11 reproductive high yield

Gametogenesis Jason M Franasiak, M.D Resident Physician University of North Carolina REPRO1_1-1 Spermatogenesis (23, 1n) Spermatozoa (23, 1n) Spermatids Meiosis II (23, 2n) Secondary spermatocytes Meiosis I (46, 4n) Primary spermatocytes (46, 2n) Spermatogonia Kaplan Anatomy: Figure I-10-2 •FA 2013: 518.1 • FA 2012: 533.1 • FA 2011: 480.1 • ME 3e: 400 • ME4e: 400 REPRO1_1-2 Spermatozoa Spermatozoa: 75 days for production - 2/3 time in seminiferous tubules - 1/3 time in epididymus Normal for fertility: Semen volume: 2-5 ml Total sperm number: > 20 million Progressive motility: > 50% Kaplan Anatomy: Figure I-10-4 •FA 2013: 518.1 • FA 2012: 533.1 • FA 2011: 479.3 • ME 3e: 400 • ME4e: 400 REPRO1_1-3 Hormonal control of testes Kaplan Anatomy 2011: Figure X-10-1 •FA 2013: 519.1 • FA 2012: 534.1 • FA 2011: 481.2 • ME 3e: 401 • ME4e: 401 REPRO1_1-4 Oogenesis Oogonium Primary Oocyte 2n 4n 4n Secondary Oocyte Ovum 2n N Replication Polar Bodies Prophase I Arrest (until ovulation) •FA 2013: 522.1 • FA 2012: 537.1 • FA 2011: 484.2 • ME 3e: 404 • ME4e: 404 Metaphase II Arrest (until fertilization) REPRO1_2-1 Folliculogenesis Kaplan Anatomy: Figure I-11-2 •FA 2013: 521.2 • FA 2012: 536.1 • FA 2011: 483.2 • ME 3e: 404 • ME4e: 404 REPRO1_2-2 Menstrual cycle Chris, commons.wikimedia.org Used with permission •FA 2013: 521.2 • FA 2012: 536.1 • FA 2011: 483.2 • ME 3e: 405 • ME4e: 405 REPRO1_3-1 Menses FA 2012: 536.1 • FA 2011: 483.2 • ME 3e: 406 FA 2010: 481 •FA 2013: 521.2 • FA 2012: 536.1 • FA 2011: 483.2 • ME 3e: 406 • ME4e: 406 • Kaplan Physiology: Figure X-11-4 REPRO1_3-2 Follicular phase Kaplan Physiology: Figure X-11-1 •FA 2013: 521.2 • FA 2012: 536.1 • FA 2011: 483.2 • ME 3e: 406 • ME4e: 406 REPRO1_3-3 Ovulation Kaplan Physiology: Figure X-11-2 •FA 2013: 521.2 • FA 2012: 536.1 • FA 2011: 483.2 • ME 3e: 406 • ME4e: 406 REPRO1_3-4 Sexually Transmitted Infections Jason M Franasiak, M.D Resident Physician University of North Carolina REPRO12_1- HSV infection Herpes simplex virus (DNA virus) HSV – Oral HSV – Genital (note: both serotypes can cause either disease) • Transmitted through contact with infected body surfaces • Painful vesicular lesions, 3-7 days after contact • Progress to painful ulcers • After first infection, remains latent in sensory ganglia • 50% recurrence rate • Recurrences usually milder, shorter duration • Activated by stress, trauma, or systemic disease • Active lesion at delivery → systemic disease in infant (must C-section) • Treatment with oral acyclovir, valacyclovir or famciclovir •FA 2013: 173.1 • FA 2012: 201.1 • FA 2011: 181.1 • ME 3e: 420 • ME4e: 420 REPRO12_1- Ed Uthman commons.wikimedia.org Used with permission HSV infection images Multi-nucleated giant cell on pap smear Perianal HSV infection in AIDS patient Nephron commons.wikimedia.org Used with permission •FA 2013: 173.1 • FA 2012: 201.1 • FA 2011: 181.1 • ME 3e: 420 • ME4e: 420 REPRO12_1- HPV infection HPV Infection DNA virus with >30 serotypes • • • • • Condyloma acuminatum – genital warts, cauliflower-like External infection: vulva, peri-anal area, scrotum Internal infection: male/female anus, cervix, male urethra Recurrence common (smokers, immunocompromised) Multiple treatment options