A patient with a history of multiple sexual partners and infrequent use of protection presents with dysuria, frequency, urgency, nocturia, and perineal pain, along with a fever and chills, what is the most likely diagnosis and appropriate management for this patient?

Acute Bacterial Prostatitis

This patient has acute bacterial prostatitis, and immediate management requires empiric broad-spectrum antibiotics with fluoroquinolones or trimethoprim-sulfamethoxazole for 4-6 weeks, along with urine culture to guide therapy and urgent imaging to exclude prostatic abscess.

1. Differential Diagnosis

Most Likely Diagnoses:

• Acute bacterial prostatitis: Fever, chills, perineal pain, firm hot prostate on exam, obstructive voiding symptoms, systemic illness 1
• Chronic prostatitis/chronic pelvic pain syndrome: Similar symptoms but typically without fever or acute systemic illness 1
• Urethritis (gonococcal/chlamydial): Multiple partners, unprotected sex, but typically presents with urethral discharge which patient denies 1

Less Likely but Important to Rule Out:

• Acute pyelonephritis: Fever and urinary symptoms present, but negative CVA tenderness and prostate findings point away from this 2
• Epididymitis/orchitis: Sexual risk factors present, but no scrotal masses or testicular pain on exam 1
• Prostatic abscess: Severe prostatitis presentation with inability to determine prostate size suggests this complication 1
• Bladder outlet obstruction from BPH: Obstructive symptoms present, but fever and acute presentation favor infection 1

2. Most Likely Diagnosis: Acute Bacterial Prostatitis

The diagnosis is acute bacterial prostatitis based on the constellation of fever (with documented temperature), chills, severe dysuria, obstructive voiding symptoms (reduced stream caliber, hesitancy, frequency), perineal pain, rectal discomfort, and the pathognomonic finding of a firm, hot, exquisitely tender prostate on digital rectal examination 1. The sexual history with multiple partners and unprotected intercourse increases risk for sexually transmitted pathogens 1. The inability to determine prostate size due to severe tenderness and the systemic symptoms (fever, chills, malaise) distinguish this from chronic prostatitis 1.

3. Pathophysiology

Acute bacterial prostatitis results from bacterial invasion of the prostate gland, most commonly by Escherichia coli (80% of cases), followed by other Enterobacteriaceae, Enterococcus species, and in sexually active men, Neisseria gonorrhoeae and Chlamydia trachomatis 1, 3.

Bacteria reach the prostate through:

• Ascending urethral infection (most common route in sexually active men) 3
• Reflux of infected urine into prostatic ducts 3
• Direct extension from rectum (less common) 3
• Hematogenous spread (rare) 3

The infection triggers an intense inflammatory response causing prostatic edema, which compresses the urethra producing obstructive symptoms 3. The inflammation extends to surrounding tissues causing perineal and rectal pain 1. Systemic symptoms result from bacterial toxins and cytokine release 3. Without treatment, complications include prostatic abscess formation, chronic prostatitis, epididymitis, bacteremia, and urosepsis 1, 3.

4. Diagnostic Testing and Imaging

Mandatory Initial Tests:

• Urinalysis with microscopy: Will show pyuria (≥10 WBCs/high-power field), bacteriuria, and possibly hematuria 2
• Urine culture with antimicrobial susceptibility testing: Essential to identify causative organism and guide antibiotic therapy 2
• Blood cultures (2 sets): Required given fever and systemic symptoms to detect bacteremia/urosepsis 2, 1
• Complete blood count: Will likely show leukocytosis with left shift 1
• Basic metabolic panel: Assess renal function and hydration status 1

Critical Imaging:

• Transrectal ultrasound or CT pelvis with contrast: Perform if patient remains febrile after 48-72 hours of appropriate antibiotics or shows clinical deterioration to exclude prostatic abscess 2, 1
• Renal ultrasound: Consider if upper tract involvement suspected or patient has risk factors for obstruction 2

Tests to AVOID:

• Prostatic massage: Absolutely contraindicated in acute prostatitis due to risk of inducing bacteremia and extreme patient discomfort 1
• Expressed prostatic secretions: Not indicated in acute phase 1

Additional Testing Based on Sexual History:

• Nucleic acid amplification testing (NAAT) for Neisseria gonorrhoeae and Chlamydia trachomatis: Given multiple partners and unprotected sex 1
• HIV testing: Offer given sexual risk factors 1
• Syphilis serology (RPR/VDRL): Consider given sexual risk profile 1

