Male genitalia exam Flashcards
Anatomic deformity (bell-clapper) allows spermatic cord to twist, resulting in occlusion of testicular blood flow.
- Occurs with trauma, exercise, but also may occur during sleep.
- Many patients report previously having a similar minor pain that spontaneously resolved. Epidemiology - Presents in young to middle aged men with sudden severe, unilateral scrotal pain often associated with nausea/vomiting.
Diagnosis – Clinical suspicion, Ultrasound, Referral to urologist
- Scrotal edema and erythema are typically present and lower abdominal pain may occur.
- Exam reveals a tender, firm affected testis that may appear retracted upward as a result of the twisted spermatic cord. Cremaster reflex is typically absent in testicular torsion. Treatment – Bilateral orchiplexy as bell-clapper deformity often occurs bilaterally. If bloodflow is restored within 6 hours of torsion, 80-100% of testes can be saved.
testicular torsion
infections
- is inflammation typically caused by infections or chronic skin conditions.
- is gradual onset of scrotal pain with fever, urethral discharge, and urinary symptoms.
- sudden onset of testicular pain and high fever. Nausea and vomiting are common.
- may involve the testicles, epididymis, or urethra. Typically do not have acute onset.
4a. Exam typically demonstrates prominent edema, induration, and erythema. Rarely associated with nausea and vomiting unless the patient has systemic illness. Fever +/- . Cremasteric reflex is present.
Balanitis
Epididymitis
Acute orchitis
Scrotal abscesse
Epidemiology – presents as the gradual onset of posterior scrotal pain that may be accompanied by urinary symptoms such as dysuria and urinary frequency. Inflammation of the epididymis, or epididymitis, is commonly seen in the outpatient setting.
Etiology and treatment are based on patient age and the likely causative organisms.
Diagnosis – Physical findings include a swollen and tender epididymis with the testis in an anatomically normal position.
Treatment – -Reflux of urine into the ejaculatory ducts is considered the most common cause of epididymitis in children <14 years.
- -Neisseria gonorrhoeae and Chlamydia trachomatis are the most common pathogens in sexually active males 14 to 35 years of age, and a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline is the treatment of choice in this age group.
- -In men who practice insertive anal intercourse, an enteric organism (e.g., Escherichia coli) is also likely, and ceftriaxone with 10 days of oral levofloxacin or ofloxacin is the recommended treatment regimen
Epididymitis
in men typically include urethral discharge, penile itching or tingling, and dysuria. C. trachomatis and N. gonorrhoeae are the primary pathogens identified in men with urethritis. In 2017, Chlamydia was the most commonly reported STI in the United States, with more than 3 times as many cases reported as gonorrhea. But, HPV is most common of all STIs.
-syphilis, gonorrhea, chlamydia and HIV are examples of reportable infections.
diagnosis
should be examined for inguinal lymphadenopathy, ulcers, or urethral discharge. Palpation of the scrotum for evidence of epididymitis or orchitis is advised. Digital rectal examination of the prostate may be considered,
Currently, urethritis is diagnosed by at least one of the following:
Presence of urethral discharge, positive leukocyte esterase test result in first-void urine, or at least 10 white blood cells per high-power field in first-void urine sediment.
- -The urethra should be gently “milked” by serial palpation down the shaft of the penis toward the urethra.
- Any discharge should be tested according to the available laboratory methods for gonorrhea and chlamydia.
- -If no discharge is present, first-void urine should be tested to document pyuria (pus in the urine), and DNA-based testing should be ordered for chlamydia and gonorrhea.
Urethritis
Genital, groin, or perineal involvement; Polymicrobial cellulitis
1. - signs or symptoms of infection followed by suppuration and necrosis of overlying skin. Non-Sexually transmitted but associated with/secondary to epididymitis.
Fournier’s gangrene
- often presents with acute onset of irritative (e.g., dysuria, urinary frequency, urinary urgency) or obstructive (e.g., hesitancy, incomplete voiding, straining to urinate, weak stream) voiding symptoms.
Patients may report suprapubic, rectal, or perineal pain. Painful ejaculation, hematospermia, and painful defecation may be present as well.
Systemic symptoms, such as fever, chills, nausea, emesis, and malaise, commonly occur, and their presence should prompt physicians to determine if patients meet clinical criteria for sepsis.
- acute onset of irritative (e.g., dysuria, urinary frequency, urinary urgency) or other signs/symptoms including cloudy or strong smelling urine, hematuria, feeling of pressure in lower abdomen, pelvic discomfort.
