This document provides information about disorders of the male reproductive system. It begins with describing the anatomy and physiology of the male reproductive system. It then discusses common diagnostic tests used to evaluate disorders like prostate-specific antigen testing, ultrasound, and biopsy. Several common disorders are explained such as benign prostate hyperplasia, prostatitis, prostate cancer, disorders of the testes, scrotum, penis and urethra. The disorders are defined and their signs, symptoms, diagnostic workup and management are outlined.

1. DISORDERS OF
MALE
REPRODUCTIVE
SYSTEM
PRESENTER-
Ms. Anshu
M.Sc Nursing
KGMU Institute of Nursing

2. LEARNING OBJECTIVES
• Describe structures and functions of the male
reproductive system.
• Discuss common diagnostic test for disorder of male
reproductive system.
• Explain various disorders of male reproductive system
with management.
• Discuss infertility, PID and STIs.

3. ANTATOMY AND
PHYSIOLOGY

4. Scrotum
• A) Protective sac around
testes
• B) Regulate temperature
(92oF/33oC)

5. 2. Testes
A) Site of spermatogenesis & hormone production
B) Structures
1) Tunica albuginea – outer cell layer
2) Each testis is subdivided into lobules
3) Each lobule contains 1-4 highly convoluted seminiferous
tubules
a) The tubules contain the spermatogonia which will mature into
sperm
b) In between the tubules are interstitial cells which produce
hormones testosterone & inhibin
4) The tubules converge and unite to form the rete testis
5) The rete testis gives rise to several ducts which open into the
epididymis

7. 3. Epididymis
• A) Site of sperm
maturation and storage
• B) Takes 20 days for
sperm to travel through it
• C) Can store sperm for
several months

8. 4. Vas deferens
• A) Conduct and store
sperm
• B) Move upward in
spermatic cord into pelvic
cavity
• C) Both sides join with
ducts of the seminal
vesicle to form
ejaculatory duct which
flows into urethra

9. 5. Prostate
• A) Chestnut shaped
• B) Encircles urethra
inferior to the bladder
• C) Expels thin, milky fluid
through a series of ducts

10. 6. Seminal vesicles
A) Yellowish, finger-shaped structures
B) Slightly inferior and posterior to bladder
C) Produces a component of semen (60%)
1) Slightly alkaline
2) Contains fructose to fuel the sperm
3) Also contains prostaglandins to initiate smooth muscle
contractions in female reproductive tract

11. 7. Bulbourethral
(Cowper’s) glands
• A) Pea-sized; empty into
the spongy urethra
• B) Secrete clear, mucus
fluid
• 1) Alkaline to neutralize
acidic urine in urethra
• 2) Provides some
lubrication for intercourse

13. 8. Penis
A) Composed of 3 columns of erectile tissue
1) Corpora cavernosa (2) – lie dorsally
2) Corpus spongiosum – lie ventrally; surrounds urethra
B) Terminates in enlarged portion known as glans penis
(covered by prepuce)
1) Location of external urethral orifice
2) Highly innervated with sensory neurons
3) Involved with physiological, sexual arousal

15. 9. Urethra
• A) Transports semen and
urine to the outside of the
body
• B) 3 divisions
• 1) Prostatic – passes
through prostate
• 2) Membranous – passes
through urogenital
diaphragm
• 3) Spongy – passes
through penis

16. COMMON DIAGNOSTIC
TEST

17. 1. PROSTATE SPECIFIC
ANTIGEN (PSA)
PURPOSE AND DESCRIPTION
• A blood test used to diagnose prostate cancer and to
monitor treatment of prostate cancer.
• The cells within prostate gland produces a protein that
can be measured in blood called PSA.

18. Conti..
• Increase in level of PSA may indicate prostate cancer,
BPH, acute urinary retention and acute prostatitis.
• Values less than 4.0ng/ml are generally consider normal,
and values more than 4.0ng/ml are consider abnormal.

19. 2. PROSTATE ULTRASOUND
PURPOSE AND DESCRIPTION
• Conducted to identify testicular torsion or masses, and to
evaluate prostate enlargement.
• Uses high-frequency sound waves, passed through
tissues of various densities, to produce a visual graphic
of tissue being examined.
RELATED NURSING CARE
• A full bladder may be required for the study.

