GENITOURINARY TRACT

INFECTIONS

Bautista, Raene Hyacinth

Olis, Cristina
Ruchti, Stephany
Villaluz, Maureen
 What is UTI?
• It is the result from the presence of microorganisms in
urine (not related to contamination) that has the potential
to invade the urinary tract and adjacent tissues
• It is one of the most common bacterial infections (~ 8M
visits/year)
• Prevalence:
– Women> men while young
– Women= men at age of 65
• Localized vs. systematic
– Localized infection is normally seen when the skin is broken and
a wound or cut becomes infected. If the infection is carried
throughout the body in the bloodstream, it is systematic.
 Types of UTI
• Uncomplicated
Infection present in individuals with normal UTI anatomy
and no alterations in urine flow or voiding mechanisms.
• Complicated
Infection resulting from predisposing lesion such as
congenital abnormalities, distortion of UT, stone,
indwelling catheter, prostatic hypertrophy and neurogenic
deficits. Affect both genders similarly, and can involve the
upper and lower UT. Men UTI’s are considered
complicated.
Anatomy of the Male Urogenital
(Reproductive) System
Anatomy of the Female Urogenital
(Reproductive) System
Urinary Tract
Kidney
 Bacterial Prostatitis

• Acute Bacterial Prostatitis

– Type 1 (most rare type)
– Well-defined infectious disease of the Lower
Urinary Tract
– Bacterial cause is Escherichia coli
– Frequently presents with bacteremia
 Clinical Presentations
• Dysuria (painful urination)
• Urinary Frequency
• Intense suprapubic pain
• Urinary obstruction
• Fever
• Arthralgia (joint pain)
• Myalgia (muscle pain)
• Malaise (feeling of general discomfort or uneasiness)
 Epidemiology

• 6% incidence, prevalence rate is 8%.

• Occurs in 0.02%of all patients of prostatitis
• 3rd most common diagnosis in men older
than 50 years, after BPH (Benign Prostatic
Hyperplasia) or BEP (Benign Enlargement
of the Prostate) and prostate cancer
 Pathogens or Etiologic Agents

• Escherichia coli
• Proteus mirabilis
• Klebsiella sp.
• Enterobacter sp.
• Pseudomonas aeruginosa
• Serratia sp.
• Staphylococcus aureus
 Pathogens or Etiologic Agents

• Escherichia coli is the most common of all

the possible pathogens of ABP

Escherichia coli
•Gram negative, facultative anaerobic,
non-sporulating
•37 °C, but some laboratory strains can
multiply at temperatures up to 49 °C
E. coli in MCA
E. coli in EMBA
 Pathogenesis
• Uropathogenic E. coli (UPEC) is responsible for
approximately 90% of urinary tract infections (UTI)

• Uropathogenic E. coli utilize P fimbriae

• Uropathogenic E. coli produce alpha- and beta-hemolysins,

which cause lysis of urinary tract cells

• UPEC can evade the body's innate immune defenses

• They also have the ability to form K antigen, capsular

polysaccharides that contribute to biofilm formation
Duration of Therapy or Laboratory
Diagnosis
• Gentle rectal examination
• Prostatic massage
– Unadvisable because it could precipitate
bacteremia
• Prostate-specific antigen
• CT scan
• Careful Transrectal Ultrasound
• Bladder Scanning
Antibiotics, Treatment and Prevention

• rapid initiation of broad-spectrum parenteral

antibiotics
• Penicillin or Penicillin-derivatives with addition of
Aminoglycoside
• Fluoroquinones after initial therapy
• Healthy way of living
• Increase fluid intake
 Bacterial Prostatitis
• Chronic Bacterial Prostatitis
• diagnosed with recurrent UTI
• most common cause of relapsing urinary tract infection
in males.
• Asymptomatic periods are interspersed between
episodes of recurrent bacteriuria.
• condition is characterized by bacterial growth in culture
of the expressed prostatic fluid, semen, or post
massage urine specimen
 Clinical Presentations
• Genitourinary pain
• Dysuria
• hematospermia
• Clear urethral discharge
• perineal, scrotal, and low back discomfort
• Vague discomfort in pelvis, perineum, lower
abdomen, back and testis
 Epidemiology

