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NURS 5432: MEN'S HEALTH AND STDS
EXAMS QUESTION AND ANSWER
cryptorchidism - Answer -undescended testicles Cryptorchidism treatment - Answer -orchiopexy typically at ages 6-18m cryptorchidism risks later in life - Answer -testicular cancer epididymitis - Answer -inflammation of the epididymis that is frequently caused by the spread of infection from the urethra or the bladder Epididymitis S/S - Answer -o pain o dysuria o urgency/frequency o low back pain/perineal pain o fever/chills/malaise o scrotal edema!! Epididymitis treatment for sexually active men under age 35 - Answer -doxy 100mg BID x 10 days AND ceftriaxone 500mg IM once epididymitis treatment for men over age 35 and you do not suspect STD - Answer -Levfloxacin 500mg PO daily x 10 days OR Ofloxacin 300mg BID X 10 days
Epididymitis treatment for men who have sex with men - Answer -think they need to cover gram negative bacteria... e. coli lives in the colon so that is the likely cause. Ceftriaxone 500mg IM once AND Levofloxacin 500mg PO daily x 10 days Epididymitis PE - Answer -Prehn's sign is positive normal cremasteric reflex possible urethral discharge enlarged and tender epididymis epididymitis diagnosis - Answer -Ultrasound: shows enlarged epidydimis and increased testicular blood flow STD testing US if they have pyuria and/or hematuria elevated CBC CRP and sed rate will be elevated hydrocele - Answer -scrotal swelling caused by a collection of fluid are hydroceles in infants communicating or non- communicating? - Answer -communicating are hydroceles in adults communicating or non- communicating? - Answer -non-communicating what is the connection between testicular cancer and hydrocele - Answer -10% of testicular malignancies present with a hydrocele
o Usually asymptomatic o Always located superior to testicle...hydrocele isn't. this is something that separates the 2 diagnosis Spermatocele management - Answer -none needed unless it is painful aspiration will show non-viable sperm does not affect fertility varicocele - Answer -enlarged veins of the spermatic cord Varicocele grading - Answer -grade 1: only palpable with valsalva maneuver grade 2: cant see it, but can feel it when they stand grade 3: clearly visible varicocele assessment - Answer -usually asymptomatic, they come in for fertility issues normally do a doppler US, IV pyelography to r/o renal tumor or venous obstruction Varicocele management - Answer -grade 1: reassure grade 2-3 and there is <20% size difference in testicles: reassure and refer to urology if they desire fertility grade 2-3 and there is >20% size difference in the testicles: refer to urology scrotal support NSAIDS semen analysis q2 years
Testicular Torsion - Answer -· Urologic emergency that occurs when the spermatic cord twists and causes constriction of the vascular supply to the testicle testicular torsion s/s - Answer -most commonly 10-20 year olds ACUTE onset of severe testicular pain does not have any voiding symptoms pain is made WORSE by prehn's sign no cresmeteric reflex noted affected testicle will have a 'high lie" testicular torsion management - Answer -US surgical referral... they need surgery quick to save the testicle hypospadias - Answer -abnormal congenital opening of the male urethra on the undersurface of the penis hypospadias s/s - Answer -o dorsal hooded foreskin o their urine stream points downward o first degree: urethra located within the glans or sub corona o second degree: urethral opening on penile shaft o third degree: urethral opening within the scrotum or perineum o Chordee (penis bows down) Hypospadias treatment - Answer -surgical reconstruction about 1 year old
BPH - Answer -· Progressive benign hyperplasia of the prostate. This narrows the urethral lumen and can lead to increased prostatic smooth muscle tone. BPH etiology - Answer -o By age 80, 80% of men have it o Cause is unknown o Is most common cause of bladder obstruction in people over 50 years old BPH s/s - Answer -Difficulty starting a urine stream (hesitancy and straining). Decreased strength of the urine stream (weak flow). Dribbling after urination. Feeling that the bladder is not completely empty. An urge to urinate again soon after urinating. Pain during urination (dysuria). BPH diagnosis - Answer -o UA to rule out UTI o Uroflometry o Abdominal US to r/o upper tract pathology o Cr/BUN will be normal o PSA greater than 4 indicates disease o Digital rectal exam What drugs should you avoid in a BPH patient - Answer - anticholinergics... it can increase risk of urinary retention Which drug classes are used to treat BPH and what do they do? - Answer -alpha-1-antagonists: affects contraction around bladder neck and urethra
