Micro lecture 24 notes p.634-665 Genitourinary infections

CDC softball team: "The Burning Sensations". Gonorrhea symptoms. Other urethral infections also. Kidneys sterile, lower tract must flush out microbes. Problem: short female urethra. Urinate after sex.

Kidney, filter blood, concentrate (countercurrent flow amplifies water recovery). Upper urinary tract sterile, difficult to obtain uncontaminated urine specimen.

Male: keep microbes out. Vagina is exception; let reproductive cells in; also bacteria, yeasts .

Urethritis, cystitis, pyelonephritis increase seriousness. Likewise for reproductive tract:

Vaginitis, endometritis, salpingitis, oophoritis, all together; PID. Repeated PID = sterility risk.

Leptospira interrogans: Don't swim with your dog? Some boys: 4 wheeler through urine-containing puddle splashed and infected. Common in tropics.

AIDS epidemic: scared into using condoms. Only temporary. "Threat of STD will not cause people to alter sexual behaviors". Sermon:"When you encounter sexual temptation, RUN away!"

Identifying sexual contacts; "People will lie and will not get off it!" CDC epidemiologist.

WWII: What contents of pilot's emergency pack? Empty sulfa vials. STD; court-martial offense.

Open-minded era; by Vietnam, "I've spent more time in the VD line than you've got in service."

Vietnamese strains resistant to all known antibiotics. Policy: no return until cured. (R&R O.K.)

Gonococci switching of surface structures: faster than antibodies provoked; adhere to tissues.

Antibiotic experience surely to be replicated with HIV. Must take all antivirals every time!

Birth control pills provoke increased transmission of gonorrhea? Many texts: YES! Local OB/GYN: NO! Textbook author: "NO" seems to be correct. Why increased rates after BC pill?

Primary, secondary, tertiary syphilis. Increasing, pernicious damage. Salvarsan (compound 606) 50% effective. Tuskeegee study of African Americans: No treatment to study. Highly unethical.

Various other STDs: more common; fewer symptoms. Chlamydia, LGV, NGU (mycoplasmas) chancroid, granuloma inguinale, viral diseases see text. Herpes is a disaster for babies.

Lessen perinatal transmission with therapy before birth (AZT drops HIV transmission rates).

Candida, trichomonas mostly annoyances, unless immunocompromised.

Bacterial (Listeria, Strep.), viral infections mother to child. Note: CMV in almost 100% of LDC.

Who should get CMV^- blood? Ethical dilemma. Can you ever justify less than the best care? Legal implications...