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Summer FDTN Exam 1 > Urethritis, Epididymitis, Prostatitis > Flashcards

Urethritis, Epididymitis, Prostatitis Flashcards

1
Q

What is urethritis

A

inflammation of the urethra

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2
Q

What are non-infectious causes of urethritis

A

Trauma
Reiter’s
Urethral stricture, stone, or lesions

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3
Q

What are infectious causes of urethritis

A

Gonorrhea (gram neg intracellular diplococci**)

chlamydia, Mycoplasma genitalium, trich, adenovirus

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4
Q

What are Sx of urethritis

A 
Dysuria 
urethral discharge 
urethral pruritis 
Gonorrhea: produse purulent discharge 
Chlamydia: clear, purulent, or absent discharge
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5
Q

What will you find on urethritis labs

A

First void UA: Leukocyte esterase, >10 WBC

Gram stain of urethral dx: >5 WBC

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6
Q

How can you test for gonorrhea

A

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

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7
Q

How can you test for chlamydia

A

Urethral swab for culture >1 hr after last void

NAAT

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8
Q

How do you treat Gonorrhea

A

Rocephin (Ceftriaxone) 250mg IM x 1 dose
alternative: Cefixime 400mg PO x 1 dose
No sex for 7 days after first dose

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9
Q

How do you treat Chlamydia

A

Azithromycin 1g po x 1 dose
Doxycycline 100mg PO BID x 7 days
No sex for 7 days after first dose

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10
Q

How do you follow up on gonorrhea s/p Tx

A

Test for cure 3 months s/p Tx

Must test 1 week and 3 months s/p Tx if Cefixime given

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11
Q

How do you follow up on chlamydia s/p Tx

A

If uncomplicated urethritis is responsive, no need to f/u

If pregnant, need test of cure 3-4 weeks s/p Tx completion

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12
Q

General urethritis follow up includes

A

Referring sex partners and treating all those in sexual contact with patient in past 60 days

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13
Q

What is epididymitis

A

Inflammation of epididymis

orchitis is inflammation of testicle- many have epididymo-orchitis

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14
Q

What can cause epididymitis

A

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

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15
Q

How does epididymitis present

A

Testicular pain

Urethral discharge and urethritis if STD

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16
Q

What will you see on epididymitis PE

A

Swollen, tender testicle, epididymis, or spermatic cord

+/- fever, hydrocele

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17
Q

What evaluation is done for epididymitis

A

Urine culture
Test for STD if suspected
+/- Scrotal US w/ doppler (will show increased blood flow)

18
Q

How do you treat epididymitis

A 
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
19
Q

What is chronic epididymitis

A

Epididymitis lasting longer than 3 months

20
Q

What referred pain can look like epididymitis

A

Stone
Hernia repair
Indirect inguinal hernia

21
Q

How do you evaluate chronic epididymitis

A

UA
Urine C&S
Scrotal US with doppler
CT for stones

22
Q

Conservative Tx for chronic epididymitis includes

A 
analgesics 
scrotal support 
modify ALD 
moist heat 
spermatic cord block 
Abx
23
Q

Surgical Tx for chronic epididymitis includes

A

Testicular denervaiton
removal of sperm granuloma
orchiopexy if torsion
inguinal orchectomy

24
Q

What is the hallmark of prostatitis

A

Prostatic pain

25
Q

What are the types of prostatitis

A

Acute bacterial
Chronic bacterial
Inflammatory, non bacterial
Prostadynia (non bacterial and non inflammatory)

26
Q

How does Acute bacterial prostatitis present

A

Fever
Irritative
Warm, boggy, tender prostate
+/- obstructive voiding

27
Q

What causes acute bacterial prostatitis

A

MC E. Coli

young men

28
Q

What should you do to evaluate acute bacterial prostatitis

A

H&P (NO vigorous prostate exam)
Urine culture (no prostate massage, dont want to spread bacteria)
CBC, blood cultures

29
Q

How do you treat acute bacterial prostatitis

A

Significant fever, high WBC, sepsis: ADMIT
after dc, 4-6 weeks abx
If fever persists, get a pelvic CT to r/o abscess

30
Q

How does Chronic bacterial prostatitis present

A

Pain: genitals, perineum, low back
Irritative urinary Sx: dysuria, urgency, frequency
Pain with ejaculation

31
Q

What causes chronic bacterial prostatitis

A

E. Coli

OLDer men

32
Q

How do you evaluate chronic prostatitis

A

Pt will have a Hx of recurrent UTI

PE shows: tender boggy prostate

33
Q

What labs should you get to eval chronic prostatitis

A

Expressed prostatic secretion

Post prostate massage urine culture

34
Q

How do you treat chronic prostatitis

A
  1. Empiric Bactrim x 8-16 wks
    #2. Empiric Fluoroquinolones (tendinitis) x 8-16 wks
    adjust based on culture results
    -NSAID, Alpha blockers, Anticholinergics
35
Q

Other chronic prostatitis Tx includes

A

Phytotheraoy, zinc, diet, stress management, prostate massage, ejaculation, sitz bath (soak in warm water for 30 min

36
Q

How does Inflammatory chronic pelvic pain syndrome (NONbacterial prostatitis)present

A

Similar to chronic prostatitis;
pain in genitals, perineum, low back
dysuria, urgency, frequency, pain with ejaculation

37
Q

What will you classically fine on evaluation of nonbacterial prostatitis

A

History of UTI
Prostate tenderness
Prostatic fluid with leukocytes (WBC) but cultures are negative!

38
Q

How do you treat Nonbacterial prostatitis

A

Empiric Bactrim x 6-8 weeks

If unresponsive, Doxy x 4-6 weeks (ureaplasma, chlamydia, mycoplasma)

39
Q

How do you treat Nonbacterial prostatitis

A

palliative measures;
NSAID, anticholinergics, alpha blockers, sitz bath, stress reduction, zinc, nickel, saw palmetto, prostate massage, caffeine, alcohol, spicy food, Benzos, TCA, analgesics

40
Q

How does Prostadynia present

A

Like chronic prostatitis
Pain in genitals, perineum, low back
pain with ejaculation
dysuria, urgency, frequency

41
Q

What will evaluation for Prostadynia show

A

No bacteria on culture
No leukocytes in prostatic fluid (not inflammatory)
hard to Dx!

42
Q

How do you treat Prostadynia

A

Same palliative measures as nonbacterial prostatitis

Summer FDTN Exam 1 (12 decks)

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