Diseases of the Genital/Urinary tract 

Diseases of the Genital/Urinary tract. By: Jaila Giles.

Trichomoniasis – Causative Agent. Trichomoniasis (sometimes known as "trich") is a sexually transmitted disease (STD). Infection with the protozoan parasite Trichomonas vaginalis is the causative agent (CDC, 2021). Although the illness has a variety of symptoms, most people who are afflicted are unaware that they are infected (CDC, 2021). Trichomoniasis is the most prevalent STD that can be cured. According to the Centers for Disease Control and Prevention (CDC), there were more than two million trichomoniasis infections in the United States in 2018. Only around 30% of those infected with trichomoniasis exhibit symptoms (CDC, 2021)..

Trichomoniasis- Disease mechanisms. Trichomoniasis pathology is produced by damage to the host epithelia caused by a multitude of mechanisms during infection, and new research has emphasized the intricate interactions between the parasite and host, commensal microbiota, and associated symbionts (Edwards et al., 2016). This parasite can be found in both sperm and vaginal secretions. It commonly spreads between a man and a woman or between two women during unprotected anal, oral, or vaginal intercourse. Furthermore, a male does not need to ejaculate to pass the parasite to his partner (CDC, 2021)..

Trichomoniasis- Disease mechanisms continued.... During intercourse, the parasite is passed from an infected person to an uninfected person (CDC, 2021). The lower vaginal tract is the most often infected region of the body in women (vulva, vagina, cervix, or urethra). The inside of the penis is the most usually infected body area in males (urethra) (CDC, 2021). The parasite rarely infects other body parts, such as the hands, mouth, or anus (CDC, 2021)..

Symptoms of Trichomoniasis. Approximately 70% of infected persons show no signs or symptoms. Trichomoniasis can produce a variety of symptoms, ranging from moderate discomfort to severe inflammation. Some people develop symptoms 5 to 28 days after becoming infected. Others don't show symptoms for a long time (CDC, 2021). Men with trichomoniasis may have the following symptoms: -Itching or irritation inside the penis; -Burning after urination or ejaculation; -Discharge from the penis..

Symptoms of Trichomoniasis. Women with trichomoniasis may have the following symptoms: -Itching, burning, redness or soreness of the genitals -Discomfort with urination -A change in their vaginal discharge (i.e., thin discharge or increased volume) that can be clear, white, yellowish, or greenish with an unusual fishy smell (CDC, 2021)..

How to Diagnose T richomoniasis?. Trichomoniasis cannot be diagnosed only based on symptoms. Your doctor should examine you and order a laboratory test to diagnose trichomoniasis in both men and women. Trichomoniasis is diagnosed using a microscope to examine a sample of vaginal fluid in women and urine in males ( Mayo Clinic, 2020) . No additional tests are required if the parasite can be observed under a microscope. Rapid antigen testing and nucleic acid amplification may be utilized if this test isn't conclusive ( Mayo Clinic, 2020)..

Prevalence of Trichomoniasis. The prevalence of Trichomonas vaginalis in the United States is 2.1% among women ages 14-59, and 0.5% among men based on a nationally representative sample of people who participated in NHANES 2013-2016. Trichomoniasis is the most prevalent treatable STD in the United States, affecting both men and women. The condition affects around 3.7 million people in the US..

Prevalence of Trichomoniasis Continued.... Prevalence was 9.6% for African American women, 1.4% for Hispanic women, and 0.8% for non-Hispanic white women(CDC - Trichomoniasis Statistics, 2021 ). For men and women, increasing poverty level, lower educational level, unmarried status, and having been born in the U.S. are associated with T. vaginalis infection ( CDC - Trichomoniasis Statistics, 2021). For women, younger age at first sex, greater number of sex partners, and a history of chlamydia infection in the past 12 months are associated with T. vaginalis infection(CDC - Trichomoniasis Statistics, 2021 )..

