Evaluation and Treatment of Urinary Tract Infections
Evaluation for UTI typically involves examination (e.g., inspection and palpation of the genitals, palpation of the lower abdomen), urinalysis and urinary culture. Treatment is based on the suspected diagnosis. If the urinary culture grows various types of bacteria for example, the patient would be treated with an antibiotic for a UTI. The choice of antibiotic would be based on susceptibility patterns from the culture and potential side effects of the antibiotic. Other considerations might be the patient’s age and whether the kidney function was compromised. Still further considerations would include whether the patient was allergic to any antibiotics. Ideally, the antibiotic chosen would be the most efficacious with the fewest potential adverse side effects.
Frequent causes of these symptoms in men include urinary tract infections (UTIs), urethritis resulting from various causes including STDs (e.g., gonorrhea, chlamydia), and epididymitis. Other, rarer causes, of these symptoms include prostatitis and cystitis.
Patients with a UTI typically have suprapubic discomfort, dysuria, and WBCs on urinalysis. Patients with urethritis may have discharge from the penis and WBCs on urinalysis. Alternatively, they may have positive leukocyte esterase on urinalysis. Patients with epididymitis will often complain of discomfort in their testicles, scrotum, or perineum.
Treatment of a UTI is typically with an antibiotic such as Bactrim. Ciprofloxacin had previously been another first-line therapy antibiotic but because of a slight risk of tendon damage/rupture, ciprofloxacin is typically only used when other first-line agents are thought to be suboptimal for various reasons (e.g., allergies, impaired kidney function). Treatment of urethritis, particularly in cases thought to be caused by gonorrhea and/or chlamydia, are typically treated with ceftriaxone and azithromycin. Cases of suspected epididymitis are typically treated with doxycycline, occasionally along with a second antibiotic.
Urinary tract infection medical expert witness specialties include urology, nursing, primary care, urgent care, emergency medicine, STDs, and infectious diseases.