THER3010 week 3 Genetic male reproductive pathology

define testicular torsion

twisting of spermatic cord (medical emergency)

etiology of testicular torsion

congenital abnormality (most common - Bell-Clapper deformity [90%]); neonates before/during descent; strenuous movement

what causes Bell-Clapper deformity

testis lack normal posterior anchoring to tunica vaginalis, allowing it to move freely, leaving potential to twist around a cord

clinical manifestations of testicular torsion

sudden scrotal pain & inflammation; absence of cremasteric reflex

how soon after incidence does testicular torsion need to be treated to save the testicle

12-24 hours

massage C/I with testicular torsion

do not treat → medical emergency

etiology of epididymitis

bacterial pathogens (UTI, prostatitis) STI (chlamydia, gonorrhea)

clinical manifestations of epididymitis

unilateral pain / swelling, erythema & edema of scrotal sac, tenderness, fever, dysuria, urethral discharge possible with STIs

true or false: in epididymitis the cremasteric reflex remains intact

true

how are epididymitis and orchitis diagnosed

elevated WBC count, urinalysis to identify bacteria, US possible

how is epididymitis and orchitis treated

address STIs, antibiotics, bed rest

massage C/I's with epididymitis or orchitis

active infection → avoid treatment

define orchitis

inflammation of testicles

etiology of orchitis

testicular infection, can be local or spread via lymphatics / blood (e.g., mumps, pneumonia)

clinical manifestations of orchitis

residual hyalinization of tubules post acute inflammation; spermatogenesis irreversibly impaired in 30% of mumps cases; fever, painful enlargement of tests

what is the most common form of scrotal cancer

skin cancer

etiology of scrotal cancer

exposure to carcinogens such as tar, soot, oil; poor hygiene; HPV

Clinical manifestations of scrotal cancer

presents around 60 years of age; can appear wartlike or ulcerative

how is scrotal cancer diagnosed

presence of ulcerative growth, Changes in skin appearance, evaluation of lymph node involvement

how is scrotal cancer treated

dependent on cell type involved - excision, chemo, radiation, etc.

etiology of testicular cancer

idiopathic; predisposing factors: undescended teste (cryptorchidism), ages 15-35, HIV

predominance of testicular cancer

rare, 1% of all male cancers

clinical manifestations of testicular cancer

enlargement of testicle, minor discomfort / painless lump; increased pain as condition progresses; metastasis not common (10%)

diagnosis of testicular cancer

physical exam; rule out other male reproductive pathologies via blood tests, urinalysis, ultrasound; early diagnosis necessary as late stages are harder to treat

how is testicular cancer treated

surgical removal, chemotherapy, radiation; can result in sexual dysfunction and infertility

define prostatitis

a variety of inflammatory disorders of the prostate gland

etiology of prostatis

acute and chronic bacterial; idiopathic / spontaneous (pelvic pain syndrome) - 90% of cases; asymptomatic inflammatory

clinical manifestations of prostatitis

ascending urethral infection (UTI), cloudy, foul-smelling urine, reflux of urine into prostatic ducts; E.Coli infection; prostatic massage produces thick discharge; possible abscess

what is the most common organism that causes acute and chronic bacterial prostatitis

E. Coli

How is prostatitis diagnosed

bacterial culture, s/s, physical exam

how is prostatitis treated

antibiotics (3-4 months if chronic), bed rest, antipyretics, analgesics / anti-inflammatories, stool softeners

massage C/Is with prostatitis

active infection → avoid massage; mods for meds

define benign prostatic hyperplasia

age related, non-malignant, prostate enlargement

etiology of benign prostatic hyperplasia

age (>50% of men over 60 affected), family history, race (african american), dietary fat & meat consumption

what hormonal factors appear to contribute to benign prostatic hyperplasia

testosterone, dihydrotestosterone, estrogens

clinical manifestations of benign prostatic hyperplasia

periurethral enlargement → urinary obstruction, increased UTI risk, bladder distension/damage, incomplete emptying of bladder, eventual renal failure

how is benign prostatic hyperplasia diagnosed

prostate-specific antigen (PSA) blood testing; ultrasound, biopsy

PSA is a glycoprotein secreted by benign and malignant tumor cells in the prostate. elevated levels can indicate what male reproductive pathologies

benign prostatic hyperplasia, prostatitis, prostate cancer

how is benign prostatic hyperplasia treated

meds to minimize growth hormones and improve urine flow (via smooth muscle relaxant), possible surgery

massage C/I’s with benign prostatic hyperplasia

monitor for UTI/kidney dysfunction; risk of prostate cancer

etiology of prostate cancer

very common; age (65+), race (african american), family history, dietary patterns, hormonal influences

factors protecting from development of prostate cancer

dietary factors (lycopene, selenium, vit E), preventative drugs

clinical manifestations of prostate cancer

early stages typically asymptomatic; late stage changes associated with voiding pattern: urgency, frequency, nocturia, hesitancy, dysuria, hematuria, blood in the ejaculate

how is prostate cancer diagnosed

PSA test for early detection

how is prostate cancer graded

based on histological characteristics; Gleason grading system used to determine lvl of differentiation from surrounding tissue; staging done with TMN system

how is prostate cancer treated

radiation seeds, hormone therapy; slow growing - occasionally no treatment

massage C/I’s with prostate cancer

avoid during use of radioactive pellets

common medications seen with male reproductive pathologies

cancer therapies, antibiotics, pain meds

primary cause of most STIs

bacterial pathogens

true or false: STI’s are typically treatable but are becoming increasingly drug resistance

