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Urinary Tract Infection
Risk Factors
- Females are more prone than males
- Diabetes
- Obesity
- Sexual Activity
Clinical Presentation
- Burning with urination
- Frequency
- May present with strangely in elderly
Diagnosis
- Symptoms alone may be enough
- U/A
- Cultures
Treatment
- – Several different options for antibiotic treatment
- Cephalexin (Keflex)
- Fluoroquinolones
- Bactrim is becoming less effective due to resistant organisms
Urethritis
Causes
- Neisseria gonorrhoeae
- Chlamydia
Clinical Presentation
- Purulent urethral discharge (think Neisseria)
- Clear discharge (think Chlamydia)
- Painful voiding
- Frequency
Labs, Studies and Physical Exam Findings
- Urethral swab
Treatment
- Antibiotics
- Ceftriaxone
- Azithromycin
- Doxycycline
Cystitis
- Cystitis in men is a sign of other pathology
- Use catheters sparingly and for as short a time as possible
Causes
- E Coli is the #1 cause
- Enterococci
Clinical Presentation
- It hurts when I pee! (dysuria)
- Frequency
- Urgency
- Hematuria is possible
Labs, Studies and Physical Exam Findings
- Urinalysis and culture
Treatment
- Several different options for antibiotic treatment
- Cephalexin (Keflex)
- Fluoroquinolones
- Bactrim is becoming less effective due to resistant organisms
Pyelonephritis
- An ascending urinary tract infection
Causes
- E. Coli is the most common cause
Clinical Presentation
- Fever
- Radiating flank pain
- Dysuria
- Abdominal pain
- Nausea and vomiting
Labs, Studies and Physical Exam Findings
- Costovertebral tenderness
- U/A
- Pyuria
- White cell casts
- Urine culture
- X-ray of the kidney, ureter and bladder (KUB)
- U/S
- CT if necessary
Treatment
- Antibiotics based on urine culture
- Fluoroquinolones
- Cephalosporins
- Aminoglycoside
- Bactrim
Epididymitis
- The most frequent cause of acute pain in the scrotum
- Associated with urethritis
Causes
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Gram negative rods
Clinical Presentation
- My scrotum hurts
- Swollen scrotum
- Urethral discharge
- Pain with voiding
- Fever
Labs, Studies and Physical Exam Findings
- Prehn’s sign is positive – elevating the scrotum provides pain relief
- CBC
- Gram stain and culture of discharge
- Gram negative intracellular diplococci = N. gonorrhoeae
- No visible organism but lots of WBCs = Chlamydia
- Urine culture
- U/A
Treatment
- Antibiotics which cover N. gonorrhoeae and Chlamydia
- Treat sexual partners as well
- Macrolides – Azithromycin
- Cephalosporins – Cefixime
Orchitis
Causes
- Chlamydia
- Gonorrhea
- Mumps
Clinical Presentation
- Severe scrotal pain
- Scrotal swelling
- Hematuria
Labs, Studies and Physical Exam Findings
- U/A
- Urine culture
Treatment
- Scrotal elevation and ice
- NSAIDS
- Opiates
Prostatitis Acute & Chronic
Causes
- Acute
- E. coli
- Pseudomonas
- Chronic
- Gram negative rods
- Enterococcus
Clinical Presentation
- Acute
- Fever
- Pain with voiding
- Perineal pain
- Chronic
Labs, Studies and Physical Exam Findings
- U/A
- Urine culture will be positive
- Acute
- Tenderness with rectal exam
- Chronic
- Rectal exam may be normal or have a boggy prostate
Treatment
- Acute patient may require hospitalization
- IV antibiotics
- Catheterization may be necessary
- Trimethoprim – sulfamethoxazole (Bactrim) for 6-12 weeks
- Fluoroquinolones for 6-12 weeks
- Cephalexin 6-12 weeks
- Erythromycin 6-12 weeks
