Male Genital Tract Flashcards
Prostatitis
Acute or chronic
Organisms in prostatitis (acute vs chronic)
Acute: Enterococcus faecalis, E. coli, chlamydia
Chronic: bacterial or non-bacterial
Features of acute prostatitis
UTIs Retention Pain Haematospermia Swollen/boggy prostate on DRE NB Chronic has same Sx but present for >3/12
Mx of acute prostatitis
Analgesia
Levofloxacin 500mg/d for 1/12
Mx of chronic prostatitis
Abx (note non-bacterial will not respond)
Anti-inflammatories
a-blockers
Prostatic massage
Presentation of penile cancer
Chronic fungating ulcer
Bloody/purulent discharge
Penile cancer
Rare cancer; related to chronic irritation, viruses (e.g. HPV), smegma
Mx of penile cancer
Early: radiotherapy, irridium wires
Late: amputation, LN dissection
Gonorrhoeal urethritis
Males: urethral pus, dysuria
Women: often asymptomatic, vaginal discharge, dysuria
Local complications of gonorrhoeal urethritis
Prostatitis
Cystitis
Salpingitis
Systemic complications of gonorrhoeal urethritis
Septicaemia: petechiae, hand or foot pustules
Arthritis
SBE/IE
Mx of gonorrhoeal urethritis
Ceftriaxone 500mg IM stat
Also treat for chlamydia (azithromycin 1g PO stat or doxycycline)
Non-gonococcal urethritis (NGU)
Commoner than gonorrhoeal
Discharge is thinner and signs less acute
Causative organisms in NGU
Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma genitalium Trichomonas vaginalis Gram -ives and anaerobes Candida
Mx of NGU
Azithromycin 1g PO stat or doxycycline
Non-infective causes of urethritis
Traumatic
Chemicals
Cancer
Foreign body
Diagnosing scrotal masses
1) Can you get above it?
2) Is it separate from the testis?
3) Cystic or solid?
Cannot get above = inguinoscrotal hernia, hydrocele extending proximally
Separate and cystic = epididymal cyst
Separate and solid = epididmyitis/varicocele
Testicular and cystic = hydrocele
Testicular and solid = tumour, haematocele, granuloma, orchitis, gumma
Causes of epididymo-orchitis
Chlamydia E. coli Mumps Gonorrhoea TB
Epididymal cysts
Usually develop in adulthood and contain clear or milky (spermatocele) fluid
Lie above and behind the testis
Remove if symptomatic
Causes of testicular atrophy
Hormonal (e.g. chronic androgen use) Viruses (e.g. mumps, HIV) Testicular cancer Testicular injury Alcoholism Age-related