true

what form of STIs are generally recurrent

viral

define human papilloma virus

viral infection manifesting as genital warts

etiology of HPV

viral infection

true or false: condoms have been proven effective at completely eliminating transmission of HPV

false

typical length of HPV infection

self-resolving, ~2 years

clinical manifestations of HPV

typically asymptomatic / subclinical; condylomata acuminata, keratotic warts, papular warts, flat warts; predisposing to cervical cancer

describe condylomata acuminata

cauliflower shaped lesions on moist skin surfaces

describe keratotic warts

thick tissue with horny layer on fully keratinized skin

describe papular warts

smooth surface usually develop on fully keratinized skin

describe flat warts

macular, sometimes raised, usually invisible to the eye; on fully or partially keratinized skin

how is HPV diagnosed

cervical PAP screening (females); s/s, physical exam; biopsy possible

treatment for HPV

no treatments available; vaccines exist for most common strains; removal of warts via surgery, cryotherapy, laser, topical acid

define genital herpes

lesions of viral cause in genital/rectal/perianal regions

what are the nine types of herpes virus

HSV-1, cold sores, HSV-2, genital herpes, varicella-zoster, chicken pox, shingles, Epstein-Barr, mononucleosis

length of infection of genital herpes

can be latent; primary are self-limiting (2-4 weeks); recurrent (7-10 days)

how is genital herpes transmitted

direct contact with infection lesions; asymptomatic shedding

clinical manifestations of primary genital herpes infection

tingling, itching, pain in genitals; small pustules → wet ulcers; dysuria, urine retention, fever headaches, malaise, muscle ache, lymphadenopathy

clinical manifestations of recurrent genital herpes infection

like primary but less severe; itching, burning, tingling, fewer lesions and fewer systemic symptoms

true or false: most genital herpes are neurotropic, meaning they can grow in neurons

true

how is genital herpes diagnosed

swabs, physical exam, s/s, serologic tests to determine Hx of infection

how is genital herpes treated

no known cure; antiviral drugs can shorten duration / frequency; suppression treatment during end stage pregnancy to avoid fetal transfer

define candidiasis

irritation in the reproductive genitalia of males and females; can grow in other locations like the mouth (AKA oral thrush)

etiology of candidiasis

fungal infection (candida); can be transmitted between partners, not always sexual; risk factors include antibiotic therapy, high hormone levels, diabetes, HIV

length of candidiasis infection

until eradication of fungus; can be chronic (4+ episodes/year)

clinical manifestations of candidiasis

thick odorless, cheesy vaginal discharge; vulvar irritation, dysuria, redness; males typically asymptomatic carriers

how is candidiasis diagnosed

s/s, physical exam, culture swabs, vaginal pH

how is candidiasis treated

antifungal agents (oral / topical)

define trichomoniasis

parasitic reproductive genitalia infection

ideology of trichmoniasis

anaerobic protozoan; very common

clinical manifestations of trichomoniasis

asymptomatic in males; common cause of vaginitis; frothy, malodorous green/yellow discharge; erythema / edema of affected mucosa; “strawberry spots” on cervix

how is trichomoniasis diagnosed

swabs, cultures

how is trichomoniasis treated

oral metronidazole / tinidazole; treat sexual partners; abstinence until full therapy is completed

side effects of trichomoniasis treatment

nausea, vomiting, skin flushing, headache, palpitations, lowering of BP with alcohol ingestion

define chlamydia / gonorrhea

STI of the reproductive tracts in males and females

etiology of chlamydia

bacteria, most prevalent STI in USA / Canada

clinical manifestations of chlamydia

often subclinical / asymptomatic; BV in females, cervical discharge most common symptom, eythema, edema, PID develops in ~40% of females

it is theorized that as many as ___ % of UTIs are caused by chlamydia / gonorrhea

50

how is chlamydia diagnosed

s/s, physical exam, swabs, discharge evaluation

possible serious complication of chlamydia, more common in males

reactive arthritis (Reiter syndrome)

how is chlamydia / gonorrhea treated

antibiotics

etiology of gonnorhea

bacterial infection; enters via genitourinary tract, eyes, oropharynx, anorectum, skin, childbirth; manifests 2-7 days post exposure

clinical manifestations of gonorrhea

septic arthritis; pain, redness, discharge; may be asymptomatic

etiology syphilis

bacterial infection; primary- painless chancre; secondary - 2-3cm condyloma lata; tertiary - syphilitic gumma

describe a condyloma lata

elevated red-brown lesions, may have discharge or be ulcerative; very contagious

describe syphilitic gumma

rubbery, necrotic lesions found in liver, bone, testes

clinical manifestations of primary syphilis

painless chancre, heals without treatment (3-12 weeks)

clinical manifestations of secondary syphilis

rash, fever, sire throat, stomatitis, nausea, loss of appetite, inflamed eyes; condyloma lata; very contagious

clinical manifestations of tertiary syphilis

CNS lesions → blindness, dementia, SCI; CV lesions → scarring of thoracic aorta, aneurysm formation

diagnosis of syphilis

serologic tests 6 weeks after incubation period; polymerase chain reaction testing

how is syphilis treated

penicillin for several weeks; long-acting injectable doses