Prostatitis
Cystitis
Organism (bacteria): gram-negative intracellular diplococci
• Classic presentation: – Men: penile discharge and dysuria or can be asymptomatic
Female: pelvic pain or mucopurulent vaginal discharge
- – Can cause infection of urogenital, anorectal, or pharyngeal infections
• Complication: – Pelvic inflammatory disease (PID) if untreated
– scarring of the fallopian tube if left untreated
- Workup: – Nucleic acid amplification tests (NAATs) on endocervical, urethral, vaginal, pharyngeal, rectal, or urine samples
- Management/Treatment:
– Antibiotics i.e. Ceftriaxone intramuscular or oral Doxycycline
– condom use
Gonorrhea (bacteria)
Organism (bacteria): gram negative bacteria, chlamydia trachamotis
• Classic presentation: – In most cases patient are asymptomatic
– Men: penile discharge, pruritus, dysuria
– Female: vaginal discharge, vaginal bleeding or pain during intercourse (dyspareunia), dysuria
– Can cause infection of urogenital, anorectal, conjunctival (neonatal), or pharyngeal infections
- Complication: – Pelvic inflammatory disease (PID) if untreated – Fertility issues due to scarring of the fallopian tube if left untreated
- Workup: – Nucleic acid amplification tests (NAATs)
- Management/Treatment:
– Antibiotics i.e. azithromycin or doxycycline – condom use
Chlamydia (bacteria)
Organism (bacteria): spirochete, Treponema pallidum
• Classic presentation:
– Primary – chancre
– Secondary - joint pains, fatigue, lymphadenopathy, mucopapular rash
– Latent phase – may be asymptomatic
– Tertiary – neurosyphilis (confusion, headache, stiff neck, vision loss)
• Complication: progression to neurosyphilis
• Workup: serologic testing, antibody detection testing, microscopy etc (nontrepomenal test and treponemal test)
• Management/Treatment:
– Antibiotic (penicillin)
Syphilis (bacteria)
Organism (virus): Herpes Simplex Virus 2 (HSV2)
- Classic presentation: – Single or clusters of vesicles on the genitalia – May have burning, tingling and pain prior to vesicle appearance
- Viral DNA travels by axon to the spinal cord sensory ganglion and persists for life
- Complication: – meningitis, PID, Hepatitis, increase risk of HIV infection (possible due to the open sores)
- Workup: – serologic test can be obtained – polymerase chain reaction assay (PCR) of sample from lesion
- Management/Treatment: – Antiviral (Acyclovir)
Genital Herpes (virus)
Organism (virus): human papillomavirus, a group of >100 viruses
- Classic presentation: – Genital warts (papules, cauliflower-like lesions or flat)
- Complication: – Most lesions are self limited – high risk strains can lead to cancer of the oropharyngeal region or lower genital tract (cervix, penile, or anorectal)
- Workup: – Routine pap smear, intervene if there are any cervical changes – May test for HPV during routine pap smear
- Management/Treatment: – Prevention by vaccinating with Gardasil vaccine during adolescent (can received 11-26 age) – Vaccine contains the most common strains that may cause cancer – Routine pap smear for survellience – Genital wart removel (cryoptherapy, prescribed creams, surgical removal)
Human papillomavirus (HPV) (virus)
a fungal infection that affects the skin of your genitals, inner thighs and buttocks.
causes an itchy, red, often ring-shaped rash in warm, moist areas of your body.
a dermatophytosis that is commonly caused by Trichophyton rubrum or T. mentagrophytes.
Diagnosis Clinical evaluation, Sometimes potassium hydroxide (KOH) wet mount
Differential diagnosis includes: Contact dermatitis, Psoriasis, Candidiasis, etc. Treatment Topical antifungal for up to 4 weeks.
Tinea cruris (Jock itch)
HPV is most common of all STIs.
Any sexually active person is at risk of getting HPV.
However, genital warts are more common for people who:
- are under the age of 30
- smoke
- have a weakened immune system
- have a history of child abuse
- are children of a mother who had the virus during childbirth
HPV
Peyronie’s disease is the development of fibrous scar tissue inside the penis that causes curved, painful erections
Peyronie’s disease
one or both of the testes fail to descend from the abdomen into the scrotum. Occurs in approximately 3 percent of all infant boys and is the most common male birth defect.
Cryptorchidism
