Epididymitis

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

1. UA, urine culture, urine GC/Chlam
   1. UA may show pyuria but absence does not r/o disease
2. Ultrasound for equivocal cases

DDx

1. Testicular torsion
2. Torsion of testicular appendage
3. Testicular tumor
4. Orchitis
5. Scrotal abscess
6. Indirect inguinal hernia

Treatment

1. Scrotal elevation
2. Analgesia
3. Abx
   1. Sexually transmitted (<35yo):
      1. CTX 250mg IM x1 for GC AND:
      2. Doxycycline 100 mg BID x10d for chlamydia
   2. Anal intercourse, nonsexually active, and/or >35yo:
      1. PO: Cipro 500mg BID x 14d OR Ofloxacin 200mg BID x 14d
      2. IV: Piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6
   3. Treat sexual partner

Disposition

1. Admit for systemic signs of toxicity (fever, chills, nausea, vomiting)
2. D/c w/ f/u in one week with Urology if non toxic

See Also

Testicular Torsion

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

CDC Guidelines