Pathophysiology

- Infertility

-Dysmenorrhea

-Sexually transmitted diseases (STD)

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 Infertility
1. Female infertility
2. Male infertility
 Female infertility, or the inability to conceive, occurs in about
10% of all women of reproductive age in the U.S.A.
Female infertility may be caused by ovarian disease, obstruction
of the uterine tubes, or conditions in which the uterus is not
adequately prepared to receive a fertilized ovum.
Male infertility (sterility) is an inability to fertilize a secondary
oocyte; it does not imply erectile dysfunction (impotence).
Male fertility requires production of adequate quantities of viable,
normal sperm by the testes, unobstructed transport of sperm
though the ducts, and satisfactory deposition in the vagina.
The seminiferous tubules of the testes are sensitive to many
factors—x-rays, infections, toxins, malnutrition, and higher-than-
normal scrotal temperatures— that may cause degenerative
changes and produce male sterility. 2
 Infertility
 One cause of infertility in females is inadequate body fat. To begin
and maintain a normal reproductive cycle, a female must have a
minimum amount of body fat.
Even a moderate deficiency of fat—10% to 15% below normal
weight for height—may delay the onset of menstruation (menarche),
inhibit ovulation during the reproductive cycle, or cause amenorrhea
(cessation of menstruation).

Many fertility-expanding techniques now exist for assisting infertile

couples to have a baby.
The birth of Louise Joy Brown on July 12, 1978, near Manchester,
England, was the first recorded case of in vitro fertilization (IVF)—
fertilization in a laboratory dish.

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 Dysmenorrhea
 Painful menstruation.

Primary dysmenorrhea, which is defined as painful menses in

women with normal pelvic anatomy, usually begins during
adolescence. It is characterized by crampy pelvic pain
beginning shortly before or at the onset of menses and lasting
one to three days.

The prevalence of dysmenorrhea is highest in adolescent women,

with estimates ranging from 20 to 90 percent, depending on the
measurement method used

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 Dysmenorrhea
Dysmenorrhea is thought to be caused by the release of
prostaglandins in the menstrual fluid, which causes uterine
contractions and pain.

Vasopressin also may play a role by increasing uterine

contractility and causing ischemic pain as a result of
vasoconstriction.
Elevated vasopressin levels have been reported in women
with primary dysmenorrhea.

Treatment:
NSAIDs are the initial therapy of choice in patients with
presumptive primary dysmenorrhea. Because all NSAIDs are
equal in efficacy, agent selection should be guided by cost,
convenience, and patient preference,
ibuprofen or naproxen. 5
 Sexually Transmitted Diseases (STD)
A sexually transmitted disease (STD) is one that is spread by
sexual contact.

STDs are diseases and infections which are capable of being

spread from person to person through:
 sexual intercourse
 oral-genital contact or in non-sexual ways.
IV drug

Ex. AIDS, hepatitis B.

Chlamydia
Gonorrhea

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 Sexually Transmitted Diseases (STD)
Symptoms
 Sores (either painful or painless)
 Blood in urine
 Burning sensation when urinating
 Rashes
 Itching
 Bumps
 Warts
 Unusual discharge

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 Sexually Transmitted Diseases (STD)
Chlamydia: is a sexually transmitted disease caused by
the bacterium Chlamydia trachomatis.

 This unusual bacterium cannot reproduce outside body

cells; it “cloaks” itself inside cells, where it divides.
 At present, chlamydia is the most prevalent sexually
transmitted disease in the United States.
 In males, urethritis is the principal result, causing a clear
discharge, burning on urination, frequent urination, and
painful urination
 Without treatment, the epididymides may also become
inflamed, leading to sterility.
 In 70% of females with chlamydia, symptoms are absent

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 Sexually Transmitted Diseases (STD)
Gonorrhea: or “the clap” is caused by the bacterium
Neisseria gonorrhoeae.
 Discharges from infected mucous membranes are the
source of transmission of the bacteria either during sexual
contact or during the passage of a newborn through the
birth canal.
 Males usually experience urethritis with profuse pus
drainage and painful urination.
 In females, infection typically occurs in the vagina, often
with a discharge of pus.
 Both infected males and females may harbor the disease
without any symptoms,
 An estimated 50,000 to 80,000 women in the US are made
infertile by gonorrhea every year as a result of scar tissue
formation that closes the uterine tubes.
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 Sexually Transmitted Diseases (STD)
Syphilis, caused by the bacterium Treponema pallidum, is
transmitted through sexual contact or exchange of blood, or
through the placenta to a fetus.

Genital herpes is an incurable STD.

Type II herpes simplex virus (HSV-2) causes genital
infections, producing painful blisters on the prepuce.

GenitalWarts: Warts are an infectious disease caused by

viruses. Human papillomavirus (HPV) causes genital warts,
which is commonly transmitted sexually.