including cryotherapy, podofilox, imiquimod and sinecatechins HPV 6, 11 → visible lesions HPV 16, 18, 31, 33 → cervical vaginal anal vulvar penile cancers Severe case of condyloma acuminatum Copyright Katsumi M Miyai, M.D., Ph.D.; Regents of the University of California Used with permission •FA 2013: 173.1 • FA 2012: 201.1 • FA 2011: 181.1 • ME 3e: 420 • ME4e: 420 REPRO12_1- Syphilis Spirochete, Treponema pallidum T pallidum on dark field microscopy Spreads via: • • • • Nephron commons.wikimedia.org Used with permission Contact with mucocutaneous lesions Congenitally by crossing placenta (a TORCH infection) IV blood transfusion Treatment with penicillins and tetracyclines •FA 2013: 137.2 • FA 2012: 165.1 • FA 2011: 152.6 • ME 3e: 421 • ME4e: 421 REPRO12_2- Stages of syphilis Stages of syphilis: Primary up to year • Painless chancre, contagious • Scraping of chancre shows spirochetes on dark-field microscopy • Low-grade fever, muscle aches (myalgia), malaise Secondary wks to mos • Lymphadenopathy after infection • Rash on palms and soles • Condyloma lata: grey plaques on Chancre on penis moist areas, also contagious • Any organ system can be affected Tertiary usually chronic • CNS, tabes dorsalis • Ascending aorta, dissection infection • Gummas, necrotic lesions in any area Gumma on nose CDC, commons.wikimedia.org Used with permission •FA 2013: 138.2 • FA 2012: 166.2 • FA 2011: 153.3 • ME 3e: 421 • ME4e: 421 REPRO12_2- Diagnosis of syphilis Diagnosis of syphilis Primary syphilis (chancre present) Scrape of chancre examined under dark-field microscopy Non-treponemal tests (screening tests) VDRL: non-specific reactivity to beef cardiolipin T pallidum on dark field microscopy RPR (Rapid Plasma Reagin), similar Nephron commons.wikimedia.org Used with permission False positives with autoimmune diseases (rheumatic fever, lupus, etc.) Specific treponemal antigen tests (confirmatory) FTA: fluorescent treponemal antibody test TPPA: treponemal pallidum particle agglutination test - Specific tests can remain positive even after treatment (25% revert to negative) •FA 2013: 138.3 • FA 2012: 166.3 • FA 2011: 153.4 • ME 3e: 421 • ME4e: 421 REPRO12_2- Congenital syphilis Congenital syphilis • Baby born to infected mother • Mother usually has primary or early secondary infection • Atypical facies – saddle nose deformity • Rhinitis (“snuffles”) • Also: Hutchinson’s teeth, saber shins, corneal keratitis, deafness •FA 2013: 138.1 • FA 2012: 166.1 • FA 2011: 153.2 • ME 3e: 421 • ME4e: 421 REPRO12_2- Gonorrhea Neisseria gonorrheae, gram-negative diplococci • Urethritis in men • Cervicitis in women • Often asymptomatic • Mucopurulent discharge from cervix or urethra • Can cause pelvic inflammatory disease (PID) - tubal damage - ectopic pregnancy - infertility • Disseminated infection: - pustular skin rashes - asymmetric septic arthritis - perihepatis (Fitz-Hugh-Curtis syndrome) - endocarditis -meningitis Urethral exudate with diplococci and neutrophils CDC commons.wikimedia.org Used with permission •FA 2013: 173.2 • FA 2012: 202.1 • FA 2011: 181.2 • ME 3e: 419 • ME4e: 419 REPRO12_3- Gonococcal ophthalmia neonatorum Conjunctivitis in newborns after contact with infected mother during birth Prophylaxis: erythromycin