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Urinary Infections

Cystitis Cystitis is the bladder infection caused by various microbic organs. The reasons for cystitis can be sexual intercourse, operations on the urinary tract, giving birth, neurological problems, the presence of a stone or another foreign body in the bladder, low water consumption level, conditions where the bladder is insufficient with biological defense barriers against […]

Cystitis

Cystitis is the bladder infection caused by various microbic organs. The reasons for cystitis can be sexual intercourse, operations on the urinary tract, giving birth, neurological problems, the presence of a stone or another foreign body in the bladder, low water consumption level, conditions where the bladder is insufficient with biological defense barriers against infectious agents. It’s typically diagnosed through the significant amount of bacteria in the urine during the first stages of pregnancy. Female individuals are under the risk of getting infected from their urinary tracts during pregnancy and the early stages following pregnancy and any infections detected should immediately be treated. The symptoms are Frequent urinating, sensation of immediately urinating, burning sensation during urinating, urinating frequently at nights, pain right under the abdomen and the sensation of ailment. Urinary incontinence and blood in the urine can be possible, high fever is quite rare for this condition. Diagnosis: It’s diagnosed by detecting the presence of infection through basic urine analysis and the type of microbe causing the infection through urine culture.

Treatment: Treatment with antibiotics is applied against the microbic agent causing the infection. However, medications that are convenient and won’t damage the fetus should be selected for pregnant patients. Increasing the consumption of water, meticulous care of personal hygiene and especially the hygiene of genital area, treatment of urinary tract problems such as stones in the system etc., treatment of vaginal secretion and infection could be considered among the possible measures that can be taken. In addition to basic measures, urine analyses during the routine check for pregnant patients can be recommended.

 

Interstitial Cystitis

Chronic severe pelvic pain and restriction of (difficulty in) daily activities are the typical symptoms.

This is a chronic inflammatory disease characterized by frequently urinating, urge to urinate, nocturia, pain during sexual intercourse and suprapubic pain and of which the etiology is unknown.

Although the clear reasons for this disease aren’t known completely; infection, autoimmunity, allergy, and stress can be considered in its etiology. While the average age for this disease is 40, 25% of the patients are under 30 years old. Symptoms of the disease can be quite severe in some cases and may affect the life quality of patients. It’s been discovered that it usually lasts 2-5 years for patients with interstitial cystitis to have the correct diagnosis and it’s been reported that they visit 5 different physicians on average during this period. Many patients with this disease live undiagnosed for around 10-30 years. The diagnosis depends on how suspicious is the doctor. The display specific for the disease can be provided through cystoscopy. Pentosan polysulphate, antihistaminics, and antidepressants are used for the treatment. Pentosan polysulphate covers the deficient GAG layer.

Treatment is possible through BOTOX injection conducted with special injectors within the bladder through cystoscopy. Minimal invasive and invasive surgery are among the treatments.

 

Eosinophilic Cystitis

Although its reasons are not completely known, it’s generally seen in the patients with the history of allergy. Syria, urge to urinate, hematuria and suprapubic pain are the symptoms. Eosinophilic infiltration holding the bladder Wall pathologically can be seen and hydronephrosis caused by this may develop. Radiologic display of bladder cyst and wall thickening may be mixed with a bladder tumor. The display specific for the disease can be provided through cystoscopy and the display may be similar to a tumor in some cases. Antihistaminic, anti-inflammatory medications can be prescribed for the treatment and steroids can also be prescribed if needed. In the cases where there are bleeding and no medical responses, TUR (transurethral resection) can be conducted. In 70% of the patients, other pathologies such as asthma, allergic rhinitis, and autoimmune diseases were detected.

Sexually Transmitted Diseases

Gonococcal Urethritis (Gonorrhea)The cause of gonococcal urethritis is Neisseria gonorrhoeae, a gram-negative diplococcus. While the incubation period ranges between 3-10 days, the time needed for the symptoms to occur might be as short as 12 hours or longer as 3 months. The most common reason for gonococcal urethritis is sexual intercourse. While for a male individual, the risk of getting transmitted from an infected partner after one intercourse is 20%, the same risk for female individuals is around 80%. The more the number of sexual intercourses with a conductor or infected partner increases, the riskier it becomes to be transmitted.

 

Symptoms and Findings:

  • Urinary burning
  • Urethral secretion (Secretion is typically inflamed, looks -yellow-brown and plenty)

Complications:

  • Periurethritis, periurethral apse
  • Urethral Stricture

Prostatitis, prostate apse, epididymitis, proctitis, and arthritis may be seenTreatment and Protection:

Gonorrhea can be prevented by regular use of condoms during the intercourse and antibiotics afterward and applying intravaginal antiseptic or antibiotics. Ceftriaxone, Spectinomycin Ciprofloxacin, Norfloxacin, Cefuroxime Aksel, Ceftizoxime and Amoxicillin can be used for treatment. Follow-up after the treatment is important. If the urethritis continues between the 3rd and 7th day of the treatment; resistance improvement, postgonococcic urethritis or re-infection should be considered. Non-gonococcal Urethritis (NGU)When N. gonorrhea can’t be found in the presence of urethritis through culture test or gram painting, then the diagnosis would be non-gonococcal urethritis. The most vital and severe agent is Chlamydia Trachomatis. It can be found in the urethra of 25-60% Male individuals with NGU and 4-35% of the male individuals with gonorrhea. 50% of the chlamydial infections are asymptomatic, however, the persons are conductors. Ureaplasma urealyticum is the cause of NGU in 20-50% of the patients. It’s the most common around the ages of 20-24. 50-75% of acute urethritis is non-gonococcal. The incubation period is between 7-35 days.

