Lecture 3: Clinical Assessment of Male Genitalia Flashcards
Differentiate Epididymitis from Acute Orchitis.
- Epididymitis: is gradual onset of scrotal pain w/ fever, urethral discharge and urinary sx’s
- Acute orchitis: is sudden onset of testicular pain and high fever, often with N/V
What is the tx of choice for sexually active males 14-35 y/o with epididymitis?
Single IM dose of ceftriaxone with 10-days of oral doxycycline
What is the tx of epididymitis in men who practice insertive anal intercourse where an enteric organism (i.e., E. coli) is also likely?
Ceftriaxone w/ 10-days of oral levofloxacin or ofloxacin
What is the recommended method for diagnosis and assessment of men presenting with urethral sx’s and suspected urethritis?
- Should examine for inguinal LAD, ulcers, or urethral discharge
- Palpation of the scrotum for evidence or epididymitis or orchitis is advised
- DRE of the prostate may be considered
Currently, urethritis is diagnosed using what criteria?
Presence of urethral discharge, (+) leukocyte esterase test result in first-void urine, or at least 10 WBC’s per HPF in first-void urine sed.
What is the level B, USPFTF recommendation for intensive behavioral counseling for STI’s?
All sexually active adolescents and for adults who are are increased risk
What are the 2, level A, USPSTF recommendations for Syphilis screening?
- Strongly recommends that clinicians screen persons at increased risk
- All pregnant women should be screened
What level of recommendation from the USPFTF is screening all asymptomatic persons, not at increased risk for syphillis?
Level D
Which level of evidence is the USPFTF recommendation for screening sexually active women age 24 years and younger and in older women at increased risk for chlamydia and gonorrhea?
Level B
What are some of the associated sx’s of patient presenting with prostatitis?
- Acute onset of irritative (i.e., dysuria, frequency or urgency) or obstructive (i.e., hesitancy, incomplete voiding, straining) voiding sx’s
- Painful ejaculation, hematospermia, and painful defecation may also be present
What are the top 3 causes of genital ulcers in the United States?
- HSV-1 and HSV-2 = most common
- Syphillis
- Chancroid (H. ducreyi)
Which lab tests can be used for herpes simplex diagnosis?
Culture or PCR
Single, painless, well-demarcated ulcer (chancre) on the genitals describes what infection?
Syphills (primary)
Non-indurated, painful genital ulcer with serpinginous border and friable base; covered w/ a necrotic, often purulent exudate describes what infection?
H. ducreyi –> gram-negative, slender rod or coccobacillus in “school of fish” pattern
A small, shallow, painless, genital or rectal papule or ulcer w/ no induration assoc. w/ unilateral tender inguinal or femoral LAD “groove sign” is dianostic of which infection?
LGV –> C. trachomatis types L1, L2, L3
Not performing routing serologic screening for HSV infection in asymptomatic adolescents and adults is what level of evidence based on the USPSTF recomendations?
Level D
What is the classic presentation of gonorrhea infection in a male?
Penile discharge and dysuria or can be asymptomatic
What is the most common of all STI’s?
HPV
What is the most common male birth defect?
Cryptorchidism
What is the recommendation for male genital exams for pre-participation sports physicals?
- Insufficient evidence exists to recommend for or against it = Level C
- May be indicated in males with sx’s or a hx
A new hydrocele or one that hemorrhages after minor trauma may be a sign of what?
Cancer
What is the level of recommendation for testicular cancer screening?
Do not screen: level D
If a man if presenting with sx’s of ED, what else should you consider screening for?
- Screen for cardiovascular risk factors; because ED sx’s present on average 3 yrs earlier than CAD sx’s
- Initial screen of fasting serum glucose + lipid panel, TSH test, and morning total testosterone
Testosterone supplementation in men w/ hypogonadism improves ED and libido, but increases risk of?
Prostatic adenocarcinoma
