Men's Health PDF

### **Men's Health** 1. **Prostate Screening** a. **Guidelines**: Prostate screening generally involves the PSA test and digital rectal exam (DRE), typically recommended starting at age 50, or earlier if there are additional risk factors. Rarely indicated in young pat...

### **Men's Health** 1. **Prostate Screening** a. **Guidelines**: Prostate screening generally involves the PSA test and digital rectal exam (DRE), typically recommended starting at age 50, or earlier if there are additional risk factors. Rarely indicated in young patients without any urinary complaints related to the prostate. Older patients with BPH symptoms prostate exam are indicated. b. **Risk Factors**: Higher risk in men over 50, African American men, and those with a family history. c. **Diagnostics**: PSA levels, DRE, and if needed, biopsy. d. **Referral and Follow-up**: Patients with elevated PSA or abnormal DRE results should be referred to a urologist. e. **Assessment Findings**: Common symptoms include urinary difficulty, pain, or erectile dysfunction. 2. **Testicular Cancer** f. **Screening**: Self-exams are essential for early detection, especially for men between 15-35 years old. g. **Risk Factors**: Cryptorchidism, family history, and genetic predispositions. h. **Assessment Findings**: Presence of a painless lump, swelling, or heaviness in the scrotum. i. **Treatment**: Surgery, chemotherapy, and/or radiation. j. **Referral and Follow-up**: Early referral to oncology or urology is crucial for effective treatment. 3. **Cryptorchidism** k. **Risk Factors**: Premature birth, low birth weight, family history, hypospadias, prenatal exposure to endocrine disruptors such as pesticides. Maternal smoking or diabetes, high maternal alpha-fetoprotein levels, Kleinfelter syndrome. l. **Assessment**: Absence of one or both testes upon palpation of the scrotum, One or both testicles in a location other than the scrotum. Perform XM with warm hands. Infant examination: supine, frog-leg position, or sitting on parents\' lap. Older child examination: supine or sitting upright cross-legged position. Most patients with cryptorchism have an inguinal hernia. m. **Referral**: referred for urologic evaluation, if testicle (s) not descent by the age of six months or for boys, older than six months (corrected for gestational age) with possibly possible newly diagnosed (acquire) cryptorchidism. Multiple specialist consultation for evaluation of possible disorders of sex development for all phenotypic newborn boys with bilateral nonpalpable testes. 4. **Inguinal Hernia** n. **Risk Factors**: Family history, chronic cough, obesity, and physical strain. o. **Assessment**: A noticeable bulge in the groin area, discomfort, especially when bending or lifting. 5. **Testicular Torsion** p. **Subjective and Objective Findings**: Acute onset of severe testicular pain, nausea, and scrotal swelling. q. **Treatment**: This is a surgical emergency requiring immediate intervention to save the testicle. 6. **Erectile Dysfunction** r. **Screening**: Identifying associated risk factors, including cardiovascular disease, diabetes, and lifestyle factors. s. **Risk Factors**: Smoking, obesity, lack of physical activity, and psychological stressors. ### **Sexually Transmitted and Genital Infections** - **Gonorrhea - Neisseria gonorrhoeae** a. **Testing: NAAT First urine of the day, vaginal/cervical swab** b. **Treatment: IM Ceftriaxone single dose** c. **Signs and Symptoms: Male symptoms of gonorrhea infection include:** **Painful urination.** **Pus-like discharge from the tip of the penis.** **Pain or swelling in one testicle** - **HPV** a. **Testing: Mostly visually found, many men are asymptomatic** b. **Treatment: Usually resolve in a year Patient applied Imiquimond 3.75% or 5% cream OR Podofilox 0.5% solution or gel, OR Sinecatechins 15% ointment OR Provider can perform Cryotherapy with liquid nitrogen or cyroprobe** c. **Signs and Symptoms: Most men asymptomatic** - **Yeast** d. **Testing**: e. **Treatment**: f. **Signs and Symptoms**: itchy or burning sensation in vagina and vulva. A thick, white vaginal discharge with the consistency of cottage cheese. Redness, swelling and or white patches vagina and vulva. Small cuts or tiny cracks in the skin because of fragile skin in the area, burning in urination, pain during sex. - **Chlamydia,** g. **Testing**: NAATS, First urine of the day, vaginal/cervical swab h. **Treatment**: **Doxycycline** 100 mg orally 2 times/day for 7 days Alternative Regimens: **Azithromycin** 1 g orally in a single dose\ OR\ **Levofloxacin** 500 mg orally once daily for 7 day i. **Signs and Symptoms**: Chlamydia is the most common STI, highest rates under age 25, often asymptomatic, screen under age 25 annually, new sex partner, more than 1 partner, recent partner with STI. If symptomatic: Burning upon urination, pain during sex, lower belly pain, abnormal, smelly discharge, bleeding between periods - **Herpes** j. **Testing**: PCR assays for HSV DNA or IGG testing which is often included in an STI panel k. **Treatment**: PRIMARY treatment: Acyclovir 400mg TID 7-10 days \*dose can vary OR Famciclovir BID x 1 day 6 hours post symptoms. Recurrence: Famciclovir BID x 1 year. SUPPRESIVE -- Acyclovir 400mg BID or Valacyclovir 500mg QD or 1gm l. **Signs and Symptoms**: Many people have no symptoms while shedding the virus - **Bacterial Vaginosis -** Gardnerella Vaginalis m. **Testing**: To be diagnosed, need at least three clinical criteria: Thin white discharge, Clue cells (seen on Wet Mount Test when Potassium hydroxide (KOH) is added), Ph\>4.5, Fishy odor with the "whiff test" n. **Treatment**: Metronidazole 500mg orally BID for 7 days, OR metronidazole gel 0.75% one full applicator (5g) intravaginally QD 5 days OR Clindamycin cream 2% one fill applicator (5g) intravaginally at bedtime for 5 days o. **Signs and Symptoms**: - **Trichomonas** p. **Testing**: **Gold standard -- Affirm (checks for BV, yeast, trich), w**et mount -\> low sensitivity, **Gold standard -- Affirm (checks for BV, yeast, trich)** q. **Treatment**: Metronidazole 2g single dose OR tinidazole 2g single dose OR Metronidazole 500mg BID x 7 days r. **Signs and Symptoms**: Vaginal discharge that is thin, frothy, and has a foul or fishy smell , itching or burning of the genitals or inner thighs, pain or discomfort when urinating or during sex , redness or swelling of the vulva or labia , symptoms can appear within 5 to 28 days of exposure, but some people don\'t develop symptoms until much later. Most people with trich don\'t have any symptoms. - **HIV** - The only way to know for sure if you have HIV is to get tested. A lab can usually detect HIV 18 to 45 days after exposure with an antigen/antibody test on blood from a vein. A rapid antigen/antibody test can also be done with a finger stick, but it can take 18 to 90 days after exposure. - HIV can be treated with antiretroviral therapy (ART), which includes pills and shots. The goal of treatment is to have an undetectable viral load, which means the level of HIV virus in your body is low enough to not be detected by a test. - If left untreated, HIV typically turns into AIDS in about 8 to 10 years. Most people with HIV live long and healthy lives if they get ART as soon as possible and stay on - **PCOS**: ### **Women's Health** 1. **Menstrual Health** a. **Amenorrhea and Irregular Vaginal Bleeding**: Primary or secondary amenorrhea; bleeding irregularities often point to underlying hormonal imbalances or structural issues. - **Primary Amenorrhea:** Complete absence of a menstrual period by the age of 16 in a person with normal sexual development.  - **Secondary Amenorrhea:** The sudden cessation of menstrual periods for several months in a person who previously had regular cycles PCOS is most common cause of Secondary Amenorrhea b. **Menstrual Cycle**: Phases of the cycle---menstrual, follicular, ovulatory, and luteal phases---each with its hormonal shifts. The rise and fall of your hormones trigger the steps in your menstrual cycle. Your hormones cause the organs of your reproductive tract to respond in certain ways. The specific events that occur during your menstrual cycle are: - **The menses phase: **This phase begins on the first day of your period. It\'s when the lining of your uterus sheds through your vagina if pregnancy hasn't occurred. Most people bleed for three to five days, but a period lasting only three days to as many as seven days is usually not a cause for worry. - **[The follicular phase](https://my.clevelandclinic.org/health/body/23953-follicular-phase):** Less consistent phase of the cycle. This phase begins on the day you get your period and ends at ovulation (it overlaps with the menses phase and ends when you ovulate). During this time, the level of the hormone estrogen rises, which causes the lining of your uterus (the endometrium) to grow and thicken. In addition, another hormone --- [follicle-stimulating hormone (FSH)](https://my.clevelandclinic.org/health/articles/24638-follicle-stimulating-hormone-fsh) --- causes