Infection on Male Reproductive Organ

Epididymitis

Epididymitis is infection or less frequently, inflammation of the epididymis (the coiled tube on the back of the testicle). The majority of men that develop epididymitis develop it because of a bacterial infection. Although males of any age can develop epididymitis, it occurs most frequently between ages of 20 to 39. When it develops in children, it is usually due to inflammation caused by trauma. However, some children develop it because of bacterial infections, some of which may be due to sexual abuse. In general, individuals have discomfort and pain in the area of the testicle(s) or groin; some may develop fever, penile discharge and blood in the urine. The epididymis is a firm tube that lies on the back surface of each testicle. It is coiled in order to fit a length of nearly 20 feet into a small space. This long length acts as a storage space for the sperm and gives sperm time to mature. The epididymis can be divided into three sections: 1) the head (an expanded upper end), 2) the body, and 3) the pointed tail. The epididymis also absorbs fluid and adds substances to help nourish the maturing sperm. Each epididymis is directly attached to the testicle so that if the epididymis becomes infected or develops inflammation, the testicle may also develop infection or inflammation. This is termed epididymo-orchitis(infection/inflammation of both the epididymis and testicle). Also, testicular infection is the most common reason for inflammation in the scrotum. The other end of the epididymis attaches to the vas deferens which leads to the prostate gland and then to the urethra. Infections and inflammation often proceed retrograde (also termed backflow) from the urethra; rarely is infection/inflammation spread through the blood to the epididymis.

Epididymitis Causes The cause of epididymitis is usually a bacterial infection. The bacteria usually get to the epididymis by moving back through (retrograde) the urethra, prostate, vas deferens into the epididymis. The responsible bacteria are usually identified in about 80% of cases. Two main groups of organisms cause most cases of epididymitis: sexually transmitted organisms and coliforms (organisms that commonly live in the intestines).
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In men younger than about 39 years of age, the causes are usually the same organisms that cause the sexually transmitted diseases of chlamydia(responsible for nearly 50%-60% of cases) and gonorrhea. The bacterial species are Chlamydia trachomatis and Neisseria gonorrhea, respectively.

In those older than 39 years of age, the causes are usually coliforms, which are bacteria (such as Escherichia coli) that live in the intestines. These organisms also frequently cause bladder infections. Any age of men who participate in anal intercourse are more likely to get infected with E. coli or other fecal bacteria. Epididymitis is rarely caused by fungi or Mycobacterium spp. Chemical epididymitis (rare) is inflammation caused by the retrograde (backward) flow of urine when exercising or having sex with a full bladder. Amiodarone (Nexterone), a frequently used heart medication, occasionally causes inflammation of the epididymis. Viral infections (including mumps), mainly in the pediatric population. Epididymitis Symptoms Symptoms of epididymitis start gradually and often peak within 24 hours. Pain usually begins in the scrotum or groin.

Abdominal or flank pain: At first, inflammation begins in the vas deferens (which is the duct that carries sperm to the urethra) and then descends to the epididymis. This descent explains why symptoms can start initially in the flank (lower back) and groin. One side of the groin or testicle may be much more painful than the other. Scrotal pain and swelling: The epididymis may swell to twice normal size within 3-4 hours (the degree of swelling is variable). Pain on urination, occasionally blood in the urine. Discharge from the urethra (at the end of the penis; especially in men younger than 39 years of age) Fever and chills Nausea Exams and Tests A health care practitioner will take a detailed history (including a sexual history), collect a urine sample, and perform a physical examination, including a prostate exam.

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Laboratory Tests Urinalysis and urine culture: These tests aid in the diagnosis of a urinary tract infection (bladder infection). y Urethral culture
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Urine can be tested for sexually transmitted diseases present in the urethra. Sometimes a swab is inserted about one-half inch into the urethra and sent for testing (although uncomfortable, it only takes a few seconds). o The results usually take about a day to come back to the health care practitioner, so follow-up is very important.
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The health care practitioner often also orders other tests such as a white blood cell count. A white blood cell count may be high if infection is present. A Gram-stain of urethral exudates, in some cases, can presumptively diagnose the infecting bacteria.