20. Transabdominal Transrectal

21. 3. PROSTATE BIOPSY
• Conducted to diagnose prostate cancer.
• Types:-
• ■ Transrectal biopsy
• ■ Transurethral biopsy

22. Transrectal biopsy
• A transrectal ultrasound
(TRUS) is often used to
guide the placement of the
needle during the
procedure.
• ■ A transrectal biopsy is
performed with a spring-
loaded needle, inserted
through the rectal wall and
into the prostate gland to
remove one or more tissue
samples.

23. Transurethral biopsy
• ■ A transurethral biopsy is
performed by inserting a
cystoscope through the
urethra and using a
cutting loop to remove
small samples of prostate
tissue.

24. RELATED NURSING CARE
• Advise the man to avoid strenuous activity for 4 hours
post procedure.
• Explain that there may be some discomfort in the biopsy
area for 1 to 2 days, there may be some blood in the
urine.

25. Conti..
• Following a transurethral biopsy, a urinary catheter may
remain in place for a few hours after the procedure and
antibiotics will be prescribed.
• Excess bleeding, pain, or signs of infection should be
reported to the physician.

26. 5. DIGITAL RECTAL
EXAMINATION (DRE)
• DRE is used to screen for prostate cancer and recommended
annually for every man older than 50 yrs of age.
• DRE enables the skilled examiner, using lubricated, gloved
finger placed in the rectum , to assess the size, symmetry,
shape, and consistency of the posterior surface of the
prostate gland.

27. Conti…
• The clinical assess for tenderness of the prostate gland
on palpation and for the presence and consistency of
any nodules.
• The DRE may be performed with the patient leaning over
an examination table or positioning the man in a side-
lying position with legs flexed toward the abdomen or
supine with legs resting in stirrups.

28. ROLE OF NURSE
• To provide comfortable position to the patient.
• Advice the patient to take deep breaths and exhale
slowly during procedure.

29. DISORDERS
• DISOREDR OF PENIS
• DISORDER OF PROSTATE GLAND
• DISORDERS OF TESTIS
• DISORDER OF SCROTUM
• DISORDERS OF URETHRA

30. 1.DISOREDR OF PENIS
• BALANITIS
• PARAPHIMOSIS AND PHIMOSIS
• PRIAPISM

31. 2. DISORDER OF PROSTATE
GLAND
• BENIGN PROSTATE HYPERTROPHY
• PROSTATITIS
• PROSTATE CANCER

32. BENIGN PROSTATE
HYPERTROPHY
INTRODUCTION
Generalized disease of the prostate due to hormonal
derangement which leads to enlargement of the gland
(increase in the number of epithelial cells and stromal
tissue)to cause compression of the urethra leading to
symptoms

33. CAUSES
• Hormonal derangement - estrogen
• Dihydrotestosteron (DHT) a metabolite of testosteron.
It’s a mediator of protatic growth.

34. RISK FACTORS
• Smoking
• Heavy alcohol consumption
• Obesity
• Reduced activity level
• Hypertension
• Heart disease
• diabetes

35. PATHOPHYSIOLOGY
Due to causes and risk factors – estrogen level increases
Prostatic cells becomes more responsive to estrogen and less to DHT
Increased proliferation of prostatic cells - BPH
Obstruct bladder neck & urethra, incomplete emptying of bladder
Gradual dilation of ureters (hydroureters) & kidney
(hydronephrosis), more chances of UTI.

36. SIGNS AND SYMPTOMS
Voiding symptoms:-
• • decrease in the urinary stream
• • Straining
• • Dribbling at the end of urination
• • Intermittency
• • Hesitancy
• • Pain or burning during urination
• • Feeling of incomplete bladder emptying
• • Urinary retention (more than 60 ml of urine
remaining in bladder)

37. DIAGNOSTIC TEST
• History & Examination
• Abdominal/GU exam
• Digital rectal exam (DRE)
• Urinalysis- hematuria & UTI
• Urine culture
• BUN, Cr
• Prostate specific antigen (PSA)
• Transrectal ultrasound – biopsy
• Uroflometry
• Postvoid residual(PVR) measurement