5. Management Steps

Immediate Management (First 24 Hours):

Step 1: Assess Severity and Need for Hospitalization

• Hospitalize if: unable to void, signs of sepsis (hypotension, tachycardia, altered mental status), intractable pain/vomiting, immunocompromised, or suspected abscess 1
• Outpatient management acceptable if: hemodynamically stable, able to tolerate oral medications, reliable for follow-up 1

Step 2: Obtain Cultures BEFORE Antibiotics

• Urine culture (midstream clean catch or catheterization if retention) 2
• Blood cultures if febrile 2, 1

Step 3: Initiate Empiric Antibiotic Therapy

For outpatient management:

• Fluoroquinolone (preferred): Ciprofloxacin 500 mg PO twice daily OR levofloxacin 500-750 mg PO once daily for 4-6 weeks 4, 5
• Alternative: Trimethoprim-sulfamethoxazole DS (160/800 mg) PO twice daily for 4-6 weeks if local resistance <20% 4, 5

For hospitalized patients:

• Fluoroquinolone IV: Ciprofloxacin 400 mg IV every 12 hours OR levofloxacin 750 mg IV daily 2
• Alternative: Ceftriaxone 1-2 g IV daily PLUS doxycycline 100 mg PO/IV twice daily (covers STI pathogens) 2, 1
• If septic/critically ill: Add aminoglycoside (gentamicin 5-7 mg/kg IV daily) until culture results available 2

Step 4: Symptomatic Management

• Pain control: NSAIDs (ibuprofen 600 mg PO every 6 hours) or acetaminophen; avoid opioids if possible 2
• Antipyretics: Acetaminophen 650-1000 mg every 6 hours for fever 1
• Alpha-blocker: Tamsulosin 0.4 mg PO daily to improve voiding (start after 24-48 hours when infection controlled) 1
• Stool softeners: Docusate sodium 100 mg twice daily to prevent straining 1
• Hydration: Encourage oral fluids 2-3 liters daily 1

Step 5: Address Urinary Retention

• If unable to void: suprapubic catheterization preferred over urethral catheterization to avoid prostatic trauma 1
• Avoid Foley catheter if possible due to pain and risk of worsening inflammation 1

Follow-Up Management:

48-72 Hour Reassessment:

• Clinical improvement expected (decreased fever, pain) 2, 1
• If no improvement: obtain imaging (CT/ultrasound) to exclude abscess, review culture results, consider antibiotic resistance 2, 1
• Adjust antibiotics based on culture and susceptibility results 2

2-Week Follow-Up:

• Assess symptom resolution 1
• Ensure compliance with full antibiotic course 1
• Repeat urine culture if symptoms persist 2

6-Week Follow-Up (Post-Treatment):

• Confirm symptom resolution 1
• Urine culture to document eradication 2
• Screen for chronic prostatitis if symptoms persist 1

6. Diagnostic Criteria and Treatment Options

Diagnostic Criteria for Acute Bacterial Prostatitis:

Clinical diagnosis requires 1:

1. Acute onset of systemic symptoms: Fever >38°C, chills, malaise
2. Lower urinary tract symptoms: Dysuria, frequency, urgency, hesitancy, weak stream
3. Pelvic pain: Perineal, suprapubic, or rectal discomfort
4. Tender prostate on digital rectal examination: Firm, hot, boggy, exquisitely tender
5. Laboratory confirmation: Pyuria (≥10 WBCs/HPF) and bacteriuria on urinalysis 2

Treatment Options by Evidence Quality:

First-Line Antibiotics (4-6 weeks duration) 4, 5:

• Fluoroquinolones: Ciprofloxacin 500 mg PO BID or levofloxacin 500-750 mg PO daily (excellent prostatic penetration)
• Trimethoprim-sulfamethoxazole: DS (160/800 mg) PO BID (good prostatic penetration, use if local resistance <20%)

Second-Line Options 2, 5:

• Doxycycline: 100 mg PO BID for 4-6 weeks (if STI suspected)
• Third-generation cephalosporin + doxycycline: For hospitalized patients or STI coverage

Agents to AVOID 2, 5:

• Nitrofurantoin: Poor tissue penetration, inadequate for prostatitis
• Fosfomycin: Insufficient data for prostatitis treatment
• Beta-lactams alone: Poor prostatic penetration except in acute inflammation