There are several rapid tests for some of the bacteria that cause epididymitis (N. gonorrhea, C. trachomatis). They detect the organisms by PCR and immunological methods. However, these tests usually require confirmation by actually culturing the bacteria. Imaging Tests y Ultrasound and nuclear scans help differentiate testicular torsion from epididymitis.
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CT and MRI scans are used occasionally to help determine and differentiate between many conditions that can cause some symptoms similar to epididymitis (for example, cysts, hydrocele formation (fluid filled area),hernias, cancerous tissue, or the extent of abscesses or gangrene in swollen testicles). The correct diagnosis of the cause of epididymitis by health care practitioners is important because an incorrect diagnosis may lead to many problems beyond the symptoms in the individual. The majority of infections involving the epididymis (over 50%) are due to sexually transmitted infectious agents or by bacteria acquired during anal intercourse. Consequently, sexual partners of many patients should be notified and treated, even if they currently show no symptoms. However, many men (usually older than 39 years of age) and some children can acquire the disease without it being linked to sexual transmission (for example, bladder infection or chemical inflammation). Consequently, health care practitioners need to take a detailed history from the patient, and the patient has the responsibility to answer medical history questions honestly. The situation is even more complex when children have symptoms of epididymitis; most experts suggest that a Child Protective Agency be contacted if sexual abuse is suspected.

What is prostatitis? Prostatitis is the general term used to describe prostate inflammation (-itis). Because the term is so general, it does not adequately describe the range of abnormalities that can be associated with prostate inflammation. Therefore, four types of prostatitis are recognized. What are the types and symptoms of prostatitis? There are four types of prostatitis:
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acute bacterial prostatitis chronic bacterial prostatitis chronic prostatitis without infection asymptomatic inflammatory prostatitis

Acute bacterial prostatitis causes and symptoms Acute bacterial prostatitis is an infection of the prostate that is often caused by some of the same bacteria that cause bladder infections. These include E. coli, Klebsiella, and Proteus. While it may be acquired as asexually transmitted disease, the infection can also spread to the prostate through the blood stream, directly from an adjacent organ, or as a complication of prostate biopsy. Patients with acute bacterial prostatitis present with signs of an infection and may have:
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fever, chills, and shakes.

Commonly there is urgency and frequency of urination and dysuria (painful or difficult urination). Chronic bacterial prostatitis causes and symptoms Chronic bacterial prostatitis is an uncommon illness in which there is an ongoing bacterial infection in the prostate. Chronic bacterial prostatitis generally causes no symptoms, however, on occasion; the low grade infection may flare and be associated with a bladder infection.

Chronic prostatitis without infection causes and symptoms Chronic prostatitis without infection, also known as chronic pelvic pain syndrome, is a condition where there is recurrent pelvic, testicle, or rectal pain without evidence of bladder infection. There may be difficulties with painful urination or ejaculation, and erectile dysfunction. The cause of chronic prostatitis without infection is not clearly understood. Asymptomatic inflammatory prostatitis causes and symptoms Asymptomatic inflammatory prostatitis is exactly as its name describes. There are no symptoms. The cause of asymptomatic inflammatory prostatitis is not clearly understood. How is prostatitis diagnosed? The diagnosis of prostatitis relies on a careful history and physical examination by the health care practitioner. The most important laboratory test is aurinalysis to help differentiate the types of prostatitis. The need for other blood tests or imaging studies like ultrasound, X-ray, andcomputerized tomography (CT) will depend upon the clinical situation and presentation. Acute bacterial prostatitis diagnosis After taking a history, the health care practitioner will likely have a directed physical examination concentrating on the scrotum, looking for inflammation of the testicle(s) orepididymis, and the flank and mid-back, where the kidney is located. If a rectal examination is performed, the prostate may be swollen and boggy, consistent with acute inflammation. Laboratory testing may include urinalysis, looking for white blood cells and bacteria, signifying infection. The urine may also be cultured to identify the bacteria that are responsible for the infection, but results will take up to seven days to return. The results will help confirm that the antibiotic chosen is correct and may help choose an alternate antibiotic should the illness progress. Chronic bacterial prostatitis diagnosis The diagnosis is made by finding an abnormal urinalysis. Sometimes, a urinalysis is collected after prostate examination. This may allow some prostatic fluid to be expressed into the urine and cultured.