38. MANAGEMENT
Pharmacological Treatment
Alpha-1-adrenergic antagonists
• Relax smooth muscle in the bladder neck, prostate capsule, and
prostatic urethra
• Immediate relief!
Examples
• Terazosin, Doxazosin, Tamsulosin, Alfuzosin
• Initiate at bedtime (hypotension)
Major Side Effects
• HYPOTENSION!
• Ejaculatory Dysfunction (particularly Tamsulosin)

39. CONTI..
5-alpha-reductase inhibitors
• Reduces the size of the prostate gland
• Prevents conversion testosterone TO dihydrotestosterone
(DHT)
• Indefinite treatment, as discontinuation may lead to symptom
relapse.
Examples
• Finasteride (initiated and maintained at 5 mg once daily)
• Dutasteride
Side Effects
• Sexual dysfunction
• Decrease PSA

40. CONTI..
Surgery or Minimally Invasive Surgical
Therapies
- Transurethral needle ablation (TUNA)
- transurethral microwave therapy (TUMT)
Endoscope
- Transurethral Resection of the Prostate(TURP)
MAJOR Surgery
- Open Prostatectomy

42. PROSTATITIS
• Infection &/ or inflammation of the prostate gland that is
often associated with lower UTI, sexual discomfort and
dysfunction.

43. CAUSES
• Infectious agents-
Bacteria, fungi and mycoplasma
• Organisms:
G-ve (E.coli, pseudomonas, klebsiella , serratia,
Enterobacter aerogenes.)
• G+ve 5-10 %
(staph aureus, saprophyticus, streptococcus
faecalis)

44. TYPES OF PROSTATITIS
• ACUTE BACTERIAL PROSTATITIS (type I)
• CHRONIC BACTERIAL PROSTATITIS (type II)
• CHRONIC PROSTATITIS/ CHRONIC PELVIC PAIN
SYNDROME (CP/CPPS) (type III)
• ASYMPTOMATIC INFLAMMATORY PROSTATITIS (type
IV)

45. SIGNS & SYMPTOMS
symptoms
• Acute onset fever.
• Chills
• Nausea &vomiting
• Perineal & suprapubic pain
• Irritative urinary symptoms ( frequency, urgency, dysuria)
• Obstructive (hesitancy, Urinary Retention, intermittency
Sings:
• Systemic toxicity
• suprapubic tenderness.
• Palpable bladder
• Tender DRE

46. DIGNOSTIC TEST
• History & Examination
• Abdominal/GU exam
• Digital rectal exam (DRE)
• Urinalysis
• Urine culture
• BUN, Cr
• Prostate specific antigen (PSA)
• Transrectal ultrasound – biopsy
• Uroflometry
• Postvoid residual

47. MANAGEMENT
• Alpha adrenergic- blockers: improve urinary
flow,& reduce intraprostatic ductal reflux
• eg- Tamsulosin (flomax)
• Anti inflammatory drugs NSAID
• Antibiotics -
• Oral quinolone ciprofloxacin 500 BID, 2-4 weeks
• I.V antibiotic- Aminoglycoside+3rd generation
cephalosporins

48. PROSTATE CANCER
RISK FACTOR-
• Family history
• Genes-
Hereditary prostate cancer 1 (HPC1)
BRCA1 and BRCA2 mutations
• Diet contain-
excessive amount of red meat or dairy products that
are high in fat
• Hormones-
Androgens & estrogen

49. SIGNS & SYMPTOMS
In case of benign
• -urinary obstruction
• -blood in urine or semen
• -painful ejaculation
• -Sexual dysfunction
In case of metastasis-
• - backache & hip pain
• -rectal discomfort
• -Anemia and weight loss

50. DIAGNOSTIC TEST
• Family history
• DRE
• Ultrasound guided TRUS with biopsy
• PSA level
• Helpful in asymptomatic patients
• > 60% of patients with prostate cancer are asymptomatic
• Diagnosis is made solely because of an elevated
screening PSA level

51. CONTI….
• Gleason score
• Bone scans
• Skeletal X-rays
• MRI
• CT Scan

52. MANAGEMENT
• 1.Androgen deprivation Therapy (ADT)
• Used to suppress androgenic stimuli to the prostate by
decreasing the level of circulating plasma testosterone or
interrupting the conversion to or binding of DHT.
• Luteinizing hormone- releasing hormone (LHRH)
agonists.
• Eg- Leuprolide
• Goserelin

53. Conti..
• 2.Cryotherapy
• 3.External beam radiotherapy
• Retropubic or perineal radical prostatectomy
• -with or without postoperative radiotherapy to the
prostate margins and pelvis
• 4.Brachytherapy (either permanent or temporary
radioactive seed implants)
• -with or without external beam radiotherapy to the
prostate margins and pelvis.