7. Impact on Family

Immediate Family Impact:

• Sexual partner exposure: Partner requires screening and empiric treatment for STIs (gonorrhea/chlamydia) given patient's sexual history and unprotected intercourse 1
• Temporary sexual abstinence: Required during acute treatment phase (4-6 weeks minimum) 1
• Emotional distress: Anxiety about STI transmission, relationship strain from sexual history disclosure 1
• Caregiver burden: Family may need to assist with activities of daily living during acute illness phase 1

Long-Term Considerations:

• Chronic prostatitis risk: 5-10% develop chronic bacterial prostatitis requiring prolonged treatment 1
• Fertility concerns: Acute prostatitis can temporarily affect sperm quality 1
• Relationship counseling: May be needed to address sexual risk behaviors and partner notification 1

8. Causes and Risk Factors

Causative Organisms:

• Escherichia coli: 80% of cases 3, 6
• Other Enterobacteriaceae: Klebsiella, Proteus, Enterobacter (10-15%) 3
• Enterococcus species: 5-10% 3
• Sexually transmitted pathogens: Neisseria gonorrhoeae, Chlamydia trachomatis (in sexually active men <35 years) 1, 3

Risk Factors Identified in This Patient:

• Multiple sexual partners without barrier protection: Increases STI risk 2, 1
• Recent unprotected sexual activity: Direct risk for ascending urethral infection 1
• Male sex: Anatomic predisposition 1
• Smoking: One pack daily for extended period may impair immune function 1

Additional Risk Factors (General):

• Urinary tract instrumentation: Catheterization, cystoscopy 1
• Bladder outlet obstruction: BPH, urethral stricture 1
• Immunosuppression: Diabetes, HIV, chronic steroid use 2, 1
• Intraprostatic ductal reflux: Anatomic predisposition 3

9. Evidence Review: Prevalence and Management

Prevalence:

Acute bacterial prostatitis accounts for approximately 2-10% of all prostatitis cases and affects men of all ages, with peak incidence in men aged 20-40 years and >60 years 3, 6. The condition represents a complicated UTI requiring extended antibiotic therapy 2, 5.

Diagnostic Accuracy:

The combination of dysuria, frequency, and fever without vaginal symptoms has a positive likelihood ratio of 24.6 for UTI in general 7. In men with these symptoms plus tender prostate on examination, the diagnosis of acute bacterial prostatitis approaches 95% certainty 1, 7.

Treatment Efficacy:

Fluoroquinolones achieve cure rates of 70-90% when given for 4-6 weeks, with ciprofloxacin and levofloxacin showing equivalent efficacy 5, 8. Trimethoprim-sulfamethoxazole demonstrates 60-80% cure rates but should only be used when local resistance patterns are favorable (<20% resistance) 4, 5, 8.

Treatment duration matters: Studies show that courses <4 weeks have significantly higher relapse rates (30-40%) compared to 4-6 week courses (10-15% relapse) 5, 8. The extended duration is necessary because antibiotics must penetrate the prostatic tissue and achieve therapeutic concentrations 3, 8.

Complications Without Treatment:

Untreated acute bacterial prostatitis can progress to prostatic abscess (5-10% of cases), chronic bacterial prostatitis (5-10%), epididymitis (2-5%), bacteremia/urosepsis (1-3%), and rarely death 3, 6.

10. ICD-10 and ICD-11 Codes

ICD-10 Codes:

• N41.0 - Acute prostatitis (primary diagnosis)
• R50.9 - Fever, unspecified (presenting symptom)
• R30.0 - Dysuria (presenting symptom)
• Z72.51 - High-risk sexual behavior (risk factor documentation)
• Z20.2 - Contact with and exposure to infections with a predominantly sexual mode of transmission (for partner notification)

Rationale: N41.0 captures the primary diagnosis of acute prostatitis. Additional codes document presenting symptoms and risk factors important for epidemiologic tracking and quality metrics 1.

ICD-11 Codes:

• GC00.0 - Acute prostatitis (primary diagnosis)
• MG26 - Fever of unknown origin (presenting symptom)
• MF50.0 - Dysuria (presenting symptom)

Rationale: ICD-11 provides more specific categorization of prostatitis as a genitourinary infection, aligning with current clinical classification systems 1.