Treatment for Trichomoniasis. Even for pregnant women, the most usual therapy for trichomoniasis is to take one megadose of metronidazole (Flagyl) or tinidazole (Tindamax). Your doctor may prescribe a lesser dose of metronidazole twice day for seven days in some circumstances ( Mayo Clinic, 2020). Both you and your partner require medical attention. You must also refrain from sexual activity until the infection has been healed, which takes about a week ( Mayo Clinic, 2020). Alcohol should not be consumed for 24 hours or 72 hours after taking metronidazole or tinidazole since it might induce severe nausea and vomiting ( Mayo Clinic, 2020). From two weeks to three months following treatment, your doctor will likely want to retest you for trichomoniasis to ensure you haven't been reinfected ( Mayo Clinic, 2020)..

Chlamydia- Causative Agent. Chlamydia is a sexually transmitted disease (STD) caused by Chlamydia trachomatis infection. In women, it can cause cervicitis, and in both men and women, it can induce urethritis and proctitis. Infections with Chlamydia can cause major problems in women, including pelvic inflammatory disease (PID), tubal factor infertility, ectopic pregnancy, and persistent pelvic discomfort (Chlamydia ,2021)..

Chlamydia – Disease Mechinisms. The Chlamydia bacterium invades and infects the host cells, which they rely on for nutrition. If the bacteria infecting human cells are deprived of these nutrients, the bacteria will die as well (Mandal, 2019). When Chlamydia bacteria are deficient in nutrients like vitamins or iron, they stop dividing and develop to an excessively big size. These abnormal cells, on the other hand, can stay alive because they can revert to a normal state and be ready to divide once the host cell circumstances return to normal (Mandal, 2019). Infected people transfer the illness to their sexual partners through unprotected vaginal, oral, or anal sexual contact. Sharing sex devices that haven't been washed or aren't covered with a fresh condom can potentially spread the virus (Mandal, 2019)..

Chlamydia – Disease Mechinisms Continued.... Penetrative sexual intercourse is not always required for infection; simply coming in contact with sexual bodily secretions from an infected individual is enough to cause infection (Mandal, 2019). Another way for the virus to spread is by vertical transmission, which occurs when a baby passes through the vaginal canal of an infected mother (Mandal, 2019)..

Symptoms of Chlamydia. Because most infected persons are asymptomatic and have no abnormal physical examination results, chlamydia is characterized as a "silent" illness (Chlamydia, 2021). The bacteria infect the cervix in women, causing signs and symptoms of cervicitis (e.g., mucopurulent endocervical discharge, readily caused endocervical hemorrhage), and occasionally the urethra, causing signs and symptoms of urethritis (e.g., pyuria, dysuria, urinary frequency) (Chlamydia, 2021)..

Symptoms of Chlamydia. Symptomatic men often experience urethritis, which manifests as a mucoid or watery urethral discharge and dysuria. Epididymitis (with or without symptomatic urethritis) affects a small percentage of infected men, causing unilateral testicular discomfort, tenderness, and swelling (Chlamydia, 2021)..

How to Diagnose Chlamydia?. Chlamydia can be diagnosed using a variety of techniques, including nucleic acid amplification tests (NAATs), cell culture, and others. NAATs are the most sensitive tests, and they may be conducted on easily accessible materials such as vaginal swabs (either obtained by the doctor or by the patient) or urine (Chlamydia ,2021). In women, vaginal swabs, either taken by the patient or by the clinician, are the best specimen to screen for genital chlamydia using NAATs; in males, urine is the preferred specimen, and it is an effective alternate specimen type for women. Self-collected vaginal swab specimens perform similarly to other NAAT-approved specimens (Chlamydia ,2021)..