54. MANAGEMENT
• SURGICAL MANAGEMENT
Radical prostatectomy
Laparoscopic radial prostatectomy

55. 3. DISORDERS OF TESTIS
• CRYPTORCHIDISM
• EPIDIDYMITIS
• ORCHITIS
• TESTICULAR TORSION

56. 4. DISORDER OF SCROTUM
• HYDROCELE
• VARICOCELE

57. HYDROCELE
• •Is is characterised by collection of fluid between visceral
& parietal membranes of the tunica vaginalis
(membranes that surrounds the testis).
• TYPES:-
• 1. Acute Hydrocele (adult >40yrs)
• 2. Chronic Hydrocele (imbalanced in fluid secretion and
reabsorption in tunica vaginalis)

58. • Fluid in the tunica vaginalis.
• Usually idiopathic
• A hydrocele may contain 100 cc or more of serous fluid.
• A hydrocele will appear and disappear as the patient
changes position.
• One can distinguish a hydrocele from a tumor mass by
trans-illuminating it with a bright flashlight in a dark
room.

60. CAUSES
• •Trauma
• •Infection (Epididymitis or orthitis)
• •Cancer of testis

61. SIGNS & SYMPTOMS
• •Painless swelling of scrotum

62. DIAGNOSTIC TEST
• Positive transillumination
• USG

63. MANAGEMENT
• •None unless swelling large & uncomfortable
• •Fluid aspiration – may be repeated 1-3 times
• •Hydrocelectomy –excision or suturing of membranes of
vaginalis

64. 5. DISORDERS OF URETHRA
• URETHRAL STRICTURE
• URETHRITIS
• HYPOSPADIAS
• EPISPADIAS

65. URETHRAL STRICTURE
• Urethral stricture is a condition in which a section of the
urethra is narrowed.
CAUSES
• It can occur congenitally or from a scar along the
urethra.
• Traumatic injury to urethra (e.g., from instrumentation or
infections)

66. Clinical features
• strictures that restrict urine flow
• decrease the urinary stream
• leading to spraying or double stream
• post voiding dribbling,
• dilation of the proximal urethra and prostatic ducts.

67. TREATMENT
• MEDICAL MANAGEMENT
• Antimicrobial agents are necessary for resolution of
UTIs, followed by long term prophylactic therapy until
stricture is corrected.
• Mannual dilations of urethra
• Treatment sholud not be considered successful until at
least 1 year has passed, because stricture may recur
anytime during that period.
• SURGICAL MANGEMENT
• Urethrotomy (surgical removal of the stricture)

68. URETHRITIS
• Inflammation and infection of urethra.

69. CAUSES
• –Gonorrhea
• –Chlamydia (NGU)

70. SIGNS & SYMPTOMS
• •Thick yellowish green purulent discharge
• •Appears 3 – 14 days after sexual exposure
• •NGU – scant to moderate amount
• •Pain in urethra
• •Redness / irritation

71. MANAGEMENT
• •Rocephin or Zithromax – Gonorrhea
• •Doxy or tetracycline – Chlamydia
• •Condom use
• •Treatment of sex partners

72. INFERTILITY
• After one year of frequent, unprotected sexual
intercourse there is no conception or maintenance of
pregnancy

73. Etiology IN FEMALES
• Endometriosis
• Tubal Blockage
Scarring (PID)
Fibroids
• Uterine Problems
Tumors
Congenital Anomalies
• Anovulation
Hypothyroidism
Stress
Decreased body weight

74. Conti…
• Cervical Mucus Problems
Vaginal Infections
Hormone Deficiencies

75. Etiology – Male Factors
• Varicocele – varicose of swollen vein in the testicle
• Cryptorchidism – undescended testicle at birth
• Occupational exposure to heat
• Immunological Factors
 Autoimmune reaction
 Production of antibodies that destroy sperm
• Obstruction in Sperm Transport
 Mumps
 Epididymitis
 STD’s

