Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 222

Chapter 29 Review: Genitourinary Problems

• It can be difficult to distinguish between problems that lie in reproductive organs and those affecting the urinary system. A careful history will help. • Problems within the GU system are likely to be either obstruction to infection or ischemia to infarction. • Infection of the vagina occurs when something upsets the normal balance between yeast and bacteria, allowing one of the species to grow out of control. • Vaginitis becomes an emergency when it migrates into the uterus and fallopian tubes, causing the infection known as pelvic inflammatory disease. • Simple yeast vaginitis may respond to nonprescription treatment in the field, including over-the- counter medications, staying dry and cool, and practicing good hygiene. Bacterial vaginitis is best evaluated and treated in a medical facility. • Uncomplicated and easily treated UTIs are generally limited to women because of the short length of the female urethra. • One of the most common cause of UTI in wilderness travelers is urinary retention. • The signs and symptoms of uncomplicated UTI include low pelvic pain; frequent urination in small • Like any other organ, testicles can become obstructed, infected, or ischemic. A rare but dangerous cause of sudden onset pain is testicular torsion. Ischemia causes pain and will result in infarction of the testicle if not corrected. • Persistent testicular pain with or without swelling should motivate an early referral for medical evaluation. • A mild UTI or vaginitis can often be treated in the field as a low-risk problem in cases where the woman has a previous history of similar symptoms and is confident in her diagnosis. • The male urinary tract can become mildly irritated by dehydration or sexual activity, but persistent pain is not normal. If infection is suspected, evacuation for testing and diagnosis before treatment is ideal. amounts; cloudy urine; and pain, tingling, or burning on urination. • The standard of care for uncomplicated UTI is oral antibiotics.