5-a-reductase inhibitors: decrease size of prostate alpha 1 blockers - Answer -used for BPH · 1st line for moderate to severe bothersome symptoms · Will affect the contraction of the smooth muscle around urethra and bladder neck · Takes 2-4 weeks to work · Can affect BP.. lowers BP... consider orthostatic hypotension as a potential AE o Doxazosin—1-8mg PO daily o Tamsulosin—0.4-0.8mg PO daily o Alfuzosin—10mg PO daily o Terazosin—1mg PO daily... max of 20mg... This one is not as recommended 5-a-reductase inhibitors - Answer -· Blocks conversion of testosterone to dihydrotestosterone, which will help decrease the size of the prostate · Most beneficial for men who have a prostate bigger than 40ml · Needs 6 months to work o Finasteride—5mg PO daily o Dutasteride—0.5mg PO daily · Only use if they have enlarged prostate · These drugs will decrease risk of acute urinary retention, prosate cancer · Used in patients with refractory hematuria after all other causes are ruled out · AE o Decreased libido and ED
alpha-1 blocker (zosin) alternative is TMP/SMZ 180/800 BID for 2-4 weeks.. but E. coli is very resistant to this.. so be careful acute prostatitis treatment if you also suspect an STD - Answer -ceftriaxone 250mg IM once cefixime 400mg PO once AND doxy 100 BID X 7 days chronic prostatitis treatment - Answer -1. ciprofloxacin, levofloxacin 4-6 weeks 2 secondary line: TMP SMZ 8-12 weeks can also use azithro if you suspect chlamydia prostate cancer - Answer -cancer of the prostate gland 2nd most common cancer in men in US prostate cancer s/s - Answer -o asymptomatic usually o can mimic BPH symptoms in early disease o bone pain in later stages due to metastasis o uremia may occur o constipation o weight loss o back or hip pain that radiates into testicular area prostate cancer exam - Answer -DRE (digital rectal exam):
- indurtaion
- asymmetry
- nodularity LE edema
Workup:
- Chem 7
- CBC
- Alkaline phoshatase
- Acid phosphatase
- PSA (0-4 ng/dl is normal) Imaging:
- TRUS (trans-rectal US) w/ biopsy
- CT
- MRI
- Bone scan testicular cancer - Answer -cancer of the testicle, usually occurring in men 15 to 35 years of age testicular cancer assessment - Answer -o Solid, firm, non- tender unilateral testicular mass o Sensation of fullness or dull ache in scrotum, perianal area or low abdomen o Previously small testicles are now normal size o Hydrocele o Gynecomastia accounts for 5% of all patients with germ cell o Does NOT transilluminate (because it is a solid mass) o ED/loss of libio testicular cancer diagnosis - Answer -o Alpha-fetaprotein
25mcg o B-HCG >
Avanafil (Stendra): 100mg PO 15 min before sex. can last a long time. Phosphodiesterase Inhibitors side effects - Answer -· Optic neuropathy · Hearing loss · Priapism... notify if erection lasts longer than 4 hours · Hypotension... do not use with nitrates! Chancroid - Answer -highly infectious nonsyphilitic venereal ulcer Chancroid caused by - Answer -Haemophilus ducreyi (gram negative bacillus) Chancroid s/s - Answer -o women are usually asymptomatic o men will typically have 1 or more painful ulcers that have an erythematous halo. It can be necrotic or very easily erosive Chancroid diagnosis - Answer -o by exclusion o you will see unilateral abscess formation o the patient will be negative for T. pallidum, HSV. o They will have tender inguinal nodes with lymphadenopathy o Definitive diagnosis made morphologically (over 80%) sensitivity Chancroid treatment - Answer -o Azithromycin 1g orally once