76. Diagnostic Studies –
Female
• Basal Body Temperature (BBT)
• Oral temp taken each day prior to arising
• Results are graphed
• Sudden dip occurs the day prior to ovulation & is
followed by a rise of 0.5 –1.0 degrees F, which indicates
ovulation

77. • Serum Hormone Testing
• Venous blood is drawn to assess levels of FSH and LH
• These are indicators of ovarian function

78. • Postcoital Exam
• Couple has sexual intercourse 8 – 12 hours prior to
exam, 1-2 days before expected ovulation
• A 10 cc syringe with catheter attached is used to collect
a specimen of secretions from the vagina
• Secretions are examined for: S/S infection, # of active
& non-motile sperm, sperm-mucus interactions, &
consistency of cervical mucus

79. • Endometrial Biopsy
• Paracervical Block to decrease cramping / pain
• Pinch of endometrium obtained to check for a luteal
phase defect (lack of progesterone)

80. • Hysterosalpingogram (HSG)
• Detects uterine anomalies (septate, unicornate,
bicornate)
• Detects Tubal anomalies or blockage
• Iodine-based radio-opaque dye is instilled through a
catheter into the uterus and tubes to outline these
structures and x-rays are taken to document findings

81. • Laparoscopy
• General or epidual anesthesia
• Abdomen is insufflated with carbon dioxide
• One or more trochars are inserted into the peritoneum
near the umbilicus & symphysis pubis
• Laparoscope visualizes structures in the pelvis
• Can perform certain surgical procedures

82. Diagnostic Studies –
Male
• Semen analysis
• Ejaculates into a specimen container
• Ejaculate examined for:
 Number
 Morphology
 Motility

83. Normal Semen Analysis
Results
• Volume >2.0 mL
• pH 7.0 – 8.0
• Total sperm count >20 million per mL
• Motility 50% or greater

84. Diagnostic Studies –
Male & Female Partner
• Anti-sperm antibody evaluation of cervical mucus and
ejaculate are tested for agglutination
• Indication that secretory immunological reactions are
occurring between cervical mucus and sperm

85. MANAGEMENT
• Intrauterine Insemination (a form of artificial
insemination)
• Sperm are collected within 3 hours of colitus and are
inserted via a catheter into the uterus
• Donor sperm may be used
• Identify of the sperm donor is kept confidential

86. • In Vitro Fertilization (IVF)
• Multiple ova are harvested via a large-bore needle and
syringe transvaginally under ultrasound guidance
• Ova are then mixed with sperm
• Up to 4 of the resultant embryos are returned to the
uterus 2-3 days later

87. Priority Nursing Diagnosis
• Compromised family coping
• Knowledge deficit
• Anxiety
• Situational low self-esteem

88. PELVIC INFLAMMATORY
DISEASE (PID)
• It is an inflammatory condition of the pelvic cavity that
may begin with cervicitis and involve the uterus
(endometritis), fallopian tube (salpingitis), ovaries
(oopharitis), pelvic peritoneum, or pelvic vascular
system.

89. ETIOLOGY
Infection caused by:-
• Virus
• Fungus
• Parasite
• Bacteria
More common:- Gonorrheal and chlamydial organisms
• STDs
• Invasive procedures- endometrial biopsy, abortion,
hysteroscopy etc.

90. PATHOPHYSIOLOGY OF PID

91. CLINICAL
MANIFESTATIONS
• Vaginal discharge
• Dyspareunia
• Lower abdominal pelvic pain
• Pain may increase with defecation and voiding
• Fever
• Malaise
• Anorexia
• Nausea
• headache

92. DIAGNOSTIC TEST
On pelvic examination:-
• Intense tenderness of the uterus palpated Or Movement
of cervix (cervical motion tenderness)
• Blood test
• Endocervical culture

93. MANAGEMENT
Treated on outpatient basis with Broad spectrum antibiotic
therapy prescribed in combination:-
• Ceftriaxone(Rocephin)
• Azithromycin
• Doxycycline
Indications for hospitalization include surgical emergencies,
pregnancy, no clinical response to oral antibiotic therapy
and tubo-ovarian abscess

