-Cystitis-
-Acute cystitis refers to infection of the bladder (lower urinary tract)
-the pathogenesis of UTI is colonization of the bacteria by uropathogens usually from fecal flora (in women) in the urethra and they ascend up through the lower urinary tract
-pyelonephritis is when the bacteria ascend up the ureter to the kidney
-Uncomplicated UTI in women consists mainly of Escherichia Coli (75-95%) with other bacteria making up the rest (enterobacter, Proteus Mirabillis, and Klebsiella pneumoniae)
-Among non pregnant women, colonization of organisms such as lactobacilli, enterococci, and group B strep from clean catch urine most commonly represents contaminated urine. If these are in symptomatic women in high counts they should be treated as a UTI
-Antibiotic resistance > 20 percent with ampicillin and bactrim, less than 10 percent with fluoroquinolones
-Augmentin and first generation cephalosporins are less than 10 percent usually
-Nitrofurantoin can also be used for pregnant patients
-Symptoms include dysuria, frequency, urgency, suprapubic pain and hematuria
-Urinalysis for the evaluation of pyuria is the most important test for a UTI
-WBC with cast are diagnostic of an upper urinary tract infection
-Leukocyte esterase (>10 leukocytes per high power field) sensitivity 75-96 sensitivity
-Treatment usually for up to 7 days with uncomplicated UTI
-Asymptomatic pyuria in men is rare. Should be done after a TURP
-Risk factor for these infections are anal intercourse and the lack of circumcision
-A complicated UTI can be upper or lower urinary tract infection but is associated with a risk factor of failing therapy. Some of these risk factors include: diabetes, pregnancy, symptoms more than 7 days, renal failure, nosocomial infection, urinary tract obstruction, instrumentation, renal transplant, and immunosuppression
-Pyelonephritis is an infection of the kidney characterized by fever, flank pain, nausea, and vomiting. Symptoms of a lower urinary tract infection are usually present
-Epididymitis-
-Epididymitis is the most common infection seen in the outpatient setting for scrotal pain.
-Epididymitis is an infection of the epididymis that lays superior to the testis
-More advanced cases present with testicular swelling and pain epididymo-orchitis
-Acute epididymitis is less than 6 weeks
-Chronic epididymitis is more than 6 weeks
-physical exam shows tenderness to the epididymis with or without swelling.
-Urinalysis should be obtained but the urine is usually negative especially in patients without urinary complaints
-Ultrasound should be performed to assess for the presence of torsion
-All men should be treated empirically with regimens that cover C. Trachomatis and N. Gonorrhoeae
(rocephin 250 mg IM plus Doxycyline 100 mg BID for 10 days)
-Men that are over 35 that practice anal intercourse should be covered with rocephin plus ofloxacin or levaquin for 10 days
-Epididymitis that is non infectious is rare and caused by trauma, vasculitis or autoimmune disorders
-Orchitis-
-Orchitis is inflammation or infection of the testis
-Orchitis without epididymitis is extremely rare
-Mumps should be considered as a diagnosis with isolated orchitis
-In immunized adults, viruses similar to those in children can cause orchitis
-When seen concurrently with epididymitis should be treated with the same antibiotic coverage as isolated epididymitis
-Prostatitis-
-Acute bacterial prostatitis is an infection of the prostate usually caused by gram negative organisms
-Entry of the microorganisms into the prostate almost always occurs via the urethra
-There may be an infection of the epididymis at the same time
-Prostatitis can occur in the presence of cystitis, urethritis, or other urogenital infections
-Common causative organisms of prostatitis include E.Coli, Proteus, Klebsiella, Enterobacter, Staphylococcus aureus, and Pseudomonas
-If patient is less than 35, the patient should be treated for gonorrhea and chlamydia
-Diagnosis is made digital rectal exam
-Treatment of acute prostatitis can include bactrim, cipro, levaquin for 6 weeks
-Chronic prostatitis is recurrent urogenital symptoms with evidence of bacterial infection of the prostate
-Pathogenesis of chronic prostatitis is the same as acute prostatitis
-Common organisms of chronic prostatitis is enterococcus, klebsiella, proteus, and pseudomonas. Chlaymida has been an associated organism
-For chronic prostatitis fluoroquinolones or bactrim is needed for at least 6 weeks
-Pyelonephritis-
-Pyelonephritis is an infection of the kidney
-Pyelonephritis presents with fever, chills, flank pain, nausea, vomiting, dysuria, polyuria, and/or hematuria
-Common organisms include E.Coli, Proteus, Klebsiella, and Staphylococcus
-Treatment should involve cipro or levaquin, cephalosporins, or beta lactam inhibitors
-Antibiotics should be administered for 10-14 days
-Urethritis-
-N. Gonorrhea is the most common cause of urethritis in the United States
-C. Trachomatis is the most common cause of non gonococcal urethritis
-Clinical manifestations of urethritis include dysuria, and penile discharge from the urethral meatus
-Diagnosis is made by penile discharge on examination, positive urethral swab, positive leukocyte esterase on first catch urine, or positive urine culture
-Gonorrhea is treated with 250 mg of rocephin
-Chlamydia is treated with 1 gram of Zithromax or 100 mg of doxycycline BID for 10 days
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