11. Patient Education Topics

Immediate Education (First Visit):

Antibiotic Compliance:

• Complete the full 4-6 week course even when symptoms improve after 3-5 days 5, 8
• Missing doses or stopping early leads to treatment failure and antibiotic resistance 5
• Set phone alarms for twice-daily dosing 5

Symptom Management:

• Avoid activities that worsen symptoms: Prolonged sitting, cycling, horseback riding 1
• Use sitz baths: Warm water 15-20 minutes three times daily for perineal pain 1
• Avoid bladder irritants: Caffeine, alcohol, spicy foods, acidic beverages 1
• Do not strain with bowel movements: Use stool softeners as prescribed 1

Sexual Health:

• Abstain from sexual activity during acute treatment phase (minimum 4-6 weeks) 1
• Partner notification required: All recent sexual partners need STI screening and treatment 1
• Condom use mandatory for all future sexual encounters to prevent recurrence and STI transmission 1

Follow-Up Education:

Prevention of Recurrence:

• Consistent condom use with all sexual partners 1
• Limit number of sexual partners 1
• Maintain adequate hydration: 2-3 liters daily 1
• Regular urination: Don't delay voiding when urge occurs 1
• Avoid urethral trauma: Proper hygiene, avoid harsh soaps 1

Warning Signs Requiring Immediate Return:

• Inability to urinate (urinary retention) 1
• High fever >39°C or worsening fever after 48 hours of antibiotics 2, 1
• Severe pain uncontrolled by medications 1
• Blood in urine (new or worsening) 1
• Confusion, dizziness, or fainting (signs of sepsis) 1

Long-Term Monitoring:

• Follow-up appointments are mandatory: 48-72 hours, 2 weeks, and 6 weeks 1
• Chronic prostatitis symptoms: Persistent pelvic pain after treatment completion requires re-evaluation 1
• Annual STI screening recommended given sexual risk factors 1

12. Medical-Legal Concerns if Unmanaged

Immediate Patient Harm:

• Progression to urosepsis: Can occur within 24-48 hours, leading to septic shock, multiorgan failure, and death 2, 3
• Prostatic abscess formation: Requires surgical drainage; delayed diagnosis increases morbidity 1, 3
• Acute urinary retention: May cause bladder rupture or permanent bladder dysfunction 1
• Chronic bacterial prostatitis: Develops in 5-10% of untreated cases, requiring months of therapy 3

Public Health Implications:

• STI transmission: Failure to diagnose and treat STI co-infections enables continued transmission to partners 1
• Partner notification failure: Legal and ethical obligation to ensure partner treatment 1
• Antimicrobial resistance: Inadequate treatment contributes to resistant organism development 5, 8

Legal Liability:

• Failure to diagnose: Missing acute prostatitis when classic symptoms and exam findings present constitutes diagnostic error 1
• Inadequate treatment duration: Prescribing <4 weeks of antibiotics falls below standard of care 5, 8
• Failure to obtain cultures: Not obtaining urine and blood cultures before antibiotics prevents targeted therapy 2
• Lack of follow-up: Not scheduling reassessment at 48-72 hours to ensure treatment response 2, 1
• Missed partner notification: Failure to counsel about STI partner treatment 1

Documentation Requirements:

• Document digital rectal exam findings in detail (prostate tenderness, size, consistency, temperature) 1
• Record sexual history including number of partners, protection use, last sexual contact 1
• Document antibiotic counseling including duration, importance of completion, side effects 5
• Document partner notification discussion and patient's agreement to inform partners 1
• Document follow-up plan with specific timeframes and warning signs 1

13. Interprofessional Collaboration

Urology:

• Urgent consultation if: Urinary retention requiring catheterization, suspected prostatic abscess, no improvement after 72 hours of antibiotics, recurrent episodes 1
• Contribution: Perform suprapubic catheterization if needed, drain prostatic abscess, evaluate for anatomic abnormalities 1

Infectious Disease:

• Consultation if: Bacteremia/sepsis, multidrug-resistant organisms on culture, immunocompromised patient, treatment failure 2, 1
• Contribution: Guide antibiotic selection for resistant organisms, manage complicated infections 2

Sexual Health/STI Clinic:

• Referral for: Comprehensive STI screening, partner notification services, HIV testing and counseling 1
• Contribution: Ensure complete STI workup, facilitate partner treatment, provide sexual health education 1