94. SEXUALLY
TRANSMITTED
DISEASES (STDs)

95. STDs
STDs are diseases and infections which are capable of
being spread from person to person through:
 Sexual Intercourse
 vaginal
 anal
 oral
 Blood-to-blood contact
 Sharing needles or other drug-use equipment
 Tattoo or body piercing
 Infected mother to her baby

96. Types of infection
• :
• Bacterial
(Chlamydia, Gonorrhea, Syphilis)
• Viral
(HSV, Hepatitis B, HIV, HPV)
• Parasitic
(Pubic lice, scabies, trichomoniasis)

97. CHLAMYDIA
• Causative Agent:- Chlamydia Trachomatis
• More common in young women between 15 and 19 yrs
of age.
SYMPTOMS:
• fever, weight loss for no reason, swollen glands, fatigue,
diarrhea, white spots on the mouth and trunk.
•

98. FEMALE SYMPTOMS:
• Vaginal discharge (white
or grey) or burning with
• urination
• Lower abdominal pain
• Bleeding between
menstrual periods.
• Low-grade fever (later
symptom)

99. MALE SYMPTOMS:
• Discharge from the penis
and/or burning when
urinating
• Burning and itching around
the opening of the penis
• Pain and swelling in the
testicles
• Low –grade fever
(associated with
epididymitis –inflammation
of the testicles)

100. DIAGNOSTIC TEST
• Gram stain
• Direct fluorescent antibody test
In female- sample taken from:-
• Endocervix
• Anal canal
• Pharynx
In male patient-
• Urethra
• Anal canal
• pharynx

101. MANAGEMENT
Recommended Regimens By CDC
guidelines 2015
• Azithromycin 1 g orally in a single dose
• OR Doxycycline 100 mg orally twice a day for 7 days

102. Gonorrhea
• People get gonorrhea from close sexual contact (anal
sex, oral sex., and vaginal).
• Gonorrhea can also be spread from mother to child
during birth.
• Gonorrhea infection can spread to other unlikely parts of
the body
• Causative Agent:- N. Gonorrhoeae

104. Symptoms of Gonorrhea
• Appear 5-7 days or can take up to 30 days to appear
• sore or red throat if you have gonorrhea in the throat
from oral sex
• rectal pain
• blood and pus in bowel movements if you have
gonorrhea in the rectum from anal sex.

105. FEMALE SYMPTOMS:
• Symptoms may show up 2-21 days after having sex
• May notice a yellow or white discharge from the vagina
• May be a burning or pain when urinating
• Bleeding between periods
• Heavier and more painful periods
• Cramps or pain in the lower abdomen, sometimes with
nausea or fever

106. GONORRHEA
MALE SYMPTOMS:
• Yellow or white
drip/discharge from penis
• Burning or pain when
urinating
• Frequent urinating
• Swollen testicles

107. Diagnosis of Gonorrhoeae
• Gram stain
• Culture
• Nucleic Acid Amplification Test (NAATs)

108. MANAGEMENT
Gonococcal Infections of the Cervix,
Urethra, Pharynx and Rectum
Recommended Regimen
• Ceftriaxone 250 mg IM in a single dose
• PLUS Azithromycin 1g orally in a single dose

109. • persons infected with N. gonorrhoeae frequently are
coinfected with C. trachomatis; this finding has led to the
longstanding recommendation that persons treated for
gonococcal infection also be treated with a regimen that
is effective against uncomplicated genital C. trachomatis
infection

110. Syphilis
• The long range effects can be very serious, including
death.
• passed from person to person through direct contact with
a syphilis sore
• Sores mainly occur on the external genitalia, vagina,
anus, or rectum. Sores can also occur on the lips and in
the mouth.
• Transmission of the organism occurs during vaginal,
anal, or oral sex.
• Causative agent- Treponema Pallidum

111. • A bacterial infection that progresses in stages:-
• Primary: (2-3 weeks) starts as a small, painless sore
called a chancre; goes away on it’s own within 2 months.
• Secondary: (2 – 8weeks) rash on the body, palms of
hands & soles of feet, hair loss, feeling sick
• Latent: lesions or rashes can recur