eye drops at birth Treatment: ceftriaxone +/- topical erythromycin Gonococcal ophthalmia neonatorum CDC commons.wikimedia.org Used with permission •FA 2013: 173.2 • FA 2012: 202.1 • FA 2011: 181.2 • ME 3e: 419 • ME4e: 419 REPRO12_3- Gonorrhea diagnosis and treatment Diagnosis and Treatment • Culture with special media: Thayer-Martin agar (anaerobic) • DNA based testing • Treat patient’s partner • Mucopurulent discharge from cervix is diagnostic • Cephalosporin (ceftriaxone), allow six weeks •FA 2013: 173.2 • FA 2012: 202.1 • FA 2011: 181.2 • ME 3e: 419 • ME4e: 419 REPRO12_3- Chlamydia Chlamydia trachomatis, gram-negative, obligate intracellular bacteria • More common than gonorrhea • Cervicitis, urethritis • Frequently asymptomatic • Can cause PID • Epididymitis in men • Reactive arthritis • Tx: doxycycline or azithromycin Chlamydial cervicitis SOA-AIDS Amsterdam, commons.wikimedia.org Used with permission •FA 2013: 173.2 • FA 2012: 202.1 • FA 2011: 181.2 • ME 3e: 419 • ME4e: 419 REPRO12_3- Vaginitis Trichomoniasis: thin white foamy or yellowish/greenish irritating discharge Bacterial vaginosis: (Gardnerella vaginalis) clear discharge Yeast infection: thick white discharge Differential diagnosis based on characteristics of discharge: • Vaginal PH > • Cervical capillary malformations, punctate hemorrhages, “strawberry cervix” • 50% asymptomatic in women, 90% asymptomatic in men (treat partners!) Treatment: metronidazole OR tinidazole •FA 2013: 173.1 • FA 2012: 201.1 • FA 2011: 181.1 • ME 3e: 420 • ME4e: 420 REPRO12_4- Chancroid Haemophilus ducreyi, gram-negative coccobacillus • One or more painful genital ulcers • Negative for Treponema on dark field microscopy • Negative for HSV on culture • Small papules → ulcerated lesions • Lymphadenopathy (can rupture if untreated) • Tx: azithromycin or ceftriaxone Chancroid ulcer CDC commons.wikimedia.org Used with permission •FA 2013: 173.1 • FA 2012: 201.1 • FA 2011: 181.1 • ME 3e: 421 • ME4e: 421 REPRO12_5- Lymphogranuloma venereum Chlamydia trachomatis • Caused by serovars L1, L2, and L3 (cervicitis/urethritis caused by D-K) • Tx: Doxycycline → OR azithromycin (in tetracycline allergic patients) Herbert L Fred, MD and Hendrik A van Dijk, commons.wikimedia.org Used with permission Primary: 4-21 day incubation genital ulcer may spontaneously resolve Secondary: 1-4 weeks later, tender inguinal/femoral lymphadenopathy can progress suppurative adenitis with a draining sinus Tertiary: scarring of sinus and fistula formation vaginal, perineal, rectal fistulas possible •FA 2013: 173.1 • FA 2012: 201.1 • FA 2011: 181.1 • ME 3e: 421 • ME4e: 421 REPRO12_5- ... X -11- 4 REPRO1_3-2 Follicular phase Kaplan Physiology: Figure X -11- 1 •FA 2013: 521.2 • FA 2012: 536.1 • FA 2 011: 483.2 • ME 3e: 406 • ME4e: 406 REPRO1_3-3 Ovulation Kaplan Physiology: Figure X -11- 2... 537.1 • FA 2 011: 484.2 • ME 3e: 404 • ME4e: 404 Metaphase II Arrest (until fertilization) REPRO1_2-1 Folliculogenesis Kaplan Anatomy: Figure I -11- 2 •FA 2013: 521.2 • FA 2012: 536.1 • FA 2 011: 483.2... FA 2012: 536.1 • FA 2 011: 483.2 • ME 3e: 405 • ME4e: 405 REPRO1_3-1 Menses FA 2012: 536.1 • FA 2 011: 483.2 • ME 3e: 406 FA 2010: 481 •FA 2013: 521.2 • FA 2012: 536.1 • FA 2 011: 483.2 • ME 3e: 406