Men and infectious disease
Men are susceptible to a variety of infectious diseases that primarily affect the reproductive and urinary tracts, as well as the immune system. Common bacterial infections include prostatitis and epididymitis, with prostatitis being the most frequent urologic diagnosis in men under fifty. Symptoms of prostatitis can vary from painful urination to sexual dysfunction, and it is primarily caused by gram-negative bacteria like Escherichia coli. Epididymitis, an inflammation of the epididymis, often results from sexually transmitted infections such as chlamydia and gonorrhea, particularly in younger men.
On the viral front, conditions like orchitis and HIV infection pose significant health risks. Orchitis, which causes testicular inflammation, can arise from viral infections such as mumps, especially in unimmunized individuals. HIV is a chronic infection that can lead to AIDS, significantly affecting the immune system and increasing vulnerability to opportunistic infections. The majority of new HIV infections in the United States occur among gay and bisexual men, emphasizing the importance of safe sexual practices and regular health check-ups.
Overall, while many infectious diseases affecting men are treatable with antibiotics, conditions like AIDS require ongoing management and prevention strategies. Awareness and timely treatment are crucial to mitigate potential health complications.
Subject Terms
Men and infectious disease
Definition
Infectious diseases that are unique to men primarily involve the reproductive and urinary tracts and the immune system. Bacterial infections can result in prostatitis and epididymitis. Viral infections are responsible for orchitis and for human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS).
Bacterial Infections
The bacterial infections that are unique to men include prostatitis and epididymitis.
Prostatitis. Prostatitis is an infection of the prostate gland. It is the most common urologic diagnosis in males younger than fifty years and among the most common diagnoses in men over fifty. The disease is classified as acute bacterial prostatitis or chronic bacterial prostatitis.
The most common causal organisms of bacterial prostatitis include gram-negative members of the Enterobacteriaceae family, which include Escherichia coli, Proteus mirabilis, Klebsiella species, Enterobacter species, Pseudomonas aeruginosa, Staphylococcus, Serratia species, and Trichomonas species. Between 50 and 90 percent of chronic bacterial prostatitis is caused by E. coli.
Symptoms of prostatitis may include pain or burning sensation when urinating (dysuria), difficulty urinating, frequent urination (particularly at night), pain in the penis or testicles, and painful ejaculation. In acute bacterial prostatitis, symptoms associated with the sudden onset of infection include high fever, chills, and nausea. In chronic bacterial prostatitis, symptoms include a clear-to-milky urethral discharge, ejaculatory pain, hematospermia (blood in the semen), and sexual dysfunction.
Initial therapy is directed at gram-negative enteric bacteria. The best antibiotic choices for treatment include antibiotics such as amoxicillin, doxycycline, or ciprofloxacin. For chronic chronic bacterial prostatitis, fluoroquinolones and trimethoprim-sulfamethoxazole are commonly used.
Epididymitis. Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Males of any age can get epididymitis, but it is most common in men between the ages of fourteen and thirty-five.
Epididymitis has a number of causes. Sexually transmitted infections like Chlamydia trachomatis and Neisseria gonorrhoeae are the most common causes of epididymitis in males younger than thirty-five. Members of the Enterobacteriaceae family and Enterococcus are frequent pathogens in older men. Sexually transmitted diseases (STDs), particularly gonorrhea and chlamydia, are the most common cause of epididymitis in young, sexually active men. In children, urinary tract infections or playing sports can cause epididymitis.
Epididymitis symptoms can include a tender, swollen, or red scrotum; testicle pain and tenderness; painful urination or an urgent or frequent need to urinate; painful intercourse or ejaculation; chills and fever; a lump on the testicle; enlarged lymph nodes in the groin; discharge from the penis; and blood in the semen. Epididymitis is treated with antibiotic medications such as ceftriaxone, ciprofloxacin, doxycycline, and levofloxacin.
Viral Infections
The viral infections that are unique to or that often affect men include orchitis and HIV infection and AIDS.
Orchitis. Orchitis is an inflammation of one or both testicles, most commonly associated with the virus that causes mumps. At least one-third of males who contract mumps after puberty develop orchitis. Other causes of orchitis usually are bacterial, including STDs such as gonorrhea or chlamydia.
Orchitis can be either bacterial or viral. Most often, bacterial orchitis is the result of epididymitis. Primary orchitis is one of the few genitourinary infections resulting from viral pathogens. Mumps, coxsackie B, Epstein-Barr, and varicella reach the testis through the bloodstream. Most cases of viral orchitis are the result of mumps in males who were not immunized against the disease. High-risk sexual behaviors that can lead to STDs also put one at risk of sexually transmitted orchitis.
Orchitis symptoms usually develop suddenly. They may include testicular swelling on one or both sides, pain ranging from mild to severe, tenderness in one or both testicles that may last for weeks, fever, discharge from the penis, and blood in the ejaculate.
Treatment for viral orchitis, the type associated with mumps, is aimed at relieving symptoms. A physician may prescribe nonsteroidal anti-inflammatory drugs and may recommend bed rest, elevation of the scrotum, and application of cold packs.