Pharmacy:

• Involvement: Medication counseling, ensure appropriate antibiotic duration dispensed, monitor for drug interactions 5
• Contribution: Reinforce compliance importance, identify potential interactions with patient's other medications 5

Nursing:

• Role: Vital sign monitoring, symptom assessment, patient education reinforcement, follow-up coordination 1
• Contribution: Early identification of clinical deterioration, ensure patient understands treatment plan 1

Social Work:

• Referral if: Barriers to medication access, need for substance abuse counseling (given alcohol use), relationship counseling needs 1
• Contribution: Address social determinants affecting treatment adherence, facilitate access to care 1

Mental Health:

• Consider referral for: Anxiety/depression related to diagnosis, sexual risk behavior counseling, relationship issues 1
• Contribution: Address psychological impact of STI diagnosis, behavior modification counseling 1

14. Communication Style and Approach

Initial Conversation Framework:

Use Direct, Non-Judgmental Language:

• "Your symptoms and examination findings indicate you have a bacterial infection of your prostate gland called acute prostatitis. This is a serious infection that requires immediate treatment with antibiotics for 4-6 weeks" 1
• Avoid medical jargon; use "prostate infection" rather than "acute bacterial prostatitis" initially 1

Address Sexual History Sensitively:

• "I need to ask some personal questions about your sexual activity because certain infections can cause prostatitis. This information is confidential and helps me provide the best treatment" 1
• Use neutral, matter-of-fact tone when discussing multiple partners and unprotected sex 1
• "Based on your sexual history, we need to test for sexually transmitted infections that could be contributing to your infection" 1

Emphasize Urgency Without Causing Panic:

• "This infection is serious and can worsen quickly if not treated properly, but with the right antibiotics started today, most men improve within 48-72 hours" 2, 1
• "The most important thing is taking all the antibiotics exactly as prescribed for the full 4-6 weeks, even when you feel better" 5

Partner Notification Discussion:

• "Your recent sexual partners need to be tested and possibly treated for infections, even if they have no symptoms. This protects both them and you from reinfection" 1
• Offer assistance: "We have resources to help notify partners confidentially if you prefer" 1

Ongoing Communication:

Check Understanding:

• Use teach-back method: "Can you tell me in your own words when you'll take your antibiotics and for how long?" 5
• "What questions do you have about your treatment plan?" 1

Provide Written Instructions:

• Medication schedule, warning signs, follow-up appointments 1
• Partner notification resources and STI clinic contact information 1

Maintain Accessibility:

• "Call immediately if you can't urinate, have worsening fever, or feel confused or dizzy" 1
• Provide direct contact number for urgent concerns 1

15. Support for Distressed Patient

Immediate Emotional Support:

Normalize the Diagnosis:

• "Prostate infections are common in sexually active men and are treatable with antibiotics. This doesn't mean you have a chronic condition" 1, 3
• "Many men experience this, and with proper treatment, full recovery is expected" 3

Address STI Concerns:

• "Testing for sexually transmitted infections is routine in this situation. Even if tests are positive, these infections are treatable" 1
• "Having an STI doesn't define you as a person. What matters now is getting treated and preventing future infections" 1

Validate Feelings:

• "It's normal to feel worried, embarrassed, or anxious about this diagnosis. These are common reactions" 1
• "Many patients feel overwhelmed by the treatment duration, but we'll support you through the process" 1

Practical Support Resources:

Medical Support:

• Scheduled follow-up calls: Nurse check-in at 48-72 hours to assess response and answer questions 1
• Patient portal messaging: For non-urgent questions between visits 1
• Symptom diary: Provide template to track improvement and medication adherence 1

Mental Health Resources:

• Counseling referral: For anxiety, depression, or relationship issues related to diagnosis 1
• Support groups: Online or in-person for men with chronic prostatitis (if condition becomes chronic) 1

Sexual Health Resources:

• STI clinic referral: Comprehensive testing, partner services, prevention counseling 1
• Educational materials: Written information about STI prevention, safe sex practices 1

Financial Support:

• Prescription assistance programs: If cost is barrier to 4-6 week antibiotic course 5
• Generic medication options: Discuss cost-effective alternatives 5

Partner Support:

• Couples counseling referral: If relationship strain from sexual history disclosure 1
• Partner education: Provide information about infection transmission and prevention 1

16. Patient-Centered, Family-Focused, Community-Oriented Care Matrix

Care Domain	Patient-Centered Interventions	Family-Focused Interventions	Community-Oriented Interventions
Diagnosis & Assessment	• Comprehensive sexual history in private, non-judgmental setting [1] • Symptom-based diagnosis with focused physical exam [1,7] • Shared decision-making about hospitalization vs. outpatient treatment [1]	• Partner STI screening and treatment [1] • Family education about non-contagious nature of prostatitis (not transmitted through casual contact) [1] • Assess family support for medication adherence [1]	• Report STI cases to public health per local requirements [1] • Contribute to local antibiotic resistance surveillance [5] • Participate in STI prevention programs [1]
Treatment Planning	• Individualized antibiotic selection based on allergies, tolerability, cost [5] • Pain management plan tailored to patient preferences [1] • Flexible follow-up scheduling to accommodate work/life [1]	• Involve partner in treatment plan discussion (with patient consent) [1] • Coordinate partner treatment timing [1] • Provide family with warning signs requiring emergency care [1]	• Prescribe antibiotics consistent with antimicrobial stewardship guidelines [5,8] • Use local antibiogram to guide empiric therapy [5] • Educate about antibiotic resistance prevention [5]
Medication Management	• Detailed counseling on 4-6 week duration importance [5] • Medication reminder strategies (alarms, pill boxes) [5] • Address cost barriers with generic options or assistance programs [5]	• Enlist family member as medication adherence partner [5] • Provide family with medication schedule [5] • Educate family about monitoring for side effects [5]	• Pharmacy collaboration for adherence monitoring [5] • Utilize community pharmacy medication therapy management [5] • Connect to prescription assistance programs [5]
Symptom Management	• Multimodal pain control (NSAIDs, sitz baths, positioning) [1] • Alpha-blocker for voiding symptoms [1] • Dietary modifications to reduce bladder irritation [1]	• Family assistance with sitz bath preparation [1] • Support for activity modifications (avoiding prolonged sitting) [1] • Help with stool softener regimen [1]	• Provide community resources for pain management (physical therapy, acupuncture) [1] • Connect to support groups for chronic pelvic pain if needed [1]
Prevention & Education	• Comprehensive safe sex counseling [1] • Condom use demonstration and provision [1] • Risk reduction strategies for future sexual encounters [1] • Smoking cessation counseling [1]	• Partner education about STI prevention [1] • Relationship counseling referral if needed [1] • Family education about prostatitis risk factors [1]	• Link to community STI prevention programs [1] • Provide free/low-cost condom access information [1] • Connect to smoking cessation programs [1] • Participate in community sexual health education [1]
Follow-Up & Monitoring	• Structured follow-up at 48-72 hours, 2 weeks, 6 weeks [1] • Patient portal access for questions [1] • Post-treatment urine culture to confirm cure [2]	• Include partner in follow-up discussions (with consent) [1] • Family check-ins about patient progress [1] • Coordinate partner follow-up testing [1]	• Report treatment outcomes to public health [1] • Contribute to quality improvement initiatives [1] • Participate in antimicrobial stewardship audits [5]
Psychosocial Support	• Screen for anxiety/depression related to diagnosis [1] • Validate emotional responses [1] • Mental health referral if distressed [1] • Address stigma concerns [1]	• Couples counseling for relationship strain [1] • Family therapy if disclosure causes conflict [1] • Support for family members' emotional reactions [1]	• Connect to community mental health resources [1] • Provide support group information [1] • Link to LGBTQ+ affirming services if applicable [1]
Care Coordination	• Single point of contact for questions [1] • Coordinated specialty referrals (urology, ID, STI clinic) [1] • Integrated electronic health record communication [1]	• Family meeting to coordinate care plan [1] • Shared care calendar for appointments [1] • Designated family contact person [1]	• Interprofessional team huddles [1] • Community health worker involvement for complex cases [1] • Collaboration with public health for partner services [1]
Health Maintenance	• Annual STI screening plan [1] • Prostate health education [1] • Smoking cessation plan [1] • Alcohol moderation counseling [1]	• Family wellness planning [1] • Partner's preventive health needs [1] • Family screening for modifiable risk factors [1]	• Link to community wellness programs [1] • Participate in men's health initiatives [1] • Support community STI screening events [1]