o Ceftriaxone 250mg IM once o Ciprofloxacin 500mg BID for 3 days o Erythromycin 500mg TID for 7 days Chlamydia - Answer -A sexually transmitted disease, the most common in developed countries, caused by the bacterium Chlamydia trachomatis. Often producing no symptoms, it can cause infertility, chronic pain, or a tubal pregnancy if left untreated. chlamydia men symptoms - Answer -more asymptomatic than females -urethritis -mucoid/watery discharge -dysuria
- maybe conjuctivitis -rare complication Chlamydia women symptoms - Answer -may have dysuria spotting between periods or post-coital painful sex vaginal discharge Chlamydia diagnosis - Answer -o NAAT is gold standard o Gen-probe (for chlamydia and gonorrhea) o Antigen detection via cervical swab or urethral swab or first catch urine § Has 80-95% sensitivity o UA will be positive for WBC o Women sexually active under 25 need to be tested yearly
Genital wart treatments they can do at home - Answer - imiquimod 3.75 or 5% 3x a week for up to 16w Podofilox 0.5% gel for 3 days, then take 4 days off...can repeat for 1-4 weeks Sinecatechins 15% TID for up to 16w Gonorrhea - Answer -A sexually transmitted bacterial disease caused by a gonococcus bacterium that causes inflammation of the genital mucous membrane, burning pain when urinating, and a discharge. gram negative. Has a lot of resistance Gonorrhea Assessment in men - Answer -§ Urethritis: purulent urethral discharge, can be blood-tinged § Dysuria § Penile edema § Acute epididymitis § Prostatitis gonorrhea assessment in females - Answer - Endocervical/vaginal discharge: Will be thin, purulent and mildly odorous Dysuria Abnormal uterine bleeding Rectal infection in up to 40% of women with gonorrhea PID gonorrhea diagnostics - Answer -§ NAAT using a urine sample
§ Gram stain of discharge shows gram negative diplococci and WBC § Cervical culture using Thayer-martin media gonorrhea treatment in uncomplicated - Answer - Ceftriaxone 500mg IM once AND azithromycin 1G PO if chlamydia cannot be ruled out, give doxy 100mg BID x 7 days if you cant get ceftriaxone, you can give 240mg IM gentamycin AND 2g azithro instead gonorrhea uncomplicated conjunctival treatment - Answer -if they are older than 1 month... ceftraixone 1G IM once AND azithro 1 G PO Herpes - Answer -o HSV 1 or HSV2, HSV2 is more common o From direct contact o Asymptomatic but still infectious most times o Incubation period is 2-12 days o Women more affected than men Herpes primary infection s/s - Answer -o Could be asymptomatic o Painful ulcerations o HA, malaise, myalgia, dysuria, prutitis o Lymphadenopathy
Famciclovir 125mg BID for 5 days Famciclovir 1g PO once Famciclovir 500mg PO as a single dose, THEN famciclovir 250mg PO BID for 2 days Valacyclovir 1g PO daily for 5 days In immunocompromised: Valacyclovir 1G BID for 5 days · Famciclovir 500mg BID for 5-10 days · Acyclovir 400mg TID for 5-10 days Herpes suppressive therapy - Answer -Acyclovir 400mg PO BID Famciclovir 250mg PO BID up to 1 year Valacyclovir 500mg-1g PO daily for 1 year If immunocompromised: · Famciclovir 500mg PO BID for 1 year · Acyclovir 400-800mg PO BID or TID · Valacyclovir 500mg-1g PO daily for 1 year Start giving suppressive therapy to pregnant females at 36 weeks gestation to reduce risks of HSV exacerbation at delivery Syphilis - Answer -an STD that attacks many parts of the body and is caused by a small bacterium called a spirochete. T. Pallidum is the bacteria Syphilis assessment primary stage - Answer -Chancre at site of inoculation that begins as a papule, the ulcerates with a hard edge
Yellow base Indurated and PAINLESS Usually located on genitalia Persists for 1-5 weeks and heals on its own Regional lymphadenopathy syphilis secondary stage - Answer -6-12 wk flu-like s/s (fever, myalgias, LAD) maculopapular rash, including palms and soles, condyloma lata resolves spontaneously, then enters latent phase mild hepatosplenomegaly syphilis latent stage - Answer -no symptoms syphilis tertiary stage - Answer -• Chiefly involves the cardiovascular system and the nervous system
- Appears years after initial infection if the initial infection was not treated
- Gumma
- Firm mass
- Noninfectious
- Destructive lesion that can result in perforation of the palatal bone Congenital syphilis - Answer -Early · FTT, stillbirth, prematurity, jaundice, anemia, nephrosis · Hallmark rash just like in secondary syphilis Late · CNS changes
