Urethritis, Epididymitis, Prostatitis Flashcards
What is urethritis
inflammation of the urethra
What are non-infectious causes of urethritis
Trauma
Reiter’s
Urethral stricture, stone, or lesions
What are infectious causes of urethritis
Gonorrhea (gram neg intracellular diplococci**)
chlamydia, Mycoplasma genitalium, trich, adenovirus
What are Sx of urethritis
Dysuria urethral discharge urethral pruritis Gonorrhea: produse purulent discharge Chlamydia: clear, purulent, or absent discharge
What will you find on urethritis labs
First void UA: Leukocyte esterase, >10 WBC
Gram stain of urethral dx: >5 WBC
How can you test for gonorrhea
Urethral swab >1hr after void (collect from meatus, or insert swab 2-4cm, rotate, withdraw)- shows sensitivity
NAAT first 10-30mL >1hr after last void- no sensitivities
How can you test for chlamydia
Urethral swab for culture >1 hr after last void
NAAT
How do you treat Gonorrhea
Rocephin (Ceftriaxone) 250mg IM x 1 dose
alternative: Cefixime 400mg PO x 1 dose
No sex for 7 days after first dose
How do you treat Chlamydia
Azithromycin 1g po x 1 dose
Doxycycline 100mg PO BID x 7 days
No sex for 7 days after first dose
How do you follow up on gonorrhea s/p Tx
Test for cure 3 months s/p Tx
Must test 1 week and 3 months s/p Tx if Cefixime given
How do you follow up on chlamydia s/p Tx
If uncomplicated urethritis is responsive, no need to f/u
If pregnant, need test of cure 3-4 weeks s/p Tx completion
General urethritis follow up includes
Referring sex partners and treating all those in sexual contact with patient in past 60 days
What is epididymitis
Inflammation of epididymis
orchitis is inflammation of testicle- many have epididymo-orchitis
What can cause epididymitis
Behcet’s disease (oral and genital ulcers, uveitis, skin lesions)
Amiodarone
Tumor of testis or epididymis
Acute bacterial (M <35, gonorrhea/chlamydia) (M>35, E. coli)
Viral
Granulomatous
fungus, ureaplasma, trichomonas
How does epididymitis present
Testicular pain
Urethral discharge and urethritis if STD
What will you see on epididymitis PE
Swollen, tender testicle, epididymis, or spermatic cord
+/- fever, hydrocele
What evaluation is done for epididymitis
Urine culture
Test for STD if suspected
+/- Scrotal US w/ doppler (will show increased blood flow)
How do you treat epididymitis
Scrotal support (provides relief) Analgesics, cold Abx- STD susp. give rocephin and doxy non-STD susp. give Levofloxacin (or doxy) May need IV abx if severe Anti-tuberculars if TB
What is chronic epididymitis
Epididymitis lasting longer than 3 months
What referred pain can look like epididymitis
Stone
Hernia repair
Indirect inguinal hernia
How do you evaluate chronic epididymitis
UA
Urine C&S
Scrotal US with doppler
CT for stones
Conservative Tx for chronic epididymitis includes
analgesics scrotal support modify ALD moist heat spermatic cord block Abx
Surgical Tx for chronic epididymitis includes
Testicular denervaiton
removal of sperm granuloma
orchiopexy if torsion
inguinal orchectomy
What is the hallmark of prostatitis
Prostatic pain
What are the types of prostatitis
Acute bacterial
Chronic bacterial
Inflammatory, non bacterial
Prostadynia (non bacterial and non inflammatory)
How does Acute bacterial prostatitis present
Fever
Irritative
Warm, boggy, tender prostate
+/- obstructive voiding
What causes acute bacterial prostatitis
MC E. Coli
young men
What should you do to evaluate acute bacterial prostatitis
H&P (NO vigorous prostate exam)
Urine culture (no prostate massage, dont want to spread bacteria)
CBC, blood cultures
How do you treat acute bacterial prostatitis
Significant fever, high WBC, sepsis: ADMIT
after dc, 4-6 weeks abx
If fever persists, get a pelvic CT to r/o abscess
How does Chronic bacterial prostatitis present
Pain: genitals, perineum, low back
Irritative urinary Sx: dysuria, urgency, frequency
Pain with ejaculation
What causes chronic bacterial prostatitis
E. Coli
OLDer men
How do you evaluate chronic prostatitis
Pt will have a Hx of recurrent UTI
PE shows: tender boggy prostate
What labs should you get to eval chronic prostatitis
Expressed prostatic secretion
Post prostate massage urine culture
How do you treat chronic prostatitis
- Empiric Bactrim x 8-16 wks
#2. Empiric Fluoroquinolones (tendinitis) x 8-16 wks
adjust based on culture results
-NSAID, Alpha blockers, Anticholinergics
Other chronic prostatitis Tx includes
Phytotheraoy, zinc, diet, stress management, prostate massage, ejaculation, sitz bath (soak in warm water for 30 min
How does Inflammatory chronic pelvic pain syndrome (NONbacterial prostatitis)present
Similar to chronic prostatitis;
pain in genitals, perineum, low back
dysuria, urgency, frequency, pain with ejaculation
What will you classically fine on evaluation of nonbacterial prostatitis
History of UTI
Prostate tenderness
Prostatic fluid with leukocytes (WBC) but cultures are negative!
How do you treat Nonbacterial prostatitis
Empiric Bactrim x 6-8 weeks
If unresponsive, Doxy x 4-6 weeks (ureaplasma, chlamydia, mycoplasma)
How do you treat Nonbacterial prostatitis
palliative measures;
NSAID, anticholinergics, alpha blockers, sitz bath, stress reduction, zinc, nickel, saw palmetto, prostate massage, caffeine, alcohol, spicy food, Benzos, TCA, analgesics
How does Prostadynia present
Like chronic prostatitis
Pain in genitals, perineum, low back
pain with ejaculation
dysuria, urgency, frequency
What will evaluation for Prostadynia show
No bacteria on culture
No leukocytes in prostatic fluid (not inflammatory)
hard to Dx!
How do you treat Prostadynia
Same palliative measures as nonbacterial prostatitis
