0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

■ Lesions can be swabbed and cultured for bacterial and viral identification.
■ Chlamydia can also be diagnosed via nucleic acid amplification testing of
swab, lymph node aspirate, and urethral or urine samples.
■ Special Chlamydia typing is required to verify strain.

TREATMENT

■ Antibiotics: For STD-associated genital ulcers (see Table 18.10)

EPIDIDYMITIS

Inflammation or infection of the epididymis, epididymitis is due to retrograde
(nothematogenous) spread of bacteria and may spread to involve the testicle
(epididymo-orchitis). Common etiologic organisms vary with age. Less com-
monly, syphilis and TB may be associated with epididymitis.

■ Prepubertal boys: Infection with Gram-negative bacteria due to congenital
structural urinary tract pathology
■ Men<35 years: ChlamydiaandN. gonorrhea
■ Men≥35 years: Gram-negative organisms, predominantly E. coli

SYMPTOMS

■ Gradual onset of pain that may begin in the flank or suprapubic area and
progress to scrotal pain.
■ Fevers/chills
■ Dysuria, urgency, frequency

EXAM

■ Swollen, tender epididymis
■ Prehn sign: Relief with elevation of the scrotum
■ Whole testicle may be swollen if associated orchitis
■ Cremasteric reflex is present.

DIAGNOSIS

■ Mostly clinical
■ Urine culture if prepubertal or over 35 years
■ Urethral swab if under 35 years
■ Ultrasound to rule out torsion, as indicated

TABLE 18.10. Treatment of Sexually Transmitted Genital Ulcers

Chancroid Azithromycin orceftriaxone or ciprofloxin

Herpes Acyclovir

Syphilis Benzathine penicillin G IM

Lymphogranuloma venereum Doxycline

Granuloma inguinale Doxycline orTrimethoprim/sulfamethoxazole