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  • Often confused with testicular torsion
    • Cremasteric reflex intact in epididymitis
  • Sexually active men <35yo:
  • Not sexually active, age >35yo, or anal intercourse:
    • Also consider E. coli, pseudomonas, enterobacter, TB, syphilis
    • Chemical epididymitis
    • Consider in the patient with afib and testicular pain
    • Testicular pain and swelling in patients on amiodarone

Clinical Features

  • Pain of gradual onset, peaks at 24hr
  • Dysuria
  • Urinary frequency
  • Fever
  • Pain relieved with elevation of testicle (Prehn sign)
    • Sensitivity: 91.3%, specificity: 78.3. Does not rule out testicular torsion

Differential Diagnosis

Testicular Diagnoses


  • Urinalysis
    • Pyuria seen in half of cases
  • Urine culture (children, elderly men)
  • Urine GC/Chlam (urethral discharge or age <40)
  • Ultrasound for equivocal cases
  • Older men should be evaluated for urinary retention


  • Scrotal elevation
  • Analgesia


  • For acute epididymitis likely caused by STI
  • For acute epididymitis most likely caused by STI and enteric organisms (MSM)
  • For acute epididymitis most likely caused by enteric organisms

Treat sexual partner if possible

  • If med adherence is an issue:
    • Ceftriaxone 250mg IM once
    • PLUS azithromycin 1 g PO once

Pediatric Epididymitis[1]

  • Rule out testicular torsion
  • Bed rest to ensure lymphatic drainage
  • Ice packs, acetaminophen, ibuprofen
  • Rarely oral narcotics
  • Pediatric urology follow up outpatient in non-toxic child for possible GU anatomical abnormalities
  • Antibiotics for 10-14 days, with urine culture sent:
    • Trimethroprim-sulfamethoxazole
    • Amoxicillin-clavulanate
    • Coverage for chlamydia and N. gonorrhoeae in suspected cases of sexual transmission
    • Avoid fluoroquinolones in pediatric patients
    • Severely ill or septic children:
      • At least, first generation cephalosporin
      • PLUS aminoglycoside


  • Admit for:
    • Systemic signs of toxicity (fever, chills, nausea/vomiting)
  • Discharge with urology follow-up in 1 week if non-toxic

See Also


  1. Richman MN and Bukowski TP. Pediatric Epididymitis: Pathophysiology, Diagnosis, and Management. Infect Urol. 2001;14(2).