Symptoms:

  • Urethral secretion, (secretion is typically little, thin and mucoid)
  • Dysuria (urinary burning) and urethral (urinary tract) itching and stinging feeling.

 

Treatment and Protection:

Tetracycline, doxycycline or erythromycin can be used. Protection from NGU is limited to use of condoms and vaginal spermicidal as in gonorrhea. Treatment of partners at the same time is a very important aspect.

 

Syphilis

 

Syphilis is caused by the spirochete called pallidum. T. pallidum goes into the body through skin and mucosa and indolent canker (a wound that looks like stapled) develops on the penis in 2-4 weeks following the sexual intercourse. The spot of pain can’t be detected by pushing. The lesion heals itself slowly when not treated. The disease proceeds to the 2nd stage. One or two-sided, independent, indolent lymphadenopathies (swelling of lymphatic glands) can be detected on the inguinal area.

 

Lab Findings:

It’s diagnosed by observing the spirochetes during dark field analysis or by fluorescent antibody techniques on the sample obtained by scratching the bottom of the canker. If the dark field analysis is not possible, the serological test should be conducted. Serological tests can give negative results even 1-3 weeks after cancer develops.

 

Complications:

Urological complications are rare and are seen on the 3rd week of the disease. Testicle and neurogenic bladder observed in neurosyphilis can be the examples for these complications.

 

Treatment:

The patients with the early stage of syphilis are prescribed penicillin G. The patients who are allergic to penicillin may be prescribed doxycycline or tetracycline.

 

Trichomonas

 

The disease is caused by Trichomonas vaginalis. The prevalence is 2%. It’s commonly seen between the ages of 15-40. It’s transmitted through sexual intercourse and it’s been diagnosed with the rate of 60% in male partners of female individuals and 67-100% in the female partners of the male individuals. It’s typically asymptomatic in male individuals.

 

Treatment and Protection:

The use of condoms is required until the treatment ends with successful results. The patient and his/her partner are prescribed metronidazole. The response to the treatment would be immediate. Treatment of both partners is vital for a complete cure.

 

Chancroid (Ulcus Molle)

 

It’s caused by Haemophilus ducrey. The papule seen few days after the sexual intercourse is the first symptom of chancroid. Afterward, one or multiple, grimy looking, painful chancroid ulcers develop. Typically causes inflamed secretion. The patients typically have fever, headache, and fatigue. Ulcers that are not treated slowly grow, pop and merge with others. Painful groin inflammation causes lymphatic obstruction and first genital lymphedema, and then elephantiasis develops in the next stage. In 50% of the patients, as a result of the examination of the sample obtained from the ulcer through gram painting, gram-negative cocobasillery is observed. The biopsy is always the diagnostic aspect.

 

Treatment:

Azithromycin 1 g. single dose, erythromycin 500 mg. 4×1 7 days, ceftriaxone 250 mg. One dose can be used. Conducting an HIV test during diagnosis and 3 months later would be convenient. Prognosis is sufficient with the correct treatment.

 

Lenfogranuloma Venereum

 

It’s caused by Chlamydia trachomatis. Genital lesions, lymphadenitis, and rectal obstruction can be seen. A papule or a pustule may develop in 5-21 days following the sexual intercourse. The genital lesion is typically small and not obvious to the eye. Reproduction of C. trachomatis in culture makes diagnosis possible.

Complications:

Running sinuses develop with the rupture of inguinal (groin) lymph nodes. Chronic inguinal inflammation may cause lymphatic obstruction and elephantiasis. Rectal obstruction is a complication that develops in the later stages.

Treatment:

Doxycycline, 100 mg. 2×1 is used for 3 weeks.

 

Granuloma Inguinale

 

It’s caused by Calymmatobacterium granulomatis (Donovan bacillus) and the incubation period is 2-3 months.

 

Clinical Findings:

The papule is the first symptom. From this papule; a swollen, erythematous on the bottom and hemorrhagic secretion containing, indolent ulcer develops. It’s diagnosed through the observation of Donovan agents in the colored smear.

 

Treatment:

Tetracycline 500 mg. 4×1 or trimethoprim-sulfamethoxazole (160/800 mg. tablet) 2×1 is used until the lesions are cured.