HIV and AIDS. AIDS is a chronic, potentially life-threatening disease. More than forty million people worldwide are living with HIV infection, including 1.2 million in the US. More than 42.3 million people have died after developing AIDS, including 700,000 in the US. Of all HIV diagnoses in the US, men account for 80 percent of cases, and of those, more than 65 percent of new infections occur in men who have sex with men.
HIV destroys CD4 cells, white blood cells that are essential in helping the body fight disease. By damaging the immune system, HIV interferes with the body’s ability to fight disease-causing organisms. A man may become infected if he has unprotected anal or oral sex with an infected partner whose blood or semen enters his body. The virus can enter the body through mouth sores or small tears that sometimes develop in the rectum during sexual activity.
Unprotected anal sex (that is, anal sex without the use of a condom) greatly increases the chance of infection. The risk increases if a person has multiple sexual partners. Open sores on the genitals act as doorways for HIV to enter the body. HIV also can be transmitted through shared needles and syringes (as in intravenous drug use) contaminated with infected blood.
Initial infection with HIV may produce no symptoms, although the infected person is contagious. An infected person may remain symptom-free for years, but the virus continues to multiply and destroy immune cells. Without treatment, the infection typically progresses to AIDS in about ten years, by which time the immune system has been severely damaged, making the person susceptible to opportunistic infections. The signs and symptoms of these infections may include night sweats, chills or high fever, cough and shortness of breath, chronic diarrhea, oral lesions, persistent fatigue, and weight loss.
Opportunistic infections include pneumonia caused by Pneumocystis or brain infection with toxoplasmosis, which can cause cognitive and psychological sequelae. A weakened immune system can increase susceptibility to lymphoma, a form of brain cancer, and a cancer of soft tissues called Kaposi’s sarcoma.
There is no vaccine to prevent HIV infection and no cure for AIDS, but a variety of drugs can be used in combination to control the HIV virus. These drugs include non-nucleoside reverse transcriptase inhibitors (efavirenz, nevirapine, rilpivirine), nucleoside reverse transcriptase inhibitors (lamivudine, emtricitabine, tenofovir alafenamide), protease inhibitors (atazanavir, darunavir, lopinavir), entry or fusion inhibitors (fuzeon, maraviroc), and integrase inhibitors (dolutegravir, elvitegravir, raltegravir).
Protection from infection is possible by avoiding any behavior that allows HIV-infected fluids, such as blood or semen, to enter the body. A new condom should be used for each act of anal or oral sex. Injection drug users should avoid sharing needles or syringes.
Impact
Infectious diseases of the male reproductive system, of which there are as many as twenty, remain a major cause of illness. Initial symptoms of disease may be relatively mild, causing many men to underestimate the potential effect on their health. If the particular disease continues to develop untreated, it can have serious consequences and may cause irreversible damage.
In addition to causing local organ dysfunction, reproductive system infections can trigger a series of systemic symptoms such as headache, fatigue, nausea, or insomnia, which may lead to erectile dysfunction or infertility. Most of these diseases are curable with antibiotics, and they normally produce no lasting problems.
By contrast, AIDS is a chronic, life-threatening disease for which there is no cure. However, many individuals live relatively normal, long lives with HIV/AIDS because of advancements in antiretroviral therapy, which also lowers the transmission rate.
Bibliography
Hayes, Kevin. Prostate and Other Urologic Diseases Sourcebook. Omnigraphics, 2021.
Kumar, Vinay, et al. “Immunodeficiency Syndromes.” Robbins and Cotran Pathologic Basis of Disease, edited by Vinay Kumar, et al., 10th ed., Saunders/Elsevier, 2021.
Nickel, J. Curtis. “Inflammatory Conditions of the Male Genitourinary Tract: Prostatitis and Related Conditions, Orchitis, and Epididymitis.” Campbell-Walsh Urology, 9th ed., Saunders, 2007, pp. 304-29.
Ratan-NM, M. "Sex Differences in Infectious Diseases." News-Medical.Net, www.news-medical.net/health/Sex-Differences-in-Infectious-Diseases.aspx. Accessed 19 Dec. 2024.
Reynard, John, et al. Oxford Handbook of Urology. 4th ed., Oxford UP, 2019.
Rupp, Timothy J., and Stephen W. Leslie. "Epididymitis." StatPearls, National Library of Medicine, 17 July 2023, www.ncbi.nlm.nih.gov/books/NBK430814. Accessed 19 Dec. 2024.
Taguchi, Yosh, and Merrily Weisbord, editors. Private Parts: An Owner’s Guide to the Male Anatomy. 3rd ed., McClelland & Stewart, 2003.
Tracy, Chad. R., et al. “Diagnosis and Management of Epididymitis.” Urologic Clinics of North America, vol. 35, no. 1, Feb. 2008, pp. 101-08, doi:10.1016/j.ucl.2007.09.013. Accessed 19 Dec. 2024.
Yin, Shan, and Jennifer L. Trainor. “Diagnosis and Management of Testicular Torsion, Torsion of the Appendix Testis, and Epididymitis.” Clinical Pediatric Emergency Medicine, vol. 10, no. 1, 2009, pp. 38–44, doi.org/10.1016/j.cpem.2009.01.010. Accessed 19 Dec. 2024.