Infections of the Male GU System Flashcards
How to dx UTI?
dipstick
microscopic
culture
+ nitrates on UA suggests presence of ________.
bacteria
+ leuks on UA suggests presence of ________.
pyuria
What test gets false-positive results when left exposed to air?
nitrite
Signs of infection on urine microscopy
> 3-5 WBC/hpf
bacteria seen
What dipstick test indicates presence of WBC in urine?
leukocyte esterase
When should urine be sent for microscopy?
Any time there is high index of suspicion
Dipstick with positive nitrite, leuk, or hemoglobin
When should urine be sent for culture?
Confirmed microscopy (WBC or bacteria)
dysuria
frequency
urgency
suprapubic pain, hematuria, and cloudy/foul-smelling urine
Acute cystitis
Why is acute cystitis rare in men?
long urethra
Because acute cystitis is rare in men, what else should be looked for?
STIs
Prostatitis
Bladder outlet obstruction (BPH, urethral stricture)
Bacterial cystitis treatment in men
all UTI’s in men considered complicated
Treat for minimum of 7 days Trimethoprim Bactrim DS one po bid Fluoroquinolones Cipro 500mg one po bid
acute vs chronic bacterial prostatitis: onset, sx’s, DRE, treatment?
acute: abrupt onset, painful DRE, can get septic, treatment x 4-6 wks
chronic: insidious onset with relapsing, recurrent UTI; +/- painful DRE; rarely septic or with fever; treatment 6 wks - 3 mon
Age of bacterial prostatitis
uncommon pre-puberty boys
common in men < 50
Signs of bacterial prostatitis
Irritative voiding sx (freq, urgency, dysuria)
Abrupt constitutional sx (fever, chills, malaise, arthralgia, rectal/perineal pain)
DRE: Tender, enlarged, boggy prostate
How to determine post void residual?
bladder ultrasonography
______ is most common causative organism in men with acute prostatitis.
E. coli
Acute bacterial prostatitis treatment
ABX for 4–6 weeks
Trimethoprim = Bactrim DS one po bid Fluoroquinolones = Cipro 500mg one po bid
Empirical treatment of prostatitis should cover what?
G- bacteria and enterococci
When to hospitalize or get urology consult for acute bacterial prostatitis?
sepsis, acute urinary retention or significant comorbidities
Chronic Bacterial Prostatitis Management
ABX therapy similar to acute - Fluoroquinolones or Bactrim
Longer duration of therapy up to x 3-4 months
May add alpha-blocker and anti-inflammatory agents to reduce recurrences
Most cases of epididymitis/orchitis in men < 35 yo due to _________. Most cases in children and elderly due to ________.
STI’s: Gonorrhea, Chlamydia
E. coli
When not to do DRE?
painful acute prostatitis
Severe scrotal pain radiating to groin or flank with enlargement and erythema.
Epididymitis/Orchitis
PE test that is positive for Epididymitis/Orchitis
+ Prehn’s sign
UA for any infection shows what?
WBCs and bacteria
Epididymitis/Orchitis may have secondary _______ that can be seen on U/S.
reactive hydrocele
Epididymitis/Orchitis management
- Oral abx x 14 days < 50 yo = doxy > 50 yo = fluoroquin - Bed rest - Scrotal elevation - NSAIDs helpful to reduce duration of sx's
Most common urologic dx in men younger than 50?
prostatitis
Duration of therapy for uncomplicated cystitis, acute and chronic prostatitis, and epididymitis/orchitis?
Uncomplicated cystitis: 7 days
Epididymitis/orchitis: 14 days
Acute prostatitis: 4-6 wks
Chronic prostatitis: 6 wks - 3 months