Prevalence of Chlamydia. According to the 2018 global STI surveillance from World Health Organization (WHO), global estimation of new Chlamydia trachomatis (CT) cases in 2016 was 127 million. Chlamydia infections are asymptomatic in 61% of women and 68% of men, and as a result often go undiagnosed, untreated, causing in onward transmission (Huai et al., 2020). Highly prevalent STD, particularly among teenagers. Chlamydia is expected to affect one out of every 20 sexually active young women aged 14 to 24 (Chlamydia, 2021). For a variety of behavioral, biological, and cultural factors, sexually active young people are at a high risk of contracting chlamydia. Some young individuals do not use condoms on a regular basis. Some teenagers may transition from one monogamous relationship to the next faster than chlamydia's anticipated infectivity phase, increasing the risk of transmission (Chlamydia, 2021)..

Treatment for Chlamydia. Antibiotics are a simple way to treat chlamydia (NHS, 2021). More than 95% of people will be cured if they take their antibiotics correctly (NHS, 2021). To prevent transmitting the infection to partners, people with chlamydia should refrain from sexual activity for 7 days after receiving a single dosage of antibiotics or until the end of a 7-day course of antibiotics. It is critical to take all the chlamydia treatment as directed (NHS, 2021). The two most often prescribed antibiotics for treatment of chlamydia is: -doxycycline – taken every day for a week -azithromycin – one dose of 1g, followed by 500mg once a day for 2 days (NHS, 2021)..

Syphilis - Causative Agent. Syphilis is caused by the bacteria Treponema pallidum (T. pallidum ) (Syphilis, 2021). There are several phases of syphilis (primary, secondary, latent, and tertiary). Each stage is marked by its own set of indications and symptoms (Syphilis, 2021 )..

Syphilis – Disease Mechinisms. Spirochetes enter the systemic circulation through mucosal membranes or tiny skin abrasions, invading the central nervous system in the early stages of illness (Gibson, 2020). Endarteritis and plasma cell-rich infiltrates are histological characteristic findings, indicating a delayed-type hypersensitivity reaction to the spirochete (Gibson, 2020). Syphilis causes vasculitis by attaching fibronectin molecules to the endothelial surface of the vessels in the organs, producing inflammation and obliteration of the tiny blood vessels (endarteritis obliterans) (Gibson, 2020)..

Symptoms of Syphilis. You may detect a single or numerous lesions during the first (primary) stage of syphilis. The sore marks the entry point for syphilis into your body. Firm, circular, and painless sores are common (though not always) (Syphilis, 2021). Whether you receive therapy, the sore normally lasts 3 to 6 weeks and heals. You must continue to receive therapy even after the sore has healed. This will prevent your infection from progressing to the next stage (Syphilis, 2021). You may develop skin rashes and/or mucous membrane lesions during the secondary stage. Mouth, vaginal, or anus sores are mucous membrane lesions. A rash on one or more parts of your body generally marks the beginning of this stage. The rash might appear while your initial sore is healing or after it has healed for several weeks. The rash might resemble a rough, itchy rash (Syphilis, 2021)..

Symptoms of Syphilis. A period of time when there are no obvious indications or symptoms of syphilis is known as the latent stage. You can have syphilis in your body for years without showing any signs or symptoms if you don't get treated (Syphilis, 2021). The majority of persons who have untreated syphilis do not progress to tertiary syphilis. When it does happen, though, it can impact a variety of organ systems (Syphilis, 2021). The heart and blood vessels, as well as the brain and nerve system, are among them. Tertiary syphilis is an extremely dangerous illness that develops 10–30 years after the first infection. The illness destroys your internal organs and might lead to death (Syphilis, 2021)..

How to Diagnose Syphilis. Antibodies specific for syphilis can be detected by treponemal tests (such as TP-PA, different EIAs, chemiluminescence immunoassays, immunoblots, and quick treponemal assays) (Syphilis, 2021). Treponemal antibodies emerge sooner than nontreponemal antibodies and are generally detectable for the rest of one's life, even if treatment is effective. If the findings of a treponemal test are positive, a nontreponemal test with titer should be done to confirm the diagnosis and guide patient care options (Syphilis, 2021)..

