Men's Health

Question 1

Acute bacterial prostatitis

Signs and symptoms?

What constitutes a severe acute bacterial prostatitis?

Answer 1

Systemic: Fevers > 38, chills, sweats

LUTS: obstructive - hesitancy, weak stream, dribbling, retention,

UTI symptoms: dysuria, increased frequency, urgency

Specifically Pelvic or perianal pressure, (prostate tenderness on DRE

Severe= systemic features

Question 2

Investigations for ABP (acute bacterial prostatitis)?

Answer 2

Urine MCS

If appropriate (sepsis or in hospital) then blood cultures

Imaging- Transrectal U/S or CT pelvis to identify an abscess

Question 3

Treatment for severe vs. non severe ABP?

ABP- acute bacterial prostatitis

Answer 3

non severe

Trimethoprim 300mg, orally, daily for 14 days
Second line: cephalexin 500mg, orally, taken 6 hourly for 14 days

(continue for 21 days if symptoms persist after 14 day course finished)

severe

Needs hospital management

Question 4

Complications that can arise from acute bacterial prostatitis?

Answer 4

Urinary retention

Abscess- prostatic

Osteomyelitis of the spine

Fistula formation

Sepsis

Potential recurrent and/or chronic bacterial prostatitis

Question 5

What are common causes for epipdidymo-orchitis in adult men under or over age 35?

Answer 5

Under 35, usually sexually transmitted infection

chlamydia or gonorrhea

Over 35 usually E.coli

Question 6

In a man age 29 with epipdidymo-orchitis, what empiric treatment would you use?

Answer 6

1. Ceftriaxone 500mg in 2ml of lidocaine 1%, given intramuscularly (or 500mg IV), stat as a single dose

PLUS

doxycycline 100mg, orally, 12 hourly for 14 days
(or second line: azithromycin 1gram orally stat, then repeated in 7 days)

Question 7

In a man aged 55 with suspected epididymo-orchitis what is the empiric treatment?

Answer 7

Over 35 years old, suggests likely UTI (e.coli) pathogen.

Treat the same as for acute bacterial prostatitis

Non severe:
Trimethoprim 300mg, orally, daily for 14 days
or
2nd line: cephalexin 500mg, orally, 6 hourly for 14 days.

If Severe –> send to hospital

Question 8

What is this condition?

How can you treat it

Answer 8

Balanitis

hydrocortisone+clotrimazole 1%+1% cream topically, twice daily until the skin is clear and symptoms have resolved