Infections of the Male Genitourinary Tract
Acute uncomplicated cystitis in adult men is uncommon but oc-casionally occurs in men whose sexual partners have vaginal in-fections with Escherichia coli. Asymptomatic bacteriuria may also occur from genitourinary manipulation, catheterization, or in-strumentation.
The incidence of sexually transmitted diseases (STDs) is in-creasing in men and women. STDs are most common in young, sexually active people, with the incidence higher in men than women (U.S. Surgeon General, 2001). STDs affect people from all walks of life—from all social, educational, economic, and racial backgrounds. Several diseases are classified as STDs: urethritis (gonococcal and nongonococcal), genital ulcers (genital herpes infections, primary syphilis, chancroid, granuloma inguinale, and lymphogranuloma venereum), genital warts (human papilloma-virus [HPV]), scabies, pediculosis pubis, molluscum contagiosum, hepatitis and enteric infections, proctitis, and acquired immuno-deficiency syndrome (AIDS). Trichomoniasis and STDs charac-terized by genital ulcers are thought to increase susceptibility to human immunodeficiency virus (HIV) infection. Trichomonia-sis is associated with nonchlamydial, nongonococcal urethritis.
Treatment of STDs must be targeted at the patient as well as his or her sexual partners and sometimes the unborn child. A thorough history that includes a sexual history is crucial to iden-tify patients at risk and to direct care and teaching. Partners of men with STDs must also be examined, treated, and counseled to prevent reinfection and complications in both partners and tolimit the spread of the disease. Sexual abstinence during treat-ment and recovery is advised to prevent the transmission of STDs (CDC, 2002). Using latex condoms for at least 6 months after completion of treatment is recommended to decrease transmis-sion of HPV infections as well as other STDs. Because patients with one STD may also have another STD, it is important toexamine and test for other STDs. Use of spermicides with nonoxynol 9 (“N-9”) is discouraged as they do not protect against HIV infection and may increase the risk for transmission of the virus (van Damme, 2000; CDC, 2002).