Prevalence of Syphilis. Many nations with endemic syphilis saw a drop in syphilis prevalence in the late 1990s, owing to the advent of syndromic care for STIs, behavioral changes, and the effect of AIDS mortality breaking sexual networks (Kojima & Klausner, 2018). However, following the advent of antiretroviral medication (ART), syphilis rates have risen, particularly among men who have sex with other men, possibly as a result of the rebuilding of sexual networks and increasing sexual contact frequency (Kojima & Klausner, 2018)..

Prevalence of Syphilis Continued.... 129,813 cases of all stages of syphilis were reported in 2019, including 38,992 cases of primary and secondary syphilis, the most infectious stages of the disease (Sexually Transmitted Disease Surveillance, 2021). After reaching a historic low in 2000 and 2001, the rate of P&S syphilis has increased almost every year, increasing 11.2% in 2018–2019. Rates rose among men and women, in every region of the country, and across all racial/ethnic groups (Sexually Transmitted Disease Surveillance, 2021)..

Treatment for Syphilis. Benzathine penicillin G 2.4 million units taken intramuscularly in a single dose is the recommended therapy for adults and adolescents with primary, secondary, or early latent syphilis (Syphilis, 2021). Benzathine penicillin G 7.2 million units total, taken in three doses of 2.4 million units intramuscularly at weekly intervals, is the recommended therapy for adults and adolescents with latent syphilis or latent syphilis of unclear duration (Syphilis, 2021). Aqueous crystalline penicillin G 18-24 million units a day, provided as 3-4 million units intravenously every 4 hours or as a continuous infusion for 10-14 days, is the recommended treatment for neurosyphilis, ocular syphilis, or otosyphilis (Syphilis, 2021)..

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References. Centers for Disease Control and Prevention. (2021). STD Facts - Trichomoniasis. Retrieved from https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm CDC - Trichomoniasis Statistics. (2021). Retrieved from https://www.cdc.gov/std/trichomonas/stats.htm Edwards, T., Burke, P., Smalley, H., & Hobbs, G. (2016). Trichomonas vaginalis: Clinical relevance, pathogenicity and diagnosis. Critical reviews in microbiology , 42 (3), 406–417. https://doi.org/10.3109/1040841X.2014.958050 Mayo Clinic. (2020). Trichomoniasis. Retrieved from https://www.mayoclinic.org/diseases-conditions/trichomoniasis/diagnosis-treatment/drc-20378613#:~:text=Trichomoniasis can be diagnosed by,acid amplification may be used..

References. Mandal, D. A. (2019). Chlamydia Infection Pathophysiology. Retrieved from https://www.news-medical.net/health/Chlamydia-Infection-Pathophysiology.aspx Detailed STD Facts - Chlamydia. (2021). Retrieved from https://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm Huai, P., Li, F., Chu, T., Liu, D., Liu, J., & Zhang, F. (2020). Prevalence of genital Chlamydia trachomatis infection in the general population: A meta-analysis - BMC Infectious Diseases. Retrieved from https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05307-w NHS. (2021). Chlamydia treatment. Retrieved from https://www.nhs.uk/conditions/chlamydia/treatment/.

References. STD Facts - Syphilis. (2021). Retrieved from https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm Gibson, M. C., M.D. (2020). Syphilis pathophysiology. Retrieved from https://www.wikidoc.org/index.php/Syphilis_pathophysiology Kojima, N., & Klausner, J. D. (2018). An Update on the Global Epidemiology of Syphilis. Current epidemiology reports , 5 (1), 24–38. https://doi.org/10.1007/s40471-018-0138-z National Overview - Sexually Transmitted Disease Surveillance, 2019. (2021). Retrieved from https://www.cdc.gov/std/statistics/2019/overview.htm.