follicles in your ovaries to grow. During days 10 to 14, one of the developing follicles will form a fully mature egg (ovum). The follicular phase of the menstrual cycle is considered less consistent compared to the luteal phase, which tends to be relatively stable in length for most women; meaning the length of the follicular phase can vary more from cycle to cycle while the luteal phase usually stays around 14 days. **[Ovulation](https://my.clevelandclinic.org/health/articles/23439-ovulation):** This phase occurs roughly at about day 14 in a 28-day menstrual cycle. A sudden increase in another hormone --- [luteinizing hormone (LH)](https://my.clevelandclinic.org/health/body/22255-luteinizing-hormone) --- causes your ovary to release its egg. This event is ovulation. **The luteal (secretory) phase:** This phase lasts from about day 15 to day 28. Your egg leaves your ovary and begins to travel through your fallopian tubes to your uterus. The level of the hormone progesterone rises to help prepare your uterine lining for pregnancy. If the egg becomes fertilized by sperm and attaches itself to your uterine wall (implantation), you become pregnant. If pregnancy doesn't occur, estrogen and progesterone levels drop and the thick lining of your uterus sheds during your period. 2. **PCOS** c. **Diagnosis**: Based on symptoms like irregular periods, hyperandrogenism, and polycystic ovaries on ultrasound. Common feature is hypersecretion of androgens. In adult women 2 of 3 must be present for diagnosis: Hyperandrogenism, Oligoovulation or anovulation, Polycystic ovaries on ultrasound d. **Management**: Lifestyle adjustments, hormonal contraceptives, and insulin-sensitizing medications. 3. **Contraception**: Discussion of options from hormonal (pills, IUDs) to barrier methods, benefits, and risks. 4. **Breast Cancer Screening**: Mammograms and breast self-exams; follow current guidelines for age and risk factors. Manual exam in every visit. 40 and over every two years for mammograms, but also encourage self exam and perform manual exam at every wellness visit 5. **Lactation and Postpartum Care** e. **Mastitis**: Recognize symptoms like breast pain, redness, and fever; treat with antibiotics. f. **Breastfeeding Support**: Guidelines on feeding frequency, latch techniques, and troubleshooting. 6. **Preeclampsia**: Management of blood pressure, regular monitoring for proteinuria, and signs of worsening condition. 7. **Labor**: Stages and physiological changes; recognizing signs of labor onset. 8. **RhoGAM**: Administration to Rh-negative mothers to prevent alloimmunization. 9. **UTI**: Prevention, common symptoms like dysuria, frequency, and urgency, and appropriate antibiotic treatment. 10. **Care of the Pregnant Patient** g. **Gestational Diabetes**: Screening at 24-28 weeks, management with diet, exercise, and insulin if needed. **Pregnancy Complications**: 10 - 20% of pregnant patients. **Early Pregnancy loss:** Within the first 13 weeks of pregnancy, miscarriage spontaneous abortion (SAB). If suspected loss referral to OBGYN or midwife. After 13 weeks GYN surgeon for possible intervention. Beta HCG after SAB follow levels until 0. Advice patient not to try to conceive until results are 0. 80% loss happens in first semester 1/5 women will miscarriage at some point. Complete AB - at some point that may actually be much higher as many women may have a late period and even a positive home pregnancy test, but we\'ll go onto Miss Perry shortly after and assume they were just having a late period and a false positive pregnancy test completed. Ectopic pregnancies- Sever abdominal pain and bleeding between week 5- 8. Emergency referral. Gestational trophoblastic disease (GTD). Molar pregnancy, intermitting spotting, grossly enlarged uterus, extreme N/V, requires D&C referred to GYN, pt not to become pregnant withing 6 months, suspect of reoccurrence with next pregnancy. Placenta previa. provided consult is recommended. 