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 AIDS: HIV Transmission

HIV is most effectively transmitted by practices that involve the

exchange of blood or body fluids.
• Direct blood-to-blood contact ex. HIV-contaminated hypodermic needles.
• HIV infected mother to her baby at birth or during breast-feeding
• Sex
• HIV is a very fragile virus; it cannot survive for long outside the human body.
• The virus is not transmitted by insect bites.
• The virus can be eliminated from personal care & medical equipment by
exposing them to heat (135°F for 10 minutes) or by cleaning them with
common disinfectants such as hydrogen peroxide, alcohol.
• Standard dishwashing and clothes washing also kill HIV.

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HIV : Structure

• HIV consists of an inner core of ribonucleic acid (RNA) covered by a

protein coat (capsid).

• Surrounding the HIV capsid is an envelope composed of a lipid

bilayer that is penetrated by glycoproteins. 12
 HIV Infection

• Outside a living host cell, a virus is unable to replicate.

• virus infects and enters a host cell, it uses the host cell’s enzymes
and ribosomes to make thousands of copies of the virus.

• HIV infection of a host cell begins with the binding of HIV

glycoproteins to receptors in the host cell’s plasma membrane.

• Causes cell to transport the virus into its cytoplasm via receptor-
mediated endocytosis.

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 HIV Infection

• Inside the host cell, HIV sheds its protein coat, and a viral enzyme
called reverse transcriptase reads the viral RNA strand & makes a
DNA copy.

• The viral DNA copy then becomes integrated into host cell’s DNA.

• The viral DNA is duplicated along with the host cell’s DNA during
normal cell division.

• In addition, the viral DNA can cause the infected cell to begin
producing millions of copies of viral RNA and to assemble new
protein coats for each copy.

• The new HIV copies bud off from the cell’s plasma membrane and
circulate in the blood to infect other cells. 14
 HIV Infection

• Over 10 billion viral copies may be produced each day.

• HIV mainly damages helper T cells, and it does so in various ways.

• helper T cells are initially replaced as fast as they are destroyed.

• After several years, however, the body’s ability to replace helper T

cells is slowly exhausted, and the number of helper T cells in
circulation progressively declines.

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 HIV Infection: Signs, Symptoms, and Diagnosis
 Soon after being infected with HIV, most people experience a
brief flulike illness.

 Common signs and symptoms are fever, fatigue, rash,

headache, joint pain, sore throat, and swollen lymph nodes.

 About 50% of infected people also experience night sweats.

As early as three to four weeks after HIV infection, plasma
cells begin secreting antibodies against HIV.

 These antibodies are detectable in blood plasma and form the

basis for some of the screening tests for HIV.

 When people test “HIV-positive,” it usually means they have

antibodies to HIV antigens in their bloodstream.
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 Treatment of HIV Infection
 infection with HIV cannot be cured.

 Vaccines designed to block new HIV infections and to reduce

the viral load.

 Two categories of drugs have proved successful in

extending the life of many HIV infected people:

1. Reverse transcriptase inhibitor

2. Protease inhibitors interfere

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 Treatment of HIV Infection

1. Reverse transcriptase inhibitors interfere with the action of

the reverse transcriptase enzyme, the enzyme that the virus
uses to convert its RNA into a DNA copy.

 Drugs: Zidovudine (ZDV, previously called AZT),

Didanosine (ddI), and
Stavudine (d4T®).

Trizivir, approved in 2000 for treatment of HIV infection,

combines three reverse transcriptase inhibitors in one pill.
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 Treatment of HIV Infection

2. Protease inhibitors interfere with the action of protease, a

viral enzyme that cuts proteins into pieces to assemble the
protein coat of newly produced HIV particles.
Drugs : Nelfinavir,
Saquinavir,
Ritonavir,
Indinavir.

In 1996, physicians treating HIV-infected patients widely adopted

highly active antiretroviral therapy (HAART )—a combination of two
differently acting reverse transcriptase inhibitors and one protease
inhibitor.

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 Treatment of HIV Infection

2. Protease inhibitors interfere with the action of protease, a

viral enzyme that cuts proteins into pieces to assemble the
protein coat of newly produced HIV particles.

Drugs : Nelfinavir,
Saquinavir,
Ritonavir,
Indinavir.

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 Treatment of HIV Infection

In 1996, physicians treating HIV-infected patients widely adopted

highly active antiretroviral therapy (HAART )—a combination of
two differently acting reverse transcriptase inhibitors and
one protease inhibitor.

individuals receiving HAART experience a drastic reduction in

viral load and an increase in the number of helper T cells in their
blood.
Not only does HAART delay the progression of HIV infection to
AIDS, but many individuals with AIDS have seen the remission or
disappearance of opportunistic infections and an apparent return
to health. 21
 Treatment of HIV Infection

Although HIV may virtually disappear from the blood with drug
treatment (and thus a blood test may be “negative” for HIV), the
virus typically still lurks in various lymphatic tissues.

 In such cases, the infected person can still transmit the virus to
another person.

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