Prostatitis

Non-Microbic Chronic Inflammation of Prostate

Chronic non-bacterial prostatitis” which is very common among male individuals is the inflammation of the prostate without the effect of any bacteria. Symptoms might be frequent urination, immediate or difficult urination, pain, and burning sensation during urination, frequent urination at nights, pain on the lower back or genital area, lower amount of urination flow, blood in the semen, pain during ejaculation, mild temperature and repetitive bladder infections. However, no bacteria are detected in the urine or prostate gland fluid. Therefore, diagnosis and treatment of this prostatitis type are quite difficult. And the aim is to relieve or lower the symptoms rather than eliminating the disease completely. Some of the factors that are believed to be stipulating this inflammation are as follows:

  • Sexual activity: It’s seen more commonly among the young male individuals with an STI (clap, chlamydia etc.) and who are sexually active. Decreased rate of sexual activity might be an improving factor for some male individuals.
  • Concern or stress: Stress causes the contraction of the muscles controlling the urine flow. These muscles are pelvic floor muscles supporting bladder and rectum. Contractions prevent muscles from regular relaxation and cause urine to go back to the prostate and damage the tissue.
  • Ending and restarting urination: Some male individuals frequently stop and restart while urinating. Stopping the urine flow causes the urine to go back and this damages the prostate.
  • Carrying Heavy Things: Carrying heavy things while the bladder is full would cause the urine to go back to the prostate.
  • Occupation: Occupations such as truck driving could be associated with this infection.
  • Miscellaneous: Activities such as cycling or jogging might damage the gland.Acute Inflammation of Prostate

While acute inflammation of prostate is hardly seen, it’s quite a severe condition. The most common symptoms of this condition are fever, chill, cold, pain, and burning sensation during urination, difficulty during urination, feeling that the bladder is not completely empty, frequent and immediate need for urination, blood in the urine, pain during ejaculation.

This prostatitis type is typically caused by the bacteria in the urinary system and large intestines. Acute bacterial prostatitis might cause severe problems such as the inability to urinate and spreading of infection through the blood flow. Therefore, the persons with these symptoms should immediately visit their doctor and be hospitalized for a couple of days in case the symptoms are severe. Acute Microbic Inflammation of Prostate

This prostatitis type is caused by bacterial infection. Unlike acute prostatitis, symptoms occur slower and they are almost the same with chronic non-bacterial prostatitis. The reason for chronic bacterial prostatitis is not clear. It might be due to bacteria in the urinary system, bladder or blood infection. Stones that might appear in the prostate gland or structural defects in the prostate might also cause prostatitis. The infection might be due to an instrument (such as a catheter) inserted in the urinary system. This is the reason why doctors usually prescribe antibiotics after urinary catheter.The two most important steps in the diagnosis of prostatitis are the elimination of other conditions causing similar symptoms and the determination of the type of prostate inflammation. In order for this, your medical history should be examined thoroughly. Examination of the treatments you received in the past, infections you had, your sexual life and family history matters. Additionally, a physical examination and a rectal digital examination would be required. During the digital exam, your physician might obtain some fluid from your prostate. This operation is called “prostate massage” or “stripping”. The fluid obtained from your prostate will be examined under a microscope for infection or inflammation symptoms. A urine sample is required for bacteria and leucocyte check. Leucocytes show inflammation, and bacteria show infection. If your urinary test is positive for both, then it means you have bacterial prostatitis. If it’s positive for leucocyte, but not bacteria, then it is the aseptic form. If there are no bacteria or leucocyte, then it means your symptoms are about other diseases.

 

Prostatitis Treatment

 

Antibiotics

Antibiotics are the first option for all prostatitis types. Your physician would prescribe you a broad spectrum antibiotic until the specific bacteria type causing the infection is discovered. The period of use for the antibiotic depends on the respond of the infection to the antibiotic. A couple of weeks treatment would be enough for acute prostatitis. On the other hand, the chronic non-bacterial type is resistant and the treatment takes a longer period, sometimes it may not be possible to treat. Additionally, the infection may repeat when you stop getting the medication. Even though non-bacterial prostatitis may not be caused by infections, your physician may prescribe an antibiotic treatment that will take a few weeks. Alpha Blockers

Your physician may prescribe an alpha-blocker treatment since the difficulty in urinating may be due to a blockage in the urinary system. These medications relieve bladder neck and prostate.

Painkillers

NSAID agents or acetaminophen may reduce the pain and ailment. However, the dose should be decided by your doctor due to possible side effects.

 

Physical Therapy

Physical therapy techniques applied in addition to medical treatment are important in terms of reducing the symptoms of prostatitis. A physiotherapist would be needed to decide the exercises and their frequency. In some male patients, tightening and relaxing pelvic muscles might reduce the symptoms. In the diathermy treatment which is one of the methods used for this, electric current is used to warm and relieve the muscle tissue. Another method, Biofeedback is a technology that helps you relax your muscles. The therapist places electrodes and receivers to your body during a biofeedback session. Electrodes are connected to a monitor and give feedback about the body functions as muscle strain. In the meantime, your therapist applies various relaxation techniques to help you relax. It’s not completely known how physiotherapy helps prostatitis. However, physiotherapy has an important role in the relaxation of muscles since it’s assumed that the condition is caused by tight and contracted muscles.

 

Prostate Massage

Prostate massage reduces edema that could cause infection and helps antibiotics to effect the inflamed tissues easier.

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