114. Untreated syphilis may lead to tertiary syphilis, which is a
slowly progressive inflammatory disease and can damage:
• The cardiovascular system (heart & blood vessels)
• The neurological system(neurosyphilis, dementia,
meningitis, stroke)
• Other major organs of the body
• Complications may lead to death

115. Diagnostic test
Nontreponemal or reagin test
• Venereal Disease Research Laboratory (VDRL) or
• Rapid plasma reagin circle test (RPR-CT)
Treponemal test
• Fluorescent treponemal antibody absoption test (FTA-
ABS)
• Micro- hemagglutination test for Treponema Pallidum
(MHA-TP)

116. MANAGEMENT
Primary and Secondary Syphilis among Persons
Recommended Regimen
• Benzathine penicillin G, 2.4 million units IM in a single
dose
Recommended Regimen Tertiary Syphilis with Normal
CSF Examination
• Benzathine penicillin G 7.2 million units total,
administered as 3 doses of 2.4 million units IM each at 1-
week intervals

117. Genital Warts / Veniral Warts
• Growths that appear on the vagina or penis, near the
anus, and sometimes in the throat.
• They are caused by viruses and spread through sexual
contact.
• The virus that causes genital warts is spread by vaginal
or anal intercourse and by oral sex.
• Warts may appear within several weeks after sex with a
person who has HPV; or they may take months or years
to appear; or they may never appear.
• A person can be infected and pass on the virus without
knowing it.

118. Symptoms
• Usually the warts look like tiny cauliflowers, but
sometimes they are flat.
• The warts may cause itching, burning and some pain,
but often don’t cause any pain at all.
• Warts may be inside the vagina or on the cervix, or in the
rectum or throat, so you might not notice them.
• They might also be so small that you cannot see them.

119. MANAGEMENT
Recommended Regimens for External Anogenital Warts (i.e.,
penis, groin, scrotum, vulva, perineum, external anus, and
perianus*)
Patient-Applied:
• Imiquimod 3.75% or 5% cream†
• OR
• Podofilox 0.5% solution or gel
• OR
• Sinecatechins 15% ointment

120. Provider–Administered:
• Cryotherapy with liquid nitrogen or cryoprobe
• OR
• Surgical removal either by tangential scissor excision,
tangential shave
• excision, curettage, laser, or electrosurgery
• OR
• Trichloroacetic acid (TCA) or bichloroacetic acid (BCA)
80%–90%
• solution

121. Candidiasis – Yeast Fungus
• Yeast fungus that may or may not be transmitted by
sexual intercourse.
• Caused by high doses of antibiotics. It is usually caused
by altering the Ph of the vagina.
SYMPTOMS:
• A thick cheesy vaginal discharge
• Severe itching

122. MANAGEMENT
• Short-course topical formulations (i.e., single dose and
regimens of 1–3 days) effectively treat uncomplicated
VVC.
• The topically applied azole drugs are more effective than
nystatin.

123. Prevention
• Abstinence
• Know your partner
• Limit your partners
• Visit your doctor
• Always look
• Keep clean!

124. COMMON NURSING
DIAGNOSIS
Nursing diagnoses commonly used for problems of the male
reproductive system may include:
1. Urinary retention related to urinary obstruction
2. Anxiety related to inability to empty bladder completely or
dribbling
3. Pain related to pressure of pelvic mass or distended bladder;
surgical incisions; or bladder spasms
4. Sexual dysfunction related to inability to achieve erection
5. Ineffective sexuality pattern related to decreased libido
6. Disturbed body image related to changes in sexual function
7. Potential fluid volume excess related to bladder irrigation.
8. Risk for infection related to stasis of urine

125. REFERENCES
• 1. Rita Funnell, Gabby Koutoukidis. Tabbner’s Nursing
Care: Theory and Practice. Elsevier Australia
publications. Page no. 717-723
• 2. Linda S Williams, Paula D Hopper. Understanding
Medical Surgical Nursing. F.A. Davis publications. Page
no. 1004-1024
• 3. Brunner & Suddarth. Textbook of Medical Surgical
Nursing. Vol- 2. 12th Edition. Wolters Kluwer. Page no.
1504-1539,1438-1447
• 4. https://nursekey.com