B8-050 Male UTI Flashcards
why are male UTIs always considered complicated? [2]
length of urethra
prostate
most common pathogens causing epididymitis in men under 35 [2]
Ng
Ct
most common pathogens causing epididymitis in men over 35
E coli or other common UTI pathogens
treatment of epididymitis in a male under 35 (concern for STI)
ceftriaxone IM & doxy 10 days
OR
single dose azithromycin IM
treatment of epididymitis in a male over 35 (no concern for STI)
levofloxacin for 10 days
[…] is the most important differential diagnosis of epididymitis and must be ruled out first
testicular torsion
(pain relief with elevation and intact cremasteric reflex point toward epididymitis)
the spread of infection from the epididymis to the testicle
Epididymo-orchitis
is PSA indicated in management of acute prostatitis?
no
70% will have elevated PSA for 1-2 months after treatment. causes unnecessary alarm
unilateral scrotal pain
dysuria, frequency, urgency
+ phren sign (pain relieved with scrotal elevation)
epididymitis
irritative and obstructive symptoms
rectal/perineal pain
painful ejaculation
boggy, tender prostate
maybe elevated PVR
acute bacterial prostatitis
obstructive voiding symptoms
enlarged, nontender prostate
negative urine culture
BPH
recurring prostatitis symptoms for 3+ months
positive urine culture with each episode
chronic bacterial prostatitis
pain attributed to the prostate with no demonstrable evidence of infection
culture negative
chronic pelvic pain syndrome
irritative voiding symptoms
normal prostate exam
cystitis
antibiotics do not have good penetration in the prostate, so treatment should be administered for […]
4 weeks
(fluoroquinolone or TMP-SMX)
when is imaging indicated in management of acute bacterial prostatitis?
if they’re still febrile 36+ hours after treatment initiation
(or if multi-drug resistant strain)
adverse effects of fluoroquinolone [2]
QT prolongation
tendon rupture
cultures positive after prostatic massage in 4 glass test
chronic bacterial prostatitis
usually presents are recurrent UTIs with the same strain
dx confirmed via four-glass test
chronic bacterial prostatitis
treatment of chronic bacterial prostatitis
fluoroquinolone or TMP-SMX for 30 days
treatment for chronic bacterial prostatitis
fluoroquinolone or TMP-SMX for 30 days
treatment of complicated UTI requires […] prior to initiation of antibiotics
urine culture
a […] is required for part of the work up for BPH
urinalysis
if the patient is a smoker and urinalysis shows hematuria, what tests are indicated?
CT
cystoscopy
(evaluate for malignancy)
