16actually is another one, too.
42:18>> [snorts]
42:18>> Um oral candidiasis
42:22is uh we know that as thrush, common in
42:25infants whose immune system hasn't
42:27developed, common in people who take
42:28antibiotics, who get stressed out, or
42:30it's also a telltale sign of HIV
42:32infection.
42:33Uh vulvovaginal candidiasis, vaginitis,
42:36is a yeast infection. So, it smells, you
42:39know, bread,
42:40thick yellowish discharge,
42:43uh microscopy or cultures, usually you
42:44don't really There's most of the time
42:46you're going to know what this is, but,
42:47you know, um
42:49you can treat it with these antifungals,
42:51clotr- um clotrimazole and fluconazole.
42:54Those are the the the antifungals you
42:55can use to treat it.
42:59There's a Gram stain, a smear of vaginal
43:01discharge, so you can see this
43:04these cells are perfectly round, dark
43:06cells. I see some bacterial cells in
43:08there, too, and they're actually So,
43:14So, we're going to talk about protozoan
43:16diseases of of the genital systems. So,
43:19uh trichomoniasis is what we're going to
43:20talk about.
43:23So, trichomoniasis,
43:25uh commonly called trick, uh this is an
43:27STD, very common one. It's caused by
43:30Trichomonas vaginalis, which actually is
43:31a normal inhabitant of the vagina and
43:33urethra. It can become uh can become
43:36overgrown when the normal acidity of the
43:38vagina is disturbed.
43:40Uh it can be spread from person to
43:41person. It It can I kind of flip-flop
43:43between people, so you got to treat both
43:45partners.
43:47You get irritation and profuse frothy
43:49greenish-yellow foul-odor discharge. Um
43:52you can look at this on a microscope,
43:54it's got a nucleus, so it's not a
43:55bacteria, so it's easy to tell. So, DNA
43:57probe or microscopic um
44:00you know, um
44:02identification.
44:04Uh the treatment of trichomoniasis is
44:06metronidazole. That's how you can kind
44:08of get rid of it.
44:12And [snorts] then this is the what it
44:13looks like. So, it's got the flagella
44:15and undulating membrane. So, it's
44:16actually a eukaryotic protozoan. That's
44:18really the only one that causes a huge
44:20issue in in in humans.
44:22>> [snorts]
44:24>> Okay, so just a little recap
44:26of um
44:28what's going on. So, diseases and the
44:30causes of vaginitis vaginosis. So,
44:33bacterial vaginosis um Gardnerella
44:35vaginalis
44:36uh Atopobium vaginae Megasphaera. Fungal
44:39diseases of course include uh Candida
44:41albicans Trichomonas vaginalis.
44:46And then looking at uh a culture. So, a
44:5126-year-old woman has abdominal pain,
44:54painful urination, fever. Cultures grow
44:56in a high carbon dioxide environment.
44:58We're dealing gram-negative diplococci.
45:01Again, that's your clue. Gram-negative
45:03cocci is a clue. What infections may be
45:05causing it? I don't expect you to answer
45:07that cuz we've already talked about this
45:08one already. So, um but uh
45:11you know, just make sure you can figure
45:13it out which ones.
45:15And then this is what the actual plate
45:18would look like.
45:21And then of course bacterial diseases
45:24and gonorrhea
45:26um non-gonococcal urethritis pelvic
45:27inflammatory disease. You should know
45:30what pathogen causes what disease. The
45:33symptoms are kind of similar. So, I
45:35expect you to know all that. Most of
45:36these are treated with doxycycline. So,
45:37I wouldn't be like, "Hey, what do you
45:38you know, treat with that?" sort of
45:39thing.
45:40Um yeah.
45:43And then the viral ones
45:45alpha papillomavirus simplex virus and
45:48then um
45:50then there are some ones we talked about
45:52already that are sexually transmitted
45:53but they don't have genitourinary
45:54pathogenecity.
45:56So, there's like there's AIDS,
45:57hepatitis, things like that. We talked
45:59about those but they don't have anything
46:01They're transmitted through the the just
46:03area, but they don't have anything wrong
46:05with that area. Does that make sense?
46:08Uh and then of course your fungal
46:09diseases, candidiasis, and
46:11trichomoniasis. Okay, so that's it um
46:14for the semester. It's been lovely going
46:17through this with you all. I hope you've
46:18learned something. I hope you've enjoyed
46:20hearing about this as much as I've
46:21enjoyed talking about it. Uh please tell
46:23me for your third and final discussion
46:25question what you thought. You could
46:26even tell me what you thought was most
46:28interesting for the entire course if you
46:29want to this point. So, what did you
46:31think was most interesting about
46:32everything we learned so far? Tell me
46:33what it was.
46:35And the rest of it's just appendices, so
46:37best of luck everybody. If you need
46:38anything, you just let me know.
48:21>> Mhm.

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