Epididymitis: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Often confused with testicular torsion | |||
**Cremasteric reflex intact | |||
*Sexually active men <35yo: | |||
**Consider chlamydia, gonorrhea | |||
*Not sexually active, age >35yo, or anal intercourse: | |||
**Also consider E. Coli, Pseudomonas, Enterobacter, TB, syphilis | |||
==Diagnosis== | ==Diagnosis== | ||
*Pain of gradual onset, peaks at 24hr | |||
**Dysuria, frequency, fever | |||
*Pain relieved with elevation of testicle (positive Prehn sign) | |||
==Work-Up== | ==Work-Up== | ||
#UA, | #UA, urine culture, urine GC/Chlam | ||
# | ##UA may show pyuria but absence does not r/o disease | ||
# | #Ultrasound for equivocal cases | ||
==DDx== | ==DDx== | ||
# | #Testicular torsion | ||
# | #Torsion of testicular appendage | ||
# | #Testicular tumor | ||
# | #Orchitis | ||
# | #Scrotal abscess | ||
# | #Indirect inguinal hernia | ||
==Treatment== | ==Treatment== | ||
# | #Scrotal elevation | ||
# | #Analgesia | ||
# | #Abx | ||
## | ##Sexually transmitted (<35yo): | ||
### | ###CTX 250mg IM x1 for GC AND azithromycin 1g PO x1 for chlamydia | ||
##Anal intercourse, nonsexually active, and/or >35yo: | |||
## | ###PO: Cipro 500mg BID x 14d OR Ofloxacin 200mg BID x 14d | ||
### | ###IV: Piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6 | ||
###IV: | ##Treat sexual partner | ||
# | |||
==Disposition== | ==Disposition== | ||
# | #Admit for systemic signs of toxicity (fever, chills, nausea, vomiting) | ||
# | #D/c w/ f/u in one week if non toxic | ||
==See Also== | ==See Also== | ||
[[Testicular Torsion]] | |||
[[Torsion of Testicular Appendages]] | |||
==Source== | ==Source== | ||
Anatomical Approach to Scrotal Emergencies: A New Paradigm for the Diagnosis and Treatment of the Acute Scrotum. The Internet Journal of Urology 2010 : Volume 6 Number 2. Sardar Ali. KhanRosens | Anatomical Approach to Scrotal Emergencies: A New Paradigm for the Diagnosis and Treatment of the Acute Scrotum. The Internet Journal of Urology 2010 : Volume 6 Number 2. Sardar Ali. KhanRosens | ||
Revision as of 01:15, 25 June 2011
Background
- Often confused with testicular torsion
- Cremasteric reflex intact
- Sexually active men <35yo:
- Consider chlamydia, gonorrhea
- Not sexually active, age >35yo, or anal intercourse:
- Also consider E. Coli, Pseudomonas, Enterobacter, TB, syphilis
Diagnosis
- Pain of gradual onset, peaks at 24hr
- Dysuria, frequency, fever
- Pain relieved with elevation of testicle (positive Prehn sign)
Work-Up
- UA, urine culture, urine GC/Chlam
- UA may show pyuria but absence does not r/o disease
- Ultrasound for equivocal cases
DDx
- Testicular torsion
- Torsion of testicular appendage
- Testicular tumor
- Orchitis
- Scrotal abscess
- Indirect inguinal hernia
Treatment
- Scrotal elevation
- Analgesia
- Abx
- Sexually transmitted (<35yo):
- CTX 250mg IM x1 for GC AND azithromycin 1g PO x1 for chlamydia
- Anal intercourse, nonsexually active, and/or >35yo:
- PO: Cipro 500mg BID x 14d OR Ofloxacin 200mg BID x 14d
- IV: Piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6
- Treat sexual partner
- Sexually transmitted (<35yo):
Disposition
- Admit for systemic signs of toxicity (fever, chills, nausea, vomiting)
- D/c w/ f/u in one week if non toxic
See Also
Torsion of Testicular Appendages
Source
Anatomical Approach to Scrotal Emergencies: A New Paradigm for the Diagnosis and Treatment of the Acute Scrotum. The Internet Journal of Urology 2010 : Volume 6 Number 2. Sardar Ali. KhanRosens