Infections and Inflammatory Diseases of the Genitourinary Tract
What this domain tests
This domain tests urinary tract infection, pyelonephritis, prostatitis, epididymitis, sexually transmitted infections, Fournier gangrene, and genitourinary tuberculosis, including when imaging or source control is urgent.
Core rules and concepts
- Uncomplicated cystitis in women is usually caused by Enterobacterales and treated with short-course antibiotics guided by local resistance. Obtain culture in pyelonephritis, pregnancy, recurrent infection, or suspected complications.
- Febrile pyelonephritis with obstruction requires urgent decompression plus antibiotics. Do not rely on antibiotics alone when pus is under pressure.
- Acute bacterial prostatitis presents with fever, dysuria, and a tender prostate; avoid vigorous prostatic massage. Chronic pelvic pain syndrome is not always infectious.
- Epididymitis in young sexually active men suggests Chlamydia or gonorrhea; treat partners and consider testicular torsion in acute scrotal pain.
- Fournier gangrene is a polymicrobial necrotizing fasciitis requiring broad antibiotics and urgent debridement. Genitourinary tuberculosis causes sterile pyuria, calcification, and contracted bladder; suspect it when routine cultures are negative.
Worked example
A 70-year-old diabetic man has fever, scrotal pain, crepitus, and skin necrosis. Reasoning: crepitus and toxicity indicate Fournier gangrene. Resuscitate, start broad-spectrum antibiotics, and take him to urgent surgical debridement; imaging must not delay surgery.
Traps
Do not treat sterile pyuria as ordinary cystitis. Do not delay debridement for imaging in Fournier gangrene. Do not miss torsion when diagnosing epididymitis.