A blood test called PSA (prostate surface antigen) may be elevated in this type of prostatitis. While PSA is used as a prostate cancer screening tool, it can also be elevated whenever the prostate is inflamed. Chronic prostatitis without infection diagnosis To make the diagnosis of chronic prostatitis without infection, symptoms should be present for at least three months. The cause of chronic prostatitis without infection (chronic pelvic pain syndrome) is not known. This is a frustrating condition for the patient and the health care practitioner since there is controversy as to the aggressiveness of testing, and exactly what tests should be done. Often, this is a diagnosis of exclusion, meaning that blood tests, urine tests, xrays and ultrasounds tend to be normal, yet the patient continues to suffer. Asymptomatic inflammatory prostatitis diagnosis There are no symptoms with this type of prostatitis, however, when routine lab tests are performed, white blood cells (a sign of inflammation) are found in the urine, but there are no associated bacteria or infection. What is the treatment for prostatitis? Acute bacterial prostatitis treatment Treatment for acute bacterial prostatitis is a prescription for antibiotics by mouth, usuallyciprofloxacin (Cipro) or tetracycline(Achromycin). Home care includes drinking plenty of fluids, medications for pain control, and rest. If the patient is acutely ill or has a compromised immune system (for example, is taking chemotherapy or other immune suppression drugs or has HIV/AIDS), hospitalization for intravenous antibiotics and care may be required. Chronic bacterial prostatitis treatment Chronic bacterial prostatitis treatment is with long-term antibiotics, up to eight weeks, with ciprofloxacin (Cipro, Cipro XR), sulfa drugs [for example, sulfamethoxazole andtrimethoprim, (Bactrim)], or erythromycin. Even with appropriate therapy, this type of prostatitis can recur. It is uncertain as to why, but it may be due to a poorly emptying bladder. A small amount of stagnant urine allows the potential for recurrent infection to occur. This situation can be caused by benign prostatic hypertrophy (BPH), bladder stones, or prostate stones. Chronic prostatitis without infection treatment

Chronic prostatitis without infection treatment addresses chronic pain control and may include physical therapy and relaxation techniques as well astricyclic antidepressant medications. Other medication possibilities include alpha-adrenergic blockers. Tamsulosin(Flomax) and terazosin (Hytrin) are drugs that block the non-heart adrenaline receptors and are used in treating BPH and bladder outlet obstruction. Allowing better bladder emptying may help minimize symptoms. Asymptomatic inflammatory prostatitis treatment Treatment is not required for this type of prostatitis. In patients undergoing infertility assessment, this inflammation may be treated with a course of either a nonsteroidal anti-inflammatory medication(ibuprofen, Motrin, Advil) or antibiotics.

Orchitis Orchitis is an acute inflammatory reaction of the testis secondary to infection. Most cases are associated with a viral mumps infection; however, other viruses and bacteria can cause orchitis. Orchitis is characterized by testicular pain and swelling. The course is variable and ranges from mild discomfort to severe pain. Associated systemic symptoms Fatigue Malaise Myalgias Fever and chills Nausea Headache Mumps orchitis follows the development of parotitis by 4-7 days. Obtain a sexual history, when appropriate. Tests and diagnosis By Mayo Clinic staff Tests that your doctor may use to diagnose orchitis and to rule out other causes of your testicle pain include:
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A physical exam. A physical exam may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side; both may be tender to the touch. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness. STI screening. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which will be viewed under a microscope or cultured to check for gonorrhea and chlamydia. Urinalysis. A sample of your urine, collected either at home first thing in the morning or at your doctor's office, is analyzed in a lab for abnormalities in appearance, concentration or content.

Ultrasound imaging. This test, which uses high-frequency sound waves to create precise images of structures inside your body, may be used to rule out twisting of the spermatic cord (testicular torsion). Ultrasound with color Doppler can determine if the blood flow to your testicle is reduced or increased, which helps confirm the diagnosis of orchitis. Nuclear scan of the testicles. Also used to rule out testicular torsion, this test involves injecting tiny amounts of radioactive material into your bloodstream. Special cameras can then detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, confirming the diagnosis of orchitis. Nursing Intervention 1. Ice pack 2. rest