With this new column, Elite Healthcare will compile an index of various infectious diseases, with occasional highlights of emerging conditions.
Urogenital (Genitourinary) Diseases and Conditions
General definitions and information: Urogenital (genitourinary) diseases are those that impact the organs involved in the excretion of bodily fluids and reproduction, including the kidneys, ureters, bladder, sphincter, and urethra. Some of the common conditions associated with the female urogenital system are a vaginal infection, infection of the pelvis, urinary tract infection (UTI), post-gynecological surgery infections, bladder cancer, and pelvic inflammatory disease (PID). In men, disorders that affect the penis, urethra, or testes include cryptorchidism (undescended testes); hydrocele, a swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding a testicle; hypospadias, a congenital condition in which the opening of the urethra is on the underside of the penis instead of at the tip; inguinal (groin) hernia; micropenis (well under the normal size range for an infant); and testicular torsion, an emergent condition that occurs when the spermatic cord, which provides blood flow to the testicle, rotates and becomes twisted. Bladder cancer and prostate cancer are also common, and men can develop UTIs as well.
This article will provide information on some of the more likely disease and conditions that patients will present within the clinical setting.
Causes & Modes of Transmission:
- PID: is an infection of the reproductive organs in women that is a complication often caused by certain sexually transmitted diseases (STDs), although other infections that are not sexually transmitted can cause PID as well, according to the Centers for Disease Control and Prevention (CDC). A number of different microorganisms can cause or contribute to PID, including chlamydia trachomatis and neisseria gonorrhoeae.1,2 According to the CDC, newer data suggest that mycoplasma genitalium may also play a role in PID and may be associated with milder symptoms.3-5 There are no diagnoses tests for PID, but common symptoms include pain in the lower abdomen, fever, an unusual vaginal discharge and odor, pain and/or bleeding during sex, a burning sensation during urination, bleeding between periods, abdominal tenderness, pelvic organ tenderness, uterine tenderness, adnexal tenderness, cervical motion tenderness, and inflammation. When diagnosed early, PID is treatable but may have already caused irreversible damage to the reproductive system. Patients can develop PID multiple times, and those who’ve previously been diagnosed have an increased chance of contracting PID again. Complications associated with the disease include the formation of scar tissue both outside and inside the fallopian tubes that can lead to tubal blockage, ectopic pregnancy (pregnancy outside the womb), infertility (inability to get pregnant), and long-term pelvic/abdominal pain.
- Prostate Cancer: The most common cancer in American men after skin cancer, different symptoms may present for prostate cancer for different patients, and some men have no symptoms at all. That said, some common symptoms include difficulty starting urination; weak or interrupted flow of urine; frequent urination; (especially at night); difficulty emptying the bladder completely; pain or burning during urination; blood in the urine or semen; pain in the back, hips, or pelvis that doesn’t go away; and painful ejaculation. According to the American Cancer Society, risk factors include older age, black men and Caribbean men of African ancestry, geography (North America, northwestern Europe, Australia, Caribbean islands), family history, gene changes, smoking, chemical exposure, poor diet, and obesity are all among the risk factors.
- UTI: UTIs are an infection in any part of the urinary system, but most commonly involve the lower urinary tract (bladder and the urethra). They don’t always cause signs and symptoms, but when they do they may include strong, persistent urge to urinate; burning sensation when urinating; passing frequent, small amounts of urine; urine that appears cloudy; urine that appears red, bright pink, or cola-colored; strong-smelling urine; and pelvic pain. Infection of the bladder (cystitis) is usually caused by Escherichia coli, a type of bacteria commonly found in the gastrointestinal tract. Infection of the urethra (urethritis) can occur when bacteria spread from the anus to the urethra and by herpes, gonorrhea, and chlamydia. Infections are more common in women, and many women experience more than one infection during their lifetimes. Risk factors include sexual activity, use of a diaphragm and/or spermicidal agents for birth control, and menopause. After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection. Babies who are born with urinary tract abnormalities that don’t allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs as well. In men, UTIs tend to occur when bacteria build up somewhere along the urinary tract.
Treatment Strategies:
- PID: Because of the polymicrobial nature of PID, broad-spectrum regimens that provide adequate coverage of likely pathogens are recommended, according to the CDC. Antibiotic treatment does not reverse any scarring that has already been caused by the infection. Woman should receive care immediately if pelvic pain or other symptoms of PID are present to possibly prevent severe damage to the reproductive organs.
- Prostate Cancer: The patient and the doctor should decide which treatment is right, according to the CDC. Some common treatments include active surveillance by performing prostate-specific antigen and digital rectal exam tests as well as prostate biopsies and treating the cancer only if it grows or causes symptoms, according to the CDC. Prostatectomy surgery is also an operation to remove the prostate and radiation therapy may be used. Cryotherapy, the placing of a special probe inside or near the prostate cancer to freeze and kill cancer cells, is another consideration.
- UTI: Antibiotics usually are the first-line treatment, and the type of bacteria found in the urine and overall health condition will determine the prescribed drugs. Often, symptoms resolve within a few days of treatment. An analgesic that numbs the bladder and urethra to relieve burning while urinating may also help. Patients should be encouraged to drink plenty of water to help dilute urine and flush out bacteria. Coffee, alcohol, and soft drinks containing citrus juices or caffeine should be avoided until the infection has cleared. Use of a heating pad is also suggested.
Prevention Parameters:
- PID: Patients should be educated to avoid multiple sexual partners and use a barrier method of birth control (condoms and/or a diaphragm) and spermicides, even if birth control pills are already prescribed. Regular gynecologic checkups and screenings should be conducted.
- Prostate Cancer: There is no certain way to prevent prostate cancer, but a healthy lifestyle may help to lower risk, according to the Mayo Clinic. Eating fruits and vegetables daily may also be effective. High-fat meats and dairy foods should be minimized, as should calcium, according to the Mayo Clinic. Physical activity should be encouraged at a rate of at least 30 minutes per day. Additionally, men who are ages 55-69 should discuss annual screenings and testing with their providers.
- UTI: Drinking water and cranberry juice and consuming other cranberry products may prevent UTIs. However, patients should not drink cranberry juice if they’re prescribed blood-thinning medication. Emptying the bladder soon after intercourse and avoiding potentially irritating feminine products or other feminine products, such as douches and powders, in the genital area can irritate the urethra. The patient may want to change their birth control method to something other than diaphragms or unlubricated or spermicide-treated condoms to reduce bacterial growth.
References
- Haggerty CL, Ness RB. Epidemiology, pathogenesis, and treatment of pelvic inflammatory disease. Expert Rev Anti Infect Ther. 2006;4:235-47.
- Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2002;186:929-37.
- Pelvic Inflammatory Disease (PID) – CDC Fact Sheet. CDC. 2017. Accessed online: www.cdc.gov/std/pid/stdfact-pid-detailed.htm
- Simms I, Eastick K, Mallinson H, et al. Association between mycoplasma genitalium, chlamydia trachomatis and pelvic inflammatory disease. J Clin Pathol. 2003;56:616.618.
- Cohen CR, Mugo NR, Astete SG, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect. 2005;81:463-6.