1 in 4 women may experience bleeding during pregnancy. Common during intercourse in the first half of pregnancy. Light bleeding with no pain least risk of SAB. R/O any immediate or life-threatening concerns more than 2 pads per hour for more than 2 hours evaluate if pt is hemodynamically stable and referred as needed. Beta HCG -- a test that uses a number to associate gestational age. May repeat every 2-3 days, an increase in HCG levels indicates a viable pregnancy. Helpful tool in evaluating early bleeding specially before 6 weeks. Ultrasound Gestetional sac can be seen as early as 4-5 weeks, yolk sac been seen at 5 weeks. Fetal heart beat and cardiac activity after 6-7 weeks. - **Second & Third Trimester Bleeding**: Emphasizes no vaginal exams and includes necessary lab tests like CBC and Type and Screen for Rh-negative cases. - **Preterm Labor and Birth** (Chapter 30): Identified as a leading cause of neonatal mortality with social and racial disparities impacting risk. Prevention includes nutrition, substance cessation, and adequate spacing between pregnancies. - **Hypertensive Disorders** (Chapter 31): Covers chronic hypertension, gestational hypertension, preeclampsia, and eclampsia, stressing accurate blood pressure measurement and early screening. Key symptoms include visual disturbances, RUQ pain, and edema. - **Gestational Diabetes** (Chapter 32): Discusses screening protocols at 24-28 weeks and includes a glucose tolerance test. Management in primary care highlights the adverse outcomes and weight gain recommendations for obese patients. - **Hyperemesis Gravidarum** (Chapter 35): Defined by symptoms like excessive nausea, likely due to high hCG, estrogen, and thyroid levels. Management strategies are outlined, including IV fluids as needed. - **Hematologic & Thromboembolic Disorders** (Chapter 43): Focuses on anemia, blood type issues, and specific conditions like Sickle Cell Disease and Thalassemia. Thrombocytopenia and folate deficiency are also noted. - **Dermatologic Disorders** (Chapter 49): Common conditions include PUPP, PG, and ICP, with reference to pre-existing conditions that may flare during pregnancy. - **Group B Strep (GBS)** (Chapter 50): Screening recommendations and treatment during labor to prevent neonatal mortality are discussed. - **STIs in Pregnancy** (Chapter 51): Regular screening and management, emphasizing treatment protocols and prevention strategies. - **Medications During Pregnancy** - [Methyldopa](https://www.goodrx.com/methyldopa/what-is) has the longest and most reassuring track record of safety in pregnancy. This medication relaxes the blood vessels, which lowers blood pressure. - [Labetalol](https://www.goodrx.com/labetalol/what-is) slows your heart rate, which lets your heart relax. - [Nifedipine](https://www.goodrx.com/nifedipine-er-procardia-xl/what-is) only needs to be taken once a day in the extended-release form. s. h. **Pre- and Post-Pregnancy Follow-up**: Importance of regular check-ups to monitor both maternal and fetal health. 11. **Ectopic Pregnancy**: **Symptoms:** Abdominal pain, vaginal bleeding, amenorrhea; may also include dizziness, fever, and syncope. 50% of patients that have an ectopic pregnancy will have: Abdominal pain, vaginal bleeding, amenorrhea. May also present with symptoms common to early pregnancy (nausea, breast fullness) Dizziness, fever, weakness, flu like symptoms, vomiting, syncope, cardiac arrest. Any of the following signs and symptoms are an EMERGENCY Abdominal rigidity, involuntary guarding, severe tenderness, evidence of hypovolemic shock (examples -- orthostatic blood pressure changes, tachycardia) **Diagnostics:** Ultrasound imaging to visually determine location and serial quantitative beta-hCG. **Treatment:** Methotrexate intramuscular for non-ruptured hemodynamically stable cases. THIS IS NOT FDA APPROVED but has been endorsed by the ACOG, it avoids surgery, hcg values must be less than 1500. Surgical intervention if unstable. 12. **Group B Strep Screening and Treatment**: Screening at 35-37 weeks gestation; antibiotics during labor for positive cases. 13. **Naegele's Rule**: Method to estimate the due date---add one year, subtract three months to the LMP and add seven days and a year. 14. **Genetic Screening**: Understanding indications and types, such as noninvasive prenatal testing (NIPT). 15. **Family Planning**: Counseling on options for future pregnancies and spacing. 16. **Management of Pregnant Patients in Primary Care**: Addressing primary care concerns while balancing pregnancy-related health needs. No live vaccines MMR, Varicella, Shingles, live flu. - **Screening Tests:** Various tests are conducted based on gestational age, including first-trimester screening, cell-free DNA testing, and Group B strep testing. - **Gestational Diabetes:** Diagnosed with glucose tolerance tests; managed with blood glucose monitoring and possibly insulin. - **Puerperium:** Postpartum period where the body adjusts and returns to its non-pregnant state, which includes uterine involution and gradual muscle tone recovery.