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vagina. Vaginal lactobacilli release lactic acid and hydrogen peroxide when they metabolize the glycogen, making the vagina more resistant to colonization by pathogens.

25.3 Urinary System Infections

1. Any condition that impairs normal bladder emptying increases the risk of infection.

2. Usually the urinary system becomes infected by organisms ascending from the urethra, but it can also be infected from the bloodstream.

Bacterial Cystitis (Table 25.1)

1. Urine is a nutritious medium for many bacteria.

2. Kidney infection, pyelonephritis, may complicate untreated bladder infection when pathogens ascend through the ureters and involve the kidneys.

3. Most urinary tract infections in healthy people are caused by Escherichia coli or other enterobacteria from the person's own normal intestinal flora.

4. Nosocomial urinary infections are common, caused by Pseudomonas aeruginosa, Serratia marcescens, and Enterococcus faecalis, organisms that are generally resistant to many antibiotics.

Leptospirosis (Table 25.2)

1. In leptospirosis, the urinary system is infected by Leptospira interrogans from the bloodstream. (Figure 25.3)

660 Chapter 25 Genitourinary Infections

2. This biphasic illness causes fever, bloodshot eyes, and pain in the septicemic phase; then improvement; then recurrent symptoms with damage to multiple organs during the immune phase.

3. Many species of animals are chronically infected with L. interrogans and excrete the organism in their urine.

25.4 Non-Venereal Genital System Diseases

1. Non-venereal means that the infection is not transmitted by sexual intercourse.

Bacterial Vaginosis (Table 25.3, Figure 25.4)

1. Bacterial vaginosis is the most common cause of vaginal symptoms, including a gray-white discharge from the vagina and a pungent fishy odor; there is no inflammation.

2. The causative agent or agents are unknown.

Vulvovaginal Candidiasis (Table 25.4)

1. Vulvovaginal candidiasis is second among causes of vaginal disorders; symptoms include itching, burning, vulvar redness and swelling, and a thick white discharge.

2. The causative agent is a yeast, Candida albicans, that is commonly part of the normal vaginal flora. (Figure 25.5)

3. Antibacterial treatment, uncontrolled diabetes, and oral contraceptives are predisposing factors, but in most cases no such factor can be identified.

Staphylococcal Toxic Shock (Table 25.5)

1. First described in children, it became widely known with a 1980 epidemic in menstruating women who used a certain kind of vaginal tampon, since removed from the market.

2. Symptoms include sudden fever, headache, muscle aches, bloodshot eyes, vomiting, diarrhea, a sunburnlike rash that later peels, and confusion. The blood pressure drops, and without treatment kidney failure and death may occur.

25.5 Sexually Transmitted Diseases: Scope of the Problem

1. In the United States, 15 million new sexually transmitted infections occur each year, including 3 million in teenagers.

2. Simple measures exist for controlling STDs: abstinence from sexual intercourse, a monogamous relationship with an uninfected person, and consistent use of latex or polyurethane condoms. (Figure 25.7)

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