• Affects 5%-10% of all patients have this

type of prostatitis
• occurs in less than 5% of patients with
prostatitis
Pathogens or Etiologic Agents
• same as in acute bacterial prostatitis.
• Most infections are caused by a single pathogen
• Obligate anaerobic bacteria rarely cause prostatic
infection.
Pathogens or Etiologic Agents
• Escherichia coli (80%)
• Klebsiella sp.
• Enterobacter sp.
• Proteus enterococci sp.
• Pseudomonas sp.
• Staphylococcus sp.
 Pathogenesis
• Biofilm-producing E. coli are resistant to immune
factors and antibiotic therapy
• The actual routes of prostatic infection are
unknown in most cases
• Routes of infection include the following:
– Ascending urethral infection
– Reflux of infected urine into prostatic ducts
– Migration of rectal bacteria via direct extension
or lymphogenous spread
– Hematogenous infection
Duration of Therapy or laboratory Diagnosis

• expressed prostatic secretions or EPS

• Prostate specific antigen
• Prostatic massage
Antibiotics, Treatment and Prevention

• Treatment requires prolonged courses (4-8 weeks)

of antibiotics
– These include quinolones (ciprofloxacin, levofloxacin),
sulfas (Bactrim, Septra) and macrolides (erythromycin,
clarithromycin)
• Radical transurethral prostatectomy
• Healthy diet
Antibiotics, Treatment and Prevention

• Antimicrobial agents that most effectively

penetrate into the prostatic fluid fluoroquinolones
and TMP-SMZ
• Treatment should be guided by urine culture
results
 Genitourinary Tuberculosis
• associated with pulmonary infection or
occurs during reactivation many years later
from infection previously seeded in the
kidneys
• second most common form of the disease
after pulmonary tuberculosis
 Clinical Presentations
• fever
• weight loss
• Urgency
• Frequency
• flank pain
• suprapubic pain
• hematuria
 Epidemiology
• affects between 3.5 and 4 million people per year
worldwide
• 4% to 9% of people with active pulmonary tuberculosis
develop genitourinary involvement
• often occurs in older people and in immigrants from
places with high prevalence rates
• predominantly a disease of young adults, with roughly
half of the patients between 20 to 40 years, and 75
percent under 50
 Pathogens or Etiologic Agents
• Mycobacterium tuberculosis
– aerobic, non-sporeforming, nonmotile bacillus
– bacilli are inhaled through the lungs to the
alveoli
– some are carried to the region's lymph nodes
– thoracic duct may deliver mycobacteria to the
venous blood
– may result in seeding of different organs,
including the kidneys
• the bacteria lodge within the tissues of the
genitourinary tract
• form caseating granulomas
• damage may obstruct the drainage system
and impair the blood supply, causing
hypertension
Infected kidney
 Duration of Therapy or Laboratory
Diagnosis
• Routine urinalysis
• Early morning urine specimens 3 days in a row
• Urine culture
• Skin test (Intradermal Mantoux)
• Intravenous urogram
• Kidney-ureter-bladder (KUB) x-ray
Antibiotics, Treatment and Prevention
• early diagnosis is important
• contact with people with active pulmonary tuberculosis
should be avoided
• GENERAL MANAGEMENT:
-Bed rest
-ensure adequate nutrition
• DRUG THERAPY:
-rifampin
-ethambutol
-isoniazid
• SURGERY:
-may be necessary to remove a nonfunctioning kidney
 Cystitis
• Cystitis is an inflammation of the bladder,
sometimes involving the tube that drains urine
from the bladder, called the urethra.

• Cystitis is the most common form of urinary tract

infection and occurs mainly in women. But men
and children also can experience cystitis.

• Bacterial infection causes most bouts of cystitis.

This bacterial growth causes the inside walls of the
bladder to become inflamed.
• There are many types of cystitis but the only
significant kind of this disease is the
Emphysemtous cystitis which is caused by gas-
forming organisms such as E. coli and
Aerobacter aerogenes.
• Other types include hemmorhagic and ulcerative
cystitis which are under acute simple infection
and cystitis follicularis which belongs to the
chronic infection.
Pathogens or Etiologic Agents
• Organisms inhabiting the perineal area, especially
Esherichia coli, Proteus and Klebsiella, are the
common infectious agents.

• Other causative agents include pseudomonas and

Corynebacterium.
 Pathogenesis
• Uropathogenic E. coli frequently produce the
extracellular protein hemolysin

• Adherence properties of gram-negative organisms

of the vaginal mucous membrane

• Ascending of the bacteria from the vaginal

reservoir to the bladder mucosal surface and
invasion of the vesical wall
 Epidemiology
• This disease can occur to 2 out of 100 people and
most cases are found in women.
 Clinical Presentations
• Pressure in the lower pelvis
• Dysuria
• urgency
• Nocturia
• Hematuria
• Foul odor of Urine
Duration of Therapy or Laboratory
Diagnosis
• Urine analysis is done if the doctor suspects
infection of the bladder
• Cystoscopy is done with a cytoscope and used
remove a sample tissue for further analysis and
inspection
• Imaging tests like X-ray or ultrasound is quite
important to help rule out other potential causes of
bladder inflammation, such as a tumor or structural
abnormality.
Antibiotics, Treatment and Prevention
• Cystitis caused by bacterial infection is generally
treated with antibiotics which serves as the first
line of treatment for cystitis caused by bacteria.
• Keeping the genital area clean and remembering to
wipe from front to back may reduce the chance of
introducing bacteria from the rectal area to the
urethra.

• Increasing the intake of fluids may allow frequent

urination to flush the bacteria from the bladder.
Emphysematous Cystitis
– A rare form of infectious cystitis
characterized by the presence of gas in
the bladder wall.
– Emphysematous cystitis is nearly
always associated with diabetes mellitus,
because gas in the bladder wall is the
result of fermentation of urinary glucose
to carbon dioxide
 Clinical Presentations
• dysuria
• haematuria
• pneumaturia
• Glycosuria
 Pathogens or Etiologic Agents
Escherichia coli and Aerobacter aerogenes
are the most commonly isolated organisms
from the infected part.
 Pathogenesis
• poorly understood
• Elevated tissue glucose levels in diabetic patients
may provide a more favorable microenvironment for
gas-forming microbes
 Diagnosis
• Radiographs
Conventional radiographs demonstrate irregular
humps in the bladder wall.

• Intravenous Urography
Intravenous Urography confirms the presence of gas in the
bladder, as a horizontal air contrast level on erect films.

• Ultrasound
Ultrasound may detect bladder wall air as intramural
echogenic foci with "dirty" shadowing.
 Antibiotics, Treatment and Prevention

• Antibiotics are used to control bacterial infection.

It is vital that one finish an entire course of
prescribed antibiotics.
• Commonly used antibiotics include:
• Nitrofurantoin
• Trimethoprim-sulfamethoxazole
• Amoxicillin
• Cephalosporins
• Ciprofloxacin or levofloxacin
 Urethritis
• Inflammation of urethra

• Very common condition that is also

associated with both nonspecific genital
infections and specific STD’s
 Divisions
• Gonococcal urethritis
- infection with Neisseria gonorrhoeae

• Non-gonococcal urethritis
- urethritis is present but gonococci are not
detected
 Epidemiology
• Occurs both in men and women
• Condition generally diagnosed only in men
• When in women and is not associated with
a urinary bladder infection(cystitis) it is
called urethral syndrome
 Clinical Presentations
• First symptoms usually appear after 1-3
weeks of initial infection:

• More frequent need to urinate

• Itch in the urethra
• Burning sensation on urination
• Signs:
• Men: urethral discharge
- clear, white or yellow
- varies from a few drops to large
amounts
• Women: urethral discharge
- slightly clear, white or yellow
- more noticeable during morning hours
 Pathogens or Etiologic Agents
• Non-gonococcal urethritis
- Chlamydia trachomatis
- Ureaplasma urealyticum
 Pathogenesis
• Attachment of Escherichia coli fimbrae on
urethral epithelium
 Diagnosis
• Personal history
• Symptoms noted
• Endourethral swabs
• Gram stain
• Urine examination
Antibiotics, Treatments and Prevention

• Non-gonococcal urethritis:
- tetracycline
- erythromycin
 Pyelonephritis
• Upper urinary tract infection
– infection of kidney (parenchyma) and pelvis (pyelum)
– usually results from non-contagious bacterial infection of
the bladder
Urethra
 Pathogens or Etiologic Agents
• Escherichia coli (Primary)
• Klebsiella pneumoniae
• Proteus mirabilis
• Pseudomonas aeruginosa
• Enterobacter spp.
 Pathogenesis
• Ascending route of infection
• Hematogenous spread
• Vesicoureteral reflux
• Kidney stones
• Instrumentation
• Urinary tract obstructions- chronic pyelonephritis
 Acute Pyelonephritis
• a sudden inflammation caused by bacteria

• most frequently occurs as a result of ascending

movement of bacteria

• can be resolved without permanent damage to

tubules
 Clinical Presentations
• shaking chills
• high fever
• flank tenderness /back pain
• dysuria
• Hematuria

irritative voiding symptoms:

• dysuria
• a sense of urgency
• increased frequency of urination
 Chronic Pyelonephritis
• or Chronic Infective Tubulointerstitial
Nephritis
• persistent or recurrent kidney inflammation

• occurs almost exclusively in patients with

major anatomic abnormalities
 Diagnosis
• results of physical examination
• laboratory tests:
• blood tests and blood cultures
• urinalysis
• urine culture
 Antibiotics, Treatment and Prevention

• antibiotic therapy (ciprofloxacin,

ampicillin or trimethoprim-
sulfamethoxazole)

• initial hospitalization

• surgery

• follow-up treatment
• increase fluid intake (cranberry juice,
blueberry juice, and fermented milk
products)

• strict personal hygiene

• frequent urination
 Glomerulonephritis
• a range of immune-mediated disorders that
cause inflammation within the glomerulus
and other compartments of the kidney
• In 1% of children and 10% of adults who
have acute glomerulonephritis, it evolves
into rapidly progressive glomerulonephritis
GLOMERULUS: NORMAL VS. INFECTED
WITH GN
Acute Postreptococcal Glomerulonephritis

• an immune complex disease caused by

group A Beta-hemolytic streptococcus types
12 and 49

• typically occurs 10 to 14 days following a

streptococcal infection
 Rapidly Progressive Glomerulonephritis

• results in a rapid decrease in glomerular

filtration rate

• presence of crescents in the majority of the

glomeruli
 Pathogens or Etiologic Agents
Streptococcus pyogenes

β-hemolytic acitivity of Streptococcus

pyogenes on SBAP
 Pathogenesis
• formation of antibodies by S. pyogenes
- hyaluronic acid capsule
- M protein
- protein F
- DNase
 Clinical Presentations
• severe and rapid loss of kidney function

• proteinuria

• cola- colored urine (hematuria)

• hypertension

• edema

• decreased urine volume

 Diagnosis
• physical exam

• kidney biopsy
 Antibiotics, Treatment and Prevention

• APGN
- antibiotic treatment (Penicillin)

- peritoneal dialysis

• RPGN
- treatment with streroids and or
cyclophosphamide