Diagnostic workup recommended:
(1) detailed medical and travel history
(2) careful physical exam including digital rectal examination (DRE)
(3) blood tests (glucose, calcium, creatinine, urea, PSA, hemoglobin A1c)
(4) urinalysis (dipstick, microscopic exam, urine culture, screen for sexually-transmitted disease)
(5) ova and parasite examinations for schistosomiasis
(6) transrectal ultrasound
Additional evaluations (not included in Figure 3) might include:
(1) chest X-ray or other tests for tuberculosis
(2) needle biopsies of the prostate if the DRE is abnormal
(3) testing for cystic fibrosis
(4) imaging studies of the pelvis
(5) semen analysis (done in the paper but not included in the algorithm)
(6) evaluation for Klinefelter's syndrome
The patient can be referred to an appropriate specialist once a diagnosis has been made or if there is no clear diagnosis.
