Epididymitis: Difference between revisions
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*Often confused with testicular torsion | *Often confused with testicular torsion | ||
**Cremasteric reflex intact in epididymitis | **Cremasteric reflex intact in epididymitis | ||
*Sexually active men <35yo | *Sexually active men <35yo → consider [[Chlamydia|chlamydia]], [[Gonorrhea|gonorrhea]] | ||
*Not sexually active, age >35yo, or anal intercourse → also consider E. coli, pseudomonas, enterobacter, TB, [[Syphilis|syphilis]] | |||
*Not sexually active, age >35yo, or anal intercourse | |||
*Chemical epididymitis | *Chemical epididymitis | ||
**Consider in the patient with afib and testicular pain | **Consider in the patient with afib and testicular pain | ||
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{{Epididymitis antibiotics}} | {{Epididymitis antibiotics}} | ||
*If med adherence is an issue: | *If med adherence is an issue: | ||
**[[Ceftriaxone]] 250mg IM once | **[[Ceftriaxone]] 250mg IM once '''AND''' | ||
** | **Azithromycin 1 g PO once | ||
===Pediatric Epididymitis<ref>Richman MN and Bukowski TP. Pediatric Epididymitis: Pathophysiology, Diagnosis, and Management. Infect Urol. 2001;14(2).</ref>=== | ===Pediatric Epididymitis<ref>Richman MN and Bukowski TP. Pediatric Epididymitis: Pathophysiology, Diagnosis, and Management. Infect Urol. 2001;14(2).</ref>=== | ||
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**Avoid fluoroquinolones in pediatric patients | **Avoid fluoroquinolones in pediatric patients | ||
**Severely ill or septic children: | **Severely ill or septic children: | ||
*** | ***First generation cephalosporin '''AND''' | ||
*** | ***Aminoglycoside | ||
==Disposition== | ==Disposition== | ||
*Admit for | *Admit for systemic signs (fever, chills, nausea/vomiting) or toxic appearance | ||
*Discharge with urology follow-up in 1 week if non-toxic | *Discharge with urology follow-up in 1 week if non-toxic | ||
Revision as of 06:29, 7 July 2017
Background
- Often confused with testicular torsion
- Cremasteric reflex intact in epididymitis
- Sexually active men <35yo → consider chlamydia, gonorrhea
- 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
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- Indirect inguinal hernia
- Inguinal lymph node (Lymphadenitis)
- Orchitis
- Scrotal abscess
- Spermatocele
- Tinea cruris
- Testicular rupture
- Testicular torsion
- Testicular trauma
- Testicular tumor
- Torsion of testicular appendage
- Varicocele
- Pyocele
- Testicular malignancy
- Scrotal wall hematoma
Evaluation
- 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
Management
- Scrotal elevation
- Analgesia
Antibiotics
- For acute epididymitis likely caused by STI [1]
- Ceftriaxone 500 mg IM in a single dose PLUS
- Doxycycline 100 mg orally twice a day for 10 days
- For acute epididymitis most likely caused by STI and enteric organisms (MSM)
- Ceftriaxone 500 mg IM in a single dose PLUS
- Levofloxacin 500 mg orally once a day for 10 days
- For acute epididymitis most likely caused by enteric organisms
- Levofloxacin 500 mg orally once daily for 10 days
For persons weighing ≥150 kg, 1 g of ceftriaxone should be administered.
- If med adherence is an issue:
- Ceftriaxone 250mg IM once AND
- Azithromycin 1 g PO once
Pediatric Epididymitis[2]
- 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:
- First generation cephalosporin AND
- Aminoglycoside
Disposition
- Admit for systemic signs (fever, chills, nausea/vomiting) or toxic appearance
- Discharge with urology follow-up in 1 week if non-toxic
See Also
References
- ↑ https://www.cdc.gov/std/treatment-guidelines/epididymitis.htm
- ↑ Richman MN and Bukowski TP. Pediatric Epididymitis: Pathophysiology, Diagnosis, and Management. Infect Urol. 2001;14(2).