Reproductive Tract Infections

Reproductive Tract Infections

Reproductive tract infections are caused by organisms normally present in the reproductive or genital tract or introduced from the outside during sexual contact or medical procedures. It occur both in men and women. Based on mode of infection reproductive tract infections are classified into three types:

1. Sexually Transmitted Disease

It  is  caused  through  means  of  sexual contact. Examples: Chlamydia, Gonnorhea, Chancroid, and Acquired Immuno Deficiency Syndrome (AIDS).

2. Endogenous Infections

These are caused by the overgrowth of organisms normally present in the genital tract of healthy women. Example: Bacterial Vaginosis or Vulvo Vaginal Candidiasis.

3. Iatrogenic Infections

These infections are associated with improperly performed medical procedures such as unsafe abortion or poor delivery practices. The endogenous organisms in the vagina or sexually transmitted organisms in the cervix may be transferred during a transcervical procedure into the upper reproductive tract and cause serious infections of the uterus, fallopian tubes, and other pelvic organs.

In men reproductive tract infections transmitted by sexual contact are much more common than by endogenous or iatrogenic reproductive infections. In women reproductive infections spread through non sexual routes are usually more common.

Mode of Transmission

Reproductive tract infections are caused by pathogenic bacteria, parasite, virus. It is mainly caused by pathogens entering into the body through the mucous mem-branes during unprotected vaginal, oral, anal intercourse with an infected part-ner. In developing countries bacterial infections like Gonorrhoea, Chlamydia, Syphilis, Bacterial Vaginosis, Lympho-granuloma Venereum, Trichomoniasis, Chancroid, and viral infections caused by Human Papilloma Virus, Hepatitis B Virus, Herpes Simplex Virus, Human Im-munodeficiency Virus are very common.

Normal Flora of Reproductive Tract

Mycobacterium smegmatis, a harmless commensal found in the smegma of the genitalia of both men and women. (Figure 12.17 & 12.18). In nomal men aerobic and anaerobic bacteria, lactobacilli, alpha haemolytic Streptococci, Chalmydia trachomatis and Ureaplasma urealyticum may also be present.

The adult female genital tract has a very complex microflora. The character of the population changes with the variation of the menstrual cycle. Mostly the predominant bacteria are acid tolerant Lactobacilli. Glycogen is accumulated in the vaginal wall due to ovarian hormonal activity. The breakdown of glycogen by the lactic acid bacteria (Doderlien’s bacillus) leads to the formation of acidic pH (4.4-4.5). This acidic nature prevents the vagina from bacterial vaginosis and yeast infections. However before puberty and after menopause there is no glycogen formation. The normal flora during this period contain normal skin microorganisms. The vaginal pH is mild alkaline. The normal vaginal flora often includes Listeria, anaerobic Streptococci, Mycoplasma, Gardnerella vaginalis, Neisseria, Spirochetes, Candida, Staphylococcus epidermidis.

Pathogenesis

After the entry of pathogenic organisms, with sufficient incubation time, symptoms are clearly manifested in the affected individual. The most common symptoms include unusual vaginal discharge, penile discharge, pelvic pain, itching, abnormal or heavy vaginal bleeding, rashes, warts, lesions, burning or pain during urination. However most of the infections are asymptomatic, which act as a effective control of reproductive tract infections. Diseases of reproductive